Measuring the Health of the Public

The Institute of Medicine released the first of three Robert Wood Johnson Foundation-commissioned reports on public health today:

The United States spends more money on health care than any other country in the world, but there's much more to good health than getting health care from doctors and hospitals. In fact, life expectancy in the United States ranks 49th among all nations, and infant mortality rates are higher in the United States than in many less-affluent nations. A new Robert Wood Johnson Foundation (RWJF)-commissioned Institute of Medicine (IOM) report argues that America’s less-than-stellar standing in these population health measures stems in part from inadequacies in the country’s system for gathering, analyzing and communicating health information that focuses not just on clinical care data but on the underlying factors that contribute to poor health, such as health behaviors and social determinants. The IOM report, For the Public’s Health: The Role of Measurement in Action and Accountability, reinforces the urgency to address health not just in the doctor’s office but where it starts—in our homes, schools, jobs and communities.

Read more here.

Using Cash to Slow Population Growth in India

An article in the NYTimes discusses a new pilot program being implemented in parts of India to slow population growth. Young couples are encouraged to delay pregnancy and are told that they can finish school and even get paid by the government if they wait to have children.

Waiting also would allow India more time to curb a rapidly growing population that threatens to turn its demography from a prized asset into a crippling burden. With almost 1.2 billion people, India is disproportionately young; roughly half the population is younger than 25. This “demographic dividend” is one reason some economists predict that India could surpass China in economic growth rates within five years. India will have a young, vast work force while a rapidly aging China will face the burden of supporting an older population.

The program in Satara is a pilot program — one of several initiatives across the country that have used a softer approach — trying to slow down population growth by challenging deeply ingrained rural customs.

“An educated girl is your best contraception,” said Dr. Amarjit Singh, executive director of the National Population Stabilization Fund, a quasi-governmental advisory agency. He said that roughly half of India’s future excess population growth was expected to come from its six poorest states.

Healthy Americans = Less Costly Americans

While much of the debate surrounding the new healthcare bill speaks to changes in insurance coverage for uninsured and underinsured Americans - a more noteworthy benefit of the overhaul is the (much overdue) focus on prevention. Under the new law, insurance companies will be required to provide preventive services - such as immunizations and check-ups - as part of the patient's insurance coverage. Patients will not be required to pay additional out-of-pocket charges for these services.

“This is transformative,” says Helen Darling, president of the National Business Group on Health, a nonprofit organization for large employers. “We’re moving from an insurance model that was based on treating illness and injury, to a model that’s focused on improving an individual’s health and identifying risk factors.” [link]

Public Health professionals have long known that focusing on preventing illness is much more cost-effective than treating illness. For example - it's much more cost-effective to encourage hand hygiene in healthcare workers than it is to treat a healthcare-associated infection. It's promising that this is also the direction healthcare reform is heading.

Farmer Suicides in Punjab Continue

A recent article in the Financial Times discusses how the suicide rate among small farmers in Punjab is much higher than official statistics.

The north-western state, the main breadbasket of Asia's third-largest economy, had appeared immune to the wave of suicides by indebted farmers that has swept drier parts of India. Yet research shows that more than 2,000 farmers in Punjab kill themselves each year to escape the shame of chronic debts related to agricultural inputs, such as seed and pesticide, and falling incomes.

Official statistics say that 132 farmers in the Punjab killed themselves in the past five years. Most suspected suicides are attributed to natural causes or alcohol or drug abuse. Inderjit Singh Jaijee, a Chandigarh-based human-rights activist and former state legislator, states that up to 40,000 farmers have taken their lives in the past 20 years. Many of their families are left destitute, receiving no state support.

Punjab benefitted greatly in the Green Revolution, a movement in the 1960s to modernize agriculture with more utilization of fertilizer and pesticides. According to the FT article, "Policymakers stress the need to boost the agricultural economy, which supports the bulk of India's 1.2bn people."

International Princess Project

Here's information and a short video about the International Princess Project, an organization aimed at giving women and young girls new opportunities to restore their lives and empower then to live in freedom.

International Princess Project advocates for women enslaved in prostitution, helping them restore their lives and empowering them to live free. Through various initiatives, International Princess Project both helps partner organizations increase capacity and provides direct support for women in need.

Language and Cultural Barriers in Healthcare

A new study, sponsored by the Robert Wood Johnson Foundation, confirms the need to address language and culture in healthcare.

Nearly half of U.S. physicians say language or other cultural barriers are obstacles to providing high-quality patient care, according to a study released by the Center for Studying Health System Change. Forty-eight percent of all physicians in 2008 reported difficulties communicating with patients because of language or cultural barriers, and said they considered the situation at least a minor problem affecting their ability to provide high-quality care. Less than 5%, however, viewed those barriers as a major problem that could result in a disparity of care across ethnic and racial populations, the study reported. Efforts to overcome the obstacles were
considered modest or uneven. [link]

Healthcare providers have legal obligations to provide needed interpreter services, at least for patients with public insurance. However, physicians in solo and group practices were less likely to adopt measures to address disparities than those in institutional practices, such as hospitals, health insurers, and medical schools, according to the study.