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Posts Tagged ‘health’

Public Health

The health of the American people has risen and fallen with fluctuations in the health of its poorest. Although more vulnerable in the past, the affluent have generally managed, major epidemics aside, to stay healthier than other Americans. Going back centuries, they regularly had nutritious food, usually clean water, decent shelter, and the ability to leave town in malarial season. The lower classes, particularly their children, were ill in normal times and especially vulnerable to periodic epidemics. One of modern America’s great achievements is the extension of the average life span, from about 40 years for a just-born infant several generations ago to about 80 years now.

That doubling was accomplished largely by improving the health of less fortunate Americans through public health projects. In a new paper, the eminent economic historian Dora Costa provides an overview of America’s health history which emphasizes the importance of those projects in the late 19th century. Reading her essay raises the question, Where are the equivalent public health projects of the early 21st century?

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We’re # Last!

If you ask young Americans how good their health is, they’ll tell you it’s great. The U.S. ranks #1 among 17 affluent, western countries in that regard, in the percentage of people aged 5 to 34 who rate their health as good. Unfortunately, when doctors look at people’s actual health, at indicators such as obesity, diabetes, and simply the chance that someone will die before his or her next birthday, the U.S. ranks last: young Americans are #17 out of 17 in real health.

The National Research Council and the National Institute of Medicine – the nation’s go-to sources for the best scientific assessments we have – recently issued a report entitled U.S. Health in International Perspective: Shorter Lives, Poorer Health. Although the press conveyed the punch line – “Younger Americans die earlier and live in poorer health than their counterparts in other developed countries” – your humble correspondent has looked through much of the 350+ pages and is here to report: It’s even worse than that.

The study’s findings signal how much the U.S. has slipped behind the rest of the advanced world in the last 40 years. And it exposes the disconnection between Americans’ pride and Americans’ reality.

 

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The 2007 Nicholson-Freeman movie, “Bucket List,” asked the question, What would you do new and differently if you had a short time to live? Let’s flip that question over. What would you do new and differently if you realized that you were going to live much longer than you thought? That is the question that many Americans faced in the early part of the twentieth century when it became clear that people were indeed living longer than had been expected since “time immemorial.” And about a generation earlier, Americans had realized that children were surviving infancy at greater rates than had been true since “time immemorial.” That raised its own questions, too.

New York, 1946 (source)

Helen Zoe Veit in a recent issue of the Journal of Social History describes one sort of reaction that American opinion-makers – doctors, journalists, health officials, and the like – had to these new extensions of life: They urged Americans to take personal responsibility for their health. Now that they could live for a long time, it was Americans’ duty to control their health by, for example, eating well and especially, said the doctors and insurance companies, by getting regular doctor check-ups.

This personal responsibility mantra is an ironic response to greater longevity, given that what had extended Americans’ lifetimes was the exercise of collective responsibility. Still, the prospects of longer, safer lives did, it seems, affect Americans’ sense of personal control over their lives.

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What’s a Life Worth?

We commonly say that lives are invaluable, that saving a life, any life, is worth any effort, any expense. But we do not mean it.

This note is prompted by a recent article on the consequences of raising the speed limits on American highways. The authors estimated that in the decade after 1995, states’ decisions to raise posted speeds increased road fatalities by over 3% — over 12,000 additional deaths. That’s about quadruple the death toll of 9/11. Yet, it is clear that Americans wanted and still want to drive that extra 10 or so miles per hour faster. What does that show about how invaluable each life is?

How much we consider a human life worth has increased substantially over the last century, by one estimate about 30-fold. Yet, we do not spend all we can to save a life. Moreover, how much we do spend to save a life is inconstant and fickle, rather than thought-out and planned; the number typically depends on whose life we are saving.  The question is whether we can and will make studied decisions based on how we actually value a life.

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Heavy Hand

History is not “history”; it is with us today. That is, the past constrains the present. This is obvious in one way: Conditions that developed long ago continue to shape our lives. We are ruled by old laws; we drive streets laid out in decades and centuries past; we operate technologies invented by earlier generations.

Lib. of Congress 1902

But history constrains us in a less obvious way, too: Even plans, customs, practices, and situations that long ago ended have enduring consequences far into the future.

This thought was stimulated by a recent report on the question, Why is life expectancy for older people — especially women — growing more slowly in the United States than it is in comparable countries? Why are the American elderly falling behind in the race to a long life?

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No Longer the Tall American

An Earlier Celts-Lakers Game (source: vedia via flickr)

From the earliest days of American settlement, Europeans typically imagined the colonists of North America as strapping specimens: tall, strong, and bold (even arrogant). And there was truth in that image: white Americans around, say, 1800 were taller, healthier, and longer-lived than their European cousins. But no more.

It is not that Americans grew shorter – or less healthy – since then. Over the last two centuries, western people in general grew taller, healthier, and longer-lived. But the western Europeans passed us by.

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Much of the heated debate leading up to passage of health care reform revolved around whether government, as a matter of principle, should have an expanded role in Americans’ health. To many people, it seemed a radical departure from American tradition. The historical truth is that government has long been enmeshed in Americans’ health. Indeed, government is largely why Americans came to live long lives.

Americans in the 19th century faced short horizons. Babies died at such high rates that American mothers could expect to bury one or two newborns or infants. But even adults did not live that long. In 1850, a male who made it through childhood to the age of 20 could expect to live, on average, only to about 60. Many factors, from poor nutrition to pervasive violence, shortened American lives. But the major single cause was disease, especially water-borne disease.
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