Harley Sorenson in the SF Chronicle refers to a
long, but fascinating lecture by a public health scientist and ER doctor in Seattle, detailing how the US rich/poor divide degrades public health. It's a personal account, but I bet there are studies to back this up. We pay more than any other country for health care, yet we are 25th in life expectancy and a number of other measures. What explains it? According to Dr. Bezruchka,
"By its very nature, medical care can't have much to do with health. To consider why, I make the analogy that medical care's role is the same as that of the army medical corps in keeping us healthy. You've been reading about all these soldiers that are coming home from Iraq with legs blown off, or other serious injuries...But most casualties, those who die, are killed outright by the blast, by the bullet or bomb. The army medical corps can't do anything for them. The army medical corps did not decide that we were going to invade Iraq, they didn't decide the battle strategies, that we were going to bomb targets including civilians, from the air, that later we would send in ground troops. They didn't decide on the day-to-day combat decisions. They didn't decide on the protective gear that troops would wear. All they do is go in and pick up the pieces, those fortunate ones who still have signs of life. That is the best that medical care can do, try to keep the survivors alive. So by its nature, medical care can't have much of an impact on health, despite what you are led to believe...That is not to say that I don't believe in medical care. I work as a doctor providing medical care, and I teach young doctors as well. And if I get sick, I see a doctor. And if I collapse here on the podium, I want you to call 911. But we should not deceive ourselves that this is what makes us healthy as a population."
"...even though we think we are all middle class there is an ever increasing gap between the rich and poor here. In a society with a bigger gap, those above put down those below, and this is related to the amount of violence in society and helps explain why we have so much homicide. Costa Rica is an example of a nearby country that is pretty egalitarian, and even though it is much poorer than the US, it is healthier than we are. Canada is another example, our neighbor to the north, which is much much healthier than the USA. The final example is Cuba, a country that we have been strangling for 44 years with trade sanctions and embargoes. Cuba is as healthy as we are, despite, or maybe because of our policies.
Consider the healthiest country in the world, Japan. Fifty-five years ago when we were one of the healthiest countries in the world, right after World War II, Japan was less healthy compared to other countries than we are today. Yet the USA gave it the medicine it needed to become the healthiest country in the world by 1978. The medicine was prescribed by the greatest population health doctor who ever lived, General Douglas MacArthur. The medicine administered during our occupation of that country from 1945 to 1950 had 3 ingredients and I will review them here. The first was demilitarization. Japan was forbidden to have an army. The second ingredient was democratization, as MacArthur wrote the country's constitution, providing for a representative democracy, free universal education, the right of labor unions to organize and engage in collective bargaining, and the right of everyone to a decent life. The third D was decentralization, as MacArthur broke up the 11 family zaibatsu that ran the huge corporations that controlled the country. He legislated a maximum wage for the country of the equivalent of $4333 in US dollars. He also carried out the most successful land reform program in history. What this did is bring down the economic hierarchy, and level the playing field. The resulting rise in health is the most rapid ever seen on the planet."
It's a hell of a speech--some Dem should pick this up.