After listening to Susan Dentzer’s one-hour-ish talk entitled, “America’s Health Deficit: what we can do about it,” it became abundantly clear to me why she is the editor-in-chief of Health Affairs, the journal Washington Post calls “The Bible of Health Policy.” For those of you who missed the talk (given at Mailman a couple weeks back), you can catch it via the link below. In that short time, she distilled and packaged a tremendous amount of information, from key components of the Affordable Care Act (including its unfinished business) to right-off-the-press findings around social and behavioral determinants of health outcomes. It’s that later half that I listened to a second time.
There’s so much to reflect and comment upon, but it’s perhaps the stuff around education and women that resonated with me the most. We learned in our Health Economics course that education (not health education, but education itself) contributes more to health outcomes than the actual delivery of health (i.e. healthcare AKA what we do). That was a paradigm-shifter for me. Susan Dentzer summarized a study published in Health Affairs in August 2012 (written by Olshansky et al) stating that today’s adult Americans with less than 12-years of education (i.e. didn’t graduate from high school) have a life expectancy similar to Americans from the 1950’s. It is startling to say the least that 60-years of medical and scientific progress hasn’t impacted this population. She went on to share that life expectancy has actually fallen for less educated women in particular. American women who didn’t graduate from high school live four fewer years compared to their 1990 counterparts, which is a drop comparable to patients with HIV in Sub-Saharan Africa. Contributors include obesity, smoking status, stress involved in trying to make ends meet, as well as a new contributor: prescription drug abuse (which interestingly falls under category, “accidental poisonings”).
“Don’t be poor” is one of the ten tips for better health as part of the Center for Social Justice’s publication on social determinants of health. Ms. Dentzer echoed this and reminded us of a study (by Dr. Christopher Murray from Harvard) that identified “eight different Americas.” An Asian American baby girl in Northern New Jersey is expected to live 91 years (amazing, even for international standards) compared to an African-American man (69 years) or Native American (58 years). This is a 33-year life difference! She goes on to describe an IOM (Institute of Medicine) report describing American life expectancy and health parameters throughout life as being worse than other rich countries, partly due to chronic disease (especially cardio- and cerebrovascular) but also motor vehicle accidents, abuse of prescription drugs (there that is again), and gun violence. Along these lines, she also described unfinished business after ACA – addressing drivers of poor health such as obesity, physical inactivity, social circumstances, etc. And more interestingly, that “most of the action is where these things interact.” For example, not walking (or doing other outdoor exercise) because you’re worried about being shot. We should not tear down parks to build stadiums, etc.
Suffice to say that Susan Dentzer is incredibly knowledgeable and it would behoove all of us to share the wealth by listening to the talk, getting inspired, and continuing the work. She asks us to conduct research and to “help build the case for public health investments” (funding cuts due to sequestration are reducing access to contraception for the poor and supplemental nutrition for pregnant women, among other things). Our sphere in public health is not just about management of healthcare institutions, but rather also about population health. And we should think creatively about contributors large and small (mostly large) like poverty, income inequality, access to produce, residential segregation, adolescent pregnancy rates, healthy food in schools, etc. She ended aptly with a quote, “Those who say it can’t be done should not interrupt those who are doing it!”
Link to the talk: http://youtu.be/wHruHjAHLyo