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Saturday, May 6th 2006

Just How Poor Is Healthcare In America?

Attacks on the current U.S. Healthcare system often center around the cost of our healthcare and how our life expectancy lags behind. However, the obvious response to this is that Americans have far less healthier lifestyles. Take a look at this summary of a recent review of British and American health.

The study thus establishes that middle-aged Americans are much sicker than their English counterparts without being able to pinpoint why. One possibility is that ill health in America reflects obesity in the past as well as today. In 1980, 15% of Americans were already obese compared with 7% of Britons. England might, thus, simply be lagging behind America in the medical impact of prolonged obesity.

The study also has an intriguing implication: that America’s medical system may not be such a poor bargain after all. As Dr Marmot’s colleague James Banks observes, if Americans are sicker, then more should be spent on treating them.

We don’t have a lower life expectancy to parts of Europe and Japan because we have an overpriced or ineffective healthcare system. We have a lower life expectancy because we virtually invented the fast food restaurant and have comparatively unhealthy lifestyles which leads to higher rates of disease and thus higher healthcare costs. But medicine can only battle such poor health habits to a limited effect.

A more notable statistic is infant mortality (death in the first year of life). Here America is ranked just 31st despite our expenditure on healthcare. I think the above explanation is very reasonable, but here is where I become a little bit of an apologist for the American healthcare system. Once again we trail behind several European countries and Japan but there are some statistical anomalies that need to be noted. Many infant deaths occur during or immediately following the birth.

In America any sign of life including heart beat usually gets the death recorded as an infant mortality. Apparently, in notable other western countries without a breath by the child the incident is recorded as a still birth. In another discrepancy, in Switzerland any premature child shorter than 30 cm, even if born breathing, isn’t counted as an infant mortality upon death.

Former Soviet nations are even worse. Most typically still use the Soviet definition of a live birth (designed to keep infant mortality low and project a very favorable image to the west) in which any child less than 35 cm, l,000 grams, or less than 28 weeks no matter what signs of life or how long s/he persists is not considered a live birth.

Finally, America has some of the highest lengths of survival of premature babies in the world. An argument, seemingly logical but obviously unsupported here by facts (they may exist somewhere), is that America’s success with premature infants actually hurts our infant mortality rate.

For instance, imagine that America resuscitates a larger number of premature infants or provides better obstetric care for high risk pregnancies than say some eastern European countries which have a lower infant mortality than us. Once again, unsupported with specific numbers but seemingly logical. However, these children, which would’ve been still births before (and not counted in the infant mortality figures), are now born alive and yet they have a very high mortality rate over the first year.

America doesn’t have the lowest infant mortality in the world, but the numbers should be taken with a grain of salt. Citing a comparison of self reported figures is always dangerous. I feel comfortable that America’s infant mortality is comparable with other western nations. As well, healthcare costs obviously aren’t being driven up by obstetrics or neonatal care, they’re being largely driven by chronic conditions which are explained by America’s incredibly poor health due to lifestyle choices.

Infant mortality myths and Mantras” Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D. on Newsmax.com

Infant Mortality” on Wikipedia