From the New England Journal of Medicine: the Shattuck Lecture on improving the health of the American people
While we wander through the mire of politicised health care reform (do not overlook the excellent clarity and critique offered by the Rolling Stone).
We Can Do Better — Improving the Health of the American People
The United States spends more on health care than any other nation in the world, yet it ranks poorly on nearly every measure of health status. How can this be? What explains this apparent paradox?
The two-part answer is deceptively simple — first, the pathways to better health do not generally depend on better health care, and second, even in those instances in which health care is important, too many Americans do not receive it, receive it too late, or receive poor-quality care. In this lecture, I first summarize where the United States stands in international rankings of health status. Next, using the concept of determinants of premature death as a key measure of health status, I discuss pathways to improvement, emphasizing lessons learned from tobacco control and acknowledging the reality that better health (lower mortality and a higher level of functioning) cannot be achieved without paying greater attention to poor Americans. I conclude with speculations on why we have not focused on improving health in the United States and what it would take to make that happen.
It is very good – much like a lot of the criticisms of the US ‘system’, it begins from a common perspective (way more money paid, way less health received in return).
He asks a few highly relevant questions, not the least being, Why Don’t Americans Focus on Factors That Can Improve Health?
I recommend it. Give it a read.