Burgess COMMENTARY

Peter Burgess

Health Indicator

We are delighted to announce our new expert advisor, Dr. Trevor Hancock, prominent internationally for his work on health indicators focusing on prevention and broad public health factors. Dr. Hancock, who serves on our Advisory Board, is a full time advisor to the Ministry of Health Planning of British Columbia, Canada. Dr. Hancock, among his many important posts has advised the World Health Organization, many European governments, and was Regents Lecturer at the University of California, Berkeley in the School of Public Health. With Dr. Hancock's help, our Health Indicator will now include Healthy Life Expectancy, factoring in disability and quality of life as people age.

Our Health Indicator shows that the United States provides more health care services at higher costs per capita than any other country in the world - but with no better outcomes than countries spending much less. After the anthrax attacks of 2001 , the US public health services were revealed as woefully under-funded and wholly inadequate to their new tasks in an age of bioterrorism. Some funding increases have passed the Congress, but are still viewed by health professionals as a fraction of what is required. The enormous health sector of our economy is also becoming a top focus of national concern since it delivers only modest improvements in health status in some areas and none in others. Of growing concern are the over 40 million Americans who have no health insurance. Meanwhile, the National Bureau of Economic Research (NBER) released a working paper, which finds that better health boosts a country's GNP. Authors David Bloom and JP Sevilla analyzed data from 104 countries and found that a one-year improvement in a country's life expectancy contributes a 4% increase in its economic output (December 3, 2001). This points to the need to re-categorize health budgets in GNP/GDP national accounts from 'expense' items to investments in human capital. The debate over a 'Patient's Bill of Rights' to hold health maintenance organizations and insurance companies more accountable for decisions over patient treatment is becoming urgent. Pharmaceutical companies' drug prices soar at three times the rate of inflation and the Medicare-related law passed in 2003, providing drug coverage for seniors, has been widely-criticized for the 'holes' in its benefits and rewards to pharmaceutical companies. Concerns grow regarding the privacy of medical records, and drug reactions and medical mistakes proliferate. Newer worries concern terrorism and the need for public health clinics nationwide, where uninsured people who may have been exposed to pathogens can be quickly tested and evaluated so as to limit epidemics.

The Health Indicator offers a model of our current system that helps to clarify the situation as a systemic set of issues. Health is being redefined beyond the medical intervention model. Today, Americans are focusing on prevention, public health, stress-reduction, and life-style choices. Beyond terrorism, tobacco and alcohol use and even the availability of guns are issues entering the public health debate. More Americans now consult 'complementary' and 'alternative' health providers than visit conventional medical doctors and facilities. This is a paradigm shift that is restructuring the entire medical-industrial complex and its technocratic, bureaucratic approach, which represents 14 percent of our GDP.

How will we integrate all these very different approaches to health? How will we provide for those left out of the current system, especially children? An October 1999 study in the Federal Reserve Bank of New York's Economic Policy Review cites the effects of urban poverty. Fifteen-year-old black and white male's life expectancy rates were compared in several cities. In areas of New York City that were predominantly low-income and African American, only 37% of the population was expected to live to age 65. In Detroit, the figure was 50%. White fifteen-year-olds in poverty areas of Detroit and Cleveland did a little better. In Detroit, 60% were found likely to live to age 65 with 64% likely in Cleveland. Average life expectancy for all US whites is 77 years compared to 62 years for blacks. Our indicator allows us to see such gaps, which of course relate to similar data in our Income, Shelter, Public Safety, Education, and Human Rights Indicators.