US Tops World in Health Care Spending, Results Lag

US is biggest spender on health care, OECD says, but US life expectancy low among rich nations

By GREG KELLER

The Associated Press

PARIS

The United States ranks near the bottom in life expectancy among wealthy nations despite spending more than double per person on health care than the industrialized world's average, an economic group said Tuesday.

Life expectancy at birth in the U.S. was 78.1 years in 2007, according to the Organization for Economic Cooperation and Development.

That's a year less than the OECD average of 79.1, and puts the U.S. just ahead of the Czech Republic, Poland and Mexico, where spending on health care is many times less per person, the Paris-based organization said in its latest survey of health trends among its 30 rich member countries.

Total U.S. spending on health care was $7,290 a person in 2007, nearly two-and-a-half times the OECD average of $2,984. The figures include spending by both individuals and governments.

Spending on health care in the U.S. grew more quickly between 1997 and 2007 than in France, Italy, Germany and Spain, averaging 3.4 percent annually over the period. The U.S. growth rate was still below the OECD average of 4.1 percent.

The U.S. far outspent the next biggest health care spenders, Norway and Switzerland, despite the fact that those countries' life expectancies are two to four years longer, according to the report.

The report notes that, in addition to the U.S., Denmark and Hungary also have lower life expectancies than would be predicted by their relative wealth and levels of health care spending.

On the other hand, the Japanese and the Spanish live longer on average than their national income and their health care spending would predict.

The U.S. also underperforms other rich countries in the health of its youngest.

U.S. infant mortality, at 6.7 deaths per 1,000 live births, was well above the OECD average of 3.9 in 2007. Only Mexico and Turkey had worse rates of infant mortality. In Luxembourg, the top performer, the infant mortality rate was only 1.8.

The report noted that research suggests many factors beyond the quality of a country's health system, such as income inequality and individual lifestyles and attitudes, influence infant mortality rates.

Per capita spending on pharmaceuticals rose by almost 50 percent over the last 10 years in OECD countries, reaching a total of $650 billion in 2007. The U.S. was the world's biggest spender on pharmaceuticals, spending $878 per person, with Canada next at $691 per person and the OECD average at $461.

The report was released as the U.S. Senate is considering a health care overhaul promised by President Barack Obama during his presidential campaign.

The Danger and Opportunity of Health Care Reform for Health Promotion

Article Summary
Brooke Gilliland

Editor’s Notes
The Danger and Opportunity of Health Care Reform Providing a Huge Influx of Funds for Health Promotion…and How to Avert Danger
By: Michael P. O’Donnell, PhD, MBA, MPH
American Journal of Health Promotion, 2009;24[2]:iv

http://healthpromotionjournal.com/publications/journal/editors_notes_pdfs/ajhp-24-02-editornotes.pdf

This article was written by Michael P. O’Donnell who is Editor in Chief of the American Journal of Health Promotion.

Mr. O’Donnell begins by describing a conversation between himself and a friend that initially sounds sarcastic in nature. The friend, who apparently was in the private sector health promotion field, says that the last thing that he wants is for the federal government to invest large amounts of money in health promotion without first considering the consequences. Mr. O’Donnell’s initial reaction to this statement was the same as mine – confusion. After consideration, he reasoned that his friend was considering how the influx of the huge resources of the federal government could and would overwhelm the private health promotion industry. Such an influx of resources would in turn eventually result in job losses, business closures, and lower tax revenues. Also negatively affecting the government coffers would be increased payments for unemployment benefits. Eventually, these monetary losses could end up causing the government funded health promotion field to fail if that happened, he questioned, would the public be willing to pay for those previously ”free” services? Would there be any incentive for the private sector to reestablish itself in this sector? Mr. O’Donnell goes on to laud the private sector’s facility to provide innovative, cost-effective services above and beyond that of any governmental agency.

There is a description of the Health Promotion FIRST Act (2004) and its provision to advance the health promotion infrastructure in non-governmental organizations to avoid governmental competition or interference.

In conclusion, in order to achieve the most effective and beneficial use of all resources, Mr. O’Donnell stresses the importance of maintaining and nurturing the private sector’s contributions while adding the assets of the federal government in a non-competitive manner.

A study of rural church health promotion

Posted by Kechuang Wu
This study examined the beliefs of church leaders about health and associations between these beliefs and the church health promotion environment (CHPE). Perceptions of the CHPE by leaders and members of the same churches were also compared. Interviews were conducted with pastors (n = 40) and members (n = 96) of rural churches. They were Baptist (60%), and 57.5% were predominantly White, while 42.5% were Black. Leaders’ beliefs regarding talking about health topics in sermons were associated with the presence of health messages in the church. There was also a significant association between leaders’ beliefs about members’ receptivity to health messages and the presence of messages in the church. Leaders’ and members’ perceptions of the CHPE were discordant. While some leaders’ beliefs may be related to the CHPE, other factors may explain why programs and policies exist in some churches and not others.

Citation: Williams, R.M., Glanz, K., Kegler, M.C., & Davis, E. (2009). A study of rural church health promotion environments: Leaders' and members' perspectives. Journal of Religious Health. Published online. Dec 4, 2009.

Pogmegranate for cancer treatment/prevention?

Review by Kyle Bahnsen

Citation:
Lansky, E.P., Jiang, W., Mo, W., Bravo, L., Froom, P., Yu, W., Harris, N.M., Neeman, I. and Campbell, M.J. (2005). Possible synergistic prostate cancer suppression by anatomically discrete pomegranate fractions. Investigational New Drugs. 23: 11-20.

Summary:
This 2005 study, on tertiary prevention of prostate cancer was particularly interesting because it not only evaluated the use of the pomegranate fruit as a whole, but it evaluated the effectiveness of the juice polyphenols, the pericarp peel, and the pomegranate seed oil, individually. While this study was primarily focused on using the pomegranate plant as a synergist to other chemotherapeutic agents, it points to the need for future pilot studies concerned with it primary prevention properties of tumor suppression. The pomegranate fragments in this study were used on PC-3 human prostate cancer cells in vitro. Prostate cancer cells were obtained from 145 different samples, and the dose of pomegranate fragment used remained constant. Results from this randomized controlled trial demonstrated that all three of the separate pomegranate fragments (seed, skin, and oil), had synergistic affects on prostate cancer cell proliferation, invasion, and phospholipase A-2 expression.

Mammogram Debate

Article Summary
Brooke Gilliland

Mammogram Debate Took Group by Surprise
By GINA KOLATA
Published: November 20, 2009

This article discusses the federal Preventative Services Task Forces’ November 2009 recommendation that women need to get (and should get) mammograms less frequently than previously suggested. Further, the article describes how this recommendation instigated and uproar of opposition response. Several groups were described as being upset about the recommendation due to the perceived health consequences. However, other groups expressed anger that there were political overtones regarding the Obama administration’s recent healthcare reform gestures.

The history of the task force and the method of choosing its members were explained. Members of the task force expressed surprise at the negative responses to their recommendation. Other physicians, not in the task force, were incredulous as to the naiveté of the task force physicians. Those doctors could not believe that the task force members would not expect their recommendation to be met with indignation by the general public and cancer groups. The task force members believe that they are insulated from political and popular influences, but others find that hard to believe.

Personal note: possibly adding to the controversy of the agency’s mammogram recommendation was the fact that they simultaneously recommended against teaching breast self-examination (BSE). They graded BSE as a Grade D recommendation meaning “The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” Also from the federal Agency for Healthcare Research and Quality’s (AHRQ) website http://www.ahrq.gov/clinic/USpstf/uspsbrca.htm on December 4, 2009 the USPSTF “unanimously voted to update the language of their recommendation regarding women under 50 years of age to clarify their original and continued intent.”

Health Policy in the News

Nov 30, 2009
Lawmakers Battle It Out Over Health Bill In Senate: Democrats Deeply Divided On Abortion, Government-Run Public Option. Published by the Associated Press.