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Volume 5, No. 5, May 2007
Abstract of the Month
Social Change Might Save More Lives Than Medical Advances
The basic notion that more lives would be saved by eliminating education-associated excess mortality than by medical advances is sufficiently robust to justify a change in policy priorities. In the past few decades, there have been heavy investments in technological advances intended to reduce morbidity and increase life expectancy. However, the pace of progress has been modest.
Minority groups have higher mortality rates than whites, and people of low socioeconomic status have higher mortality rates and poorer health status than the general population. This article explores the possibility that addressing social determinants of health might do more to save lives than the incremental advancements in the technology of care that consume the bulk of societal investments in health. The authors examined death rates among adults with inadequate education, a group known to have excess mortality rates.
The authors examined mortality data for 1996 through 2002 reported by the National Center for Health Statistics. They compared (1) the maximum number of deaths averted by the downward secular trend in mortality and
(2) the number of deaths that would have been averted had mortality rates among adults with less than a high-school education (LHS adults) been the same as those among adults with some college education.
The authors found that
* The downward secular trend in age-adjusted mortality rates in the United States saved an average of 25,456 lives per year during 1996 through 2002.
* Each year, an average of 195,619 deaths would have been averted if mortality rates among LHS adults had been the same as mortality rates among college-educated adults.
* Disparities in education-associated excess mortality were more acute among LHS adults than among those with a high-school education (but no college diploma). Nonetheless, because high-school graduates outnumber LHS adults, a majority of the lives saved by eliminating education-associated excess mortality -- 870,286 (63.6%) of the
1,369,335 averted deaths -- would involve adults with a high-school diploma.
This data suggests that correcting the conditions that cause people with inadequate education to die in greater numbers will do far more to save lives than making incremental improvements in the technology of medical care.
Woolf SH, Johnson RE, Phillips, RL, et al. 2007. Giving everyone the health of the educated: An examination of whether social change would save more lives than medical advances. American Journal of Public Health. Am J Public Health. 2007 Apr;97(4):679-83.
http://www.ajph.org/cgi/content/abstract/AJPH.2005.084848v1
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OB/GYN CCC Editorial comment:
The United States, the richest country in the world, currently ranks 27th in the health of its citizens*. Lagging behind not only most of the rich countries, but a few poor ones as well. Fifty years ago, the US was among the top five. What happened in the past five decades to cause this decline?
Stephen Bezruchka# in his lecture ‘Womb to Tomb’ explains that an increasing stratification between the rich and the poor plays a major role. Life spans and infant mortality rates depend very much on the hierarchal structure of a society. And new research shows that half of what influences our health as adults is largely determined before the age of five. What can we learn from other countries whose citizens live longer and healthier lives?
In Indian Country we should use our expertise as public health advocates to improve the whole of Indian ‘health’, not just direct health care.
From Womb to Tomb , Stephen Bezruchka M.D, University of Washington
http://www.alternativeradio.org/programs/BEZS002.shtml
*Life expectancy in the US has declined further since the above lecture. It now lags behind Cuba
Resource:
Deaths: Preliminary Data for 2004, National Center for Health Statistics
http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimdeaths04/preliminarydeaths04.htm
# Stephen Bezruchka teaches at the University of Washington and works as an emergency room physician in Seattle. His particular areas of research are population health and societal hierarchy and its application to health. He is author of numerous articles and essays. His most recent contribution is to Sickness and Wealth, a collection of essays on the effects of global corporatization on health.
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OB/GYN
Dr. Neil Murphy is the Obstetrics and Gynecology Chief Clinical Consultant (OB/GYN C.C.C.). Dr. Murphy is very interested in establishing a dialogue and/or networking with anyone involved in women's health or maternal child health, especially as it applies to Native or indigenous peoples around the world. Please don't hesitate to contact him by e-mail or phone at 907-729-3154.
