Sickness and Wealth
The strangest thing about human beings is their shortsightedness. In terms of health, many would contend that if people understood the kind of pain, discomfort, and loss of life their daily behaviors were likely to eventually cause them, they would stop. The beauty of social epidemiology (the study of social distribution and social determinants of disease) is that we are increasingly able to offer the population good information about behavior and disease correlates. However, even with our expanded knowledge and information distribution systems through mass media, people in both the richest and poorest countries continue to die prematurely from completely preventable diseases. The first question is of course WHY??? but the main question (and perhaps the big money question) is what individuals and policy makers can do to alter these trends.
Wealth Difference – There is a difference in the severity of health problems on a global scale. People in the world's poorest nations die on average a full two decades earlier than the US and other rich nations. In Haiti , before the recent coup, the government's health budget only allotted $1.75 per person per year. Why so low? The main reason is that Haiti is the poorest country in the hemisphere. The other key reason though, is that their state health programs were scaled back in the 1990s to qualify the nation for development loans from the World Bank and International Monetary Fund. These Structural Adjustment Programs (SAPs) seek to scale back state social programs of all sorts in order to allow more free market competition that they believe will generate wealth and a healthy and independent national economy that won't need more loans in the future.
Human Rights? – Is proper medical treatment a human right? The United Nations has said so… but the slippery point is how much medical treatment. There was a time when there was only one form of accepted treatment for a particular disease. Now, there are many approaches with varying success rates and more importantly, varying costs. So how would a human rights stance on health reconcile this growing inequality in treatment methods? Does everyone have a right to the best care available, or just some basic level? Despite the advances in AIDS treatments over the last 15 years, 95% of those infected with the disease don't have access to even the cheapest antiretrovirals because they can't afford them. Even in emergencies, many people in poor places must pay before receiving treatment. Many are “held hostage” till their family can scrape together the money. How can it be that in the "Third World", publicly available drinking water is usually unsafe for human consumption, but that Coca Cola is universally available at affordable prices? Well, because the potential profits demand the market supply it... but that seems sick to most of us.
Diseases of Leisure and Anxiety – In the developing world, but in the United States especially, one need only look at the leading causes of death to see that much of our modern health problems stem from poor lifestyle habits. Smoking, overeating poor foods, and alcoholism pretty much top off the list. These coupled an overall lack of exercise produce very high levels of disease for older Americans. For the younger crowd, mental disorders are much more common. While the exact reasons behind our very high rate of mental disturbance are not really known, they are normally associated with the advent of modern societies and their busy, detached citizens. We believe that all these diseases are easily preventable, but as of yet have not found consistent avenues to get prevention methods adopted on a broad scale. One reason may be that an ounce of prevention may be very worthwhile, but the pound of cure is much more profitable.
Insurance Problems – In the United States , 1 in 6 people don't have health insurance. Many more are under insured. We are the only industrialized nation without a universal health care program. However, our privatized system offers some of the best treatments available in the entire world. Unluckily, many of those who need these advanced treatments most won't be able to afford them. Instead, they will get what Medicaid or Medicare agrees to cover. While our socialized medicine programs are smaller than most rich nations, they still cover about a third of medical expenditures in the country.
Socialized Medicine Elsewhere – Historically, in most places, steep economic downturn has meant a steep drop in life expectancy – Russia (the former USSR ) is perhaps the best example. However, an interesting example of a poor country with great healthcare is Cuba . Despite crushing poverty and a lack of advanced medical tools due to the continued US embargo, Cuba has a life expectancy matching the US and many other rich nations at 78 years ( Japan is at 82). Nearby Haiti has a life expectancy of 53 years, a quarter century less. How can this be? It should make us wonder why other poor countries cannot organize a similar national medical program. If the problem is not wealth, but organization, perhaps there is something to be learned here. Instead of trying to teach poor nations economic discipline through SAPs dismantling their socialized health programs, perhaps they could be remodeled like Cuba – this doesn't require communism or global isolation.
The Medical Industry – Companies develop treatments primarily to make money, although helping sick people feel better is a nice bonus. The problem lies in how companies go about marketing their product in such a way that the maximum number of patients think they need the treatment. The aggressive promotion of prescription drugs on television over the last decade is a wonderful example. Drug companies want patients to think of themselves as consumers and doctors as customer service representatives. Thus, patients are encouraged to seek out particular treatments although they likely do not understand the risks involved or the alternatives available. It is up to doctors to provide complete product information to the best of their ability. Unluckily, much of that information has been produced by the companies themselves or by groups with ties to the companies. This conflict of interest pits science against business. Furthermore, elective procedures have basically become the norm in American medicine.