Health v. Health Care

This topic should probably have been my first post. Poor job on my part. It is more basic and philosophical than most of my entries. The usual assumption is that good health care leads to good health, but is that true? Actually, let me complicate things more and bring it to a more primal level. What is health? The absence of illness? Or from the World Health Organization, “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Try defining spiritual well-being. I imagine health as a spectrum. We are not all healthy or all sick at any given time, but sliding back and forth between the two. Also, I’m no expert, but other world cultures see health very differently than we do in the West. Traditional Chinese Medicine sees things as a balance – the ying and the yang (a very crude and oversimplified summary) and there are so many more. I would love to hear more insights on what health is?
From a policy point of view, and assuming that my goal is to improve the health of all Americans, what is the best way to achieve my goal? Is it by improving health care services? Maybe. Maybe not. But if it isn’t then I’ve been focused on the wrong areas. Oops!

Here are some interesting tidbits.

  • We spend less than 5% of health care dollars on public health, even though, the majority of the gains in life expectancy over the past 75 years or so can be attributed to public health policy (sanitation, vaccines, clean water, health codes, mineral and vitamin fortification, etc).
  • Wealth seems to be highly correlated with health, but to some surprise rank of wealth is even more correlated. So the richest person in America should be healthier than the second richest even though both can afford the same amount of health care. Further, geographical areas with greater wealth disparity (distance between the poorest person and the wealthiest person) have poorer health outcomes than areas with less wealth disparity. So if you are rich, but live in an area where there is a large wealth disparity you may have poorer health than a relatively poorer person in an area with a small wealth disparity. This holds true between countries, states and metropolitan areas. I think this is strange, but it seems to be true.
  • Also, education is highly correlated to health (more than access to health care). That raises interesting questions. If we are spending 16% of our national wealth on health care and education has a stronger correlation to health than maybe we are misallocating our resources? Maybe?

I don’t have these answers, but as we reform our health care system realize that the more money we spend on health care, the less money we have for other things. As health care spending continues to out-pace inflation and creeps closer to 20% of GDP it will eat into other budget items. Some of these budget items may be very important to our nation’s health.

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2 responses to “Health v. Health Care

  1. Interesting statistics, to which I can only add a caution: correlations don’t equate to causality. For example, if higher education correlates to better health, one cannot necessarily conclude that we could improve health simply by improving education. It’s possible that those who are more responsible are predisposed to become more educated and that it’s their focus on personal responsibility that has enabled them to lead healthier lives, not their education. If that’s the case, focusing on providing more education might do little or nothing to improve health because it wouldn’t necessarily cause people to take more personal responsibility in managing their health. Correlations often raise more questions than they answer and can generally lead to actionable insights only when tested using experiments having both test and control groups.

    Regarding health care expenses as a percent of GDP, it’s important to recognize the impact of demographics. The aging of the baby boom generation will necessarily cause health care expenses to grow at a faster rate than other expenses since older people generate more medical expenses than younger people. And growing demand by boomers will likely cause health care costs to rise at a faster pace than other expenses due to supply and demand factors.

    It would be interesting to see some information on what our system does that artificially restricts the supply of health care. For example, AMA restrictions on medical practice, accreditation limitations on medical schools, the extent that malpractice claims raise insurance rates and encourage excessive testing and procedures, etc.

  2. You are completely right regarding correlations. They say nothing about causation, but like you said they raise interesting questions.

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