Kim’s public health blog

The Wall Street Journal (11/10, Dalton) reports that some countries’ governments have stopped focusing on individual discipline to combat obesity, and instead are working to make entire communities more healthy by reducing the opportunities to live unhealthily. Laura Kettel Khan, an obesity expert at the CDC, says that “people are finally acknowledging that the obesity problem is so pervasive that it isn’t just because people are making bad choices.” The Journal describes obesity programs across Europe and in the US, noting that these initiatives are taking off because obesity has become too expensive a problem to handle on an individual basis.

Patients who die in the hospital in the United States are almost five times as likely to have spent part of their last hospital stay in the ICU than patients in England. What’s more, over the age of 85, ICU usage among terminal patients is eight times higher in the US than in England, according to new research that compared the two countries’ use of intensive care services during final hospitalizations.

A new report from the Guttmacher Institute identifies how improved access to family planning services has reduced the use of abortion services worldwide although problems if access to either opportunities varies widely among different countries, particularly in the developing  countries..

In a new study, Harvard School of Public Health (HSPH) researchers found that if vaccine coverage and efficacy are high in girls, a universal recommendation to vaccinate young boys is unlikely to provide comparatively good value for resources, compared with vaccinating girls only. The study was reported in the BMJ  October 9..

The Commonwealth Fund just released its State Scorecard on Health System Performance. The scorecard points to substantial opportunities to improve. If all states could reach the level achieved by the top performing states:

•Twenty-nine million more people would have health insurance—cutting the number of uninsured by more than half;

•Nearly 78,000 fewer adults and children would die prematurely every year from conditions that could have been prevented with timely and effective health care;

•Nine million more adults age 50 and older would receive recommended preventive care, and almost 800,000 more children would receive key vaccinations;

•Five billion dollars could be saved annually by avoiding preventable hospital admissions and readmissions for vulnerable elderly and disabled residents.

In an op-ed in The Hill (10/8), former FDA commissioner Andrew C. von Eschenbach, now a senior adviser at the Center for Health Transformation, and Wayne W. Oliver, a CHT vice president, write that despite A plan to spend $5 billion of stimulus funds on government grants to increase medical research, “not one dollar of stimulus money will be used to enhance the capacity and capability of the FDA.” Despite “decades of neglect” the agency continues to have “a diminished capacity to embrace new scientific technologies and meet the demands needed to protect the public health.” Von Eschenbach and Oliver call for new resources and “the design and implementation of a 21st century regulatory framework” that will help the FDA “drive innovation, dramatically shorten the time between discovery and delivery, and allow Americans everywhere to have access to safe, effective and miraculous discoveries”  Comment: In previous Blogs I have said the FDA was severely restricted by funds yet Congress keeps adding duties, including the most recent tobacco responsibilities.

A study performed at  The University of Rochester Medical School   showed that when adolescents graduate to young adulthood, their preventive care tends to fall by the wayside. A recent study has found that young adults are much less likely to use ambulatory or preventive care, even though their mortality rate is more than twice that of adolescents. COMMENT: I have difficulty understanding why this should surprise anyone when the  various insurance programs, including Medicaid fail to pay for counseling by primary care practitioners. Further once the individual reaches 18 years of age eligibility for Medicaid vanishes.

In the New York Times (9/22) Economic Scene column, according to Harvard economist Amitabh Chandra, “$60 billion a year, or about three percent of overall medical spending, is a reasonable upper-end estimate” of what is spent on defensive medicine in the US. Leonhardt argues that the current “malpractice system does” indeed “affect the morale of doctors,” leaving “them wondering when they will be publicly accused of doing the very thing they’ve sworn not to do: harm patients.”

“The most important healthcare document released this week was not Sen. Max Baucus’s Healthy Future Act. It was the Kaiser Family Foundation’s 2009 Employer Benefits Survey.” The survey, “which polls employers about health benefits to assemble a detailed look at the actual cost of healthcare, fits it squarely in our pocketbooks. The truth is we all pay, and much more than we recognize, for healthcare.” According to Kaiser, “the average healthcare coverage for the average family now costs $13,375.” Over the past decade, “premiums have increased by 138 percent.

Also in JAMA [JAMA. 2009;302(11):1223-1224] is a useful article suggesting how to reduce cost while trying to expand access the health care. Disease prevention initiatives aimed at improving nutrition, physical activity, tobacco use, and related lifestyle behaviors are likely to have the greatest effect on slowing the annual increase in health care costs. Evidence suggests that investment in physical activity, nutrition, and smoking cessation yields a 5-fold greater return in cost savings² than that documented for most clinical preventive services, owing to the inability of identifying the specific high-risk populations likely to benefit from such interventions as opposed to across-the-board screening and testing.^{1, 3} Current health reform proposals that would allocate $10 billion for a Prevention and Wellness Fund targeted to promoting healthier lifestyles and communities represents a major step toward slowing the annual increase in health care spending over time, given the current evidence on return on investment.