Social Medicine and Public Health

[chickenfeet]

What follows was triggered by a debate with arcana_mundi.

We were discussing, inter alia, the relatively poor showing of the US on many population health indicators despite the US spending more on health than the rest of the OECD and whether the US healthcare financing and delivery model was responsible for that.  She argued that there are many factors affecting population health indicators besides the US healthcare model including lifestyle issues, incidence of poverty etc and, of course, she is correct.

The train of thought that I have been playing with in my head goes something like this.  Maybe there is a correlation between lifestyle factors and the extent to which healthcare is taxpayer funded.  Public health interventions are almost invariably tapayer funded (this was true even in impeccably laissez faire Victorian England) because nobody else is going to pay for them.  Well designed public health interventions can be very successful but the opposition to them is usually vocal and concentrated, the benefits hard to measure in the short term and beneficiaries may not be aware or unduly concerned about the outcomes.  The big exception is where public health investments ease the strain on a publicly funded healthcare system since there the immediate payor and the apparent financial beneficiary are one and the same.
 
To take perhaps the most obvious example, smoking cessation policies can save a fortune in down the road healthcare costs but are invariably opposed by the cigarette companies and the tobacco farmers (and usually by the ministry of finance who find short term tobacco revenues more attractive than long term savings.  Wasn't there a Yes, Prime Minister episode on that very theme?).   It took a very long time for Ontario to adopt fairly aggression smoking cessation strategies precisely because of the strength of that lobby in the province  and one wonders if it would ever have happened if the costs imposed by smoking on the healthcare system were not being met from the public purse.

If it is the case that polities with substantially publicly funded healthcare systems are more likely to engage in public health interventions, one might reasonably expect that to result in healthier lifestyles in those polities.  Of course, there are other reasons why the government of a polity with a private healthcare system might choose to make public health interventions and, of course, they do.  My suspicion is that they do less.  It would though be interesting to compare comparative spending on public health interventions across, say, the OECD, and see if there are correlations either to the degree that healthcare is socialised(1) or to population health statistics.

I don't have access to J-STOR until I get back to the Cancer Pits but I might try and have a look then.

(1) It is a question of degree.  Contrary to popular belief and a lot of political rhetoric, all of the OECD countries have mixed healthcare systems with a mix of taxpayer and non-taxpayer funding and delivery split, in different proportions, between government, not for profit and commercial providers.

Comments

[f4f3.livejournal.com]

...speaking from the heart disease and stroke leaders of the Western World, I'm not sure that the NHS has been interventionist enough in this socialised health care market. However, there have been a couple of early studies on the smoking ban in Scotland which do show astonishing (and therefore suspect) results.

[gramarye1971]

That particular Yes, Prime Minister episode also had a classic bit of Sir Humphrey cynicism where he remarked that if smokers stopped dying off early, then the government would not only lose the tobacco revenue but also would end up having to pay out more in pensions and benefits as a result of increased life expectancy. ^^;;

[chickenfeet2003.livejournal.com]

I remember. I had the same problem myself once trying to write a business case for investment in IT for cancer care. Improving health care invariably drives up otal health spending however efficiently one does it.

[kittenexploring.livejournal.com]

Is that just considering the total spending on health or does it include the increased earnings of the healthy (or even some way of measuring quality of life for the individual or community)?


With a change of federal government here I'm hoping for less of a focus on political gain/sweeping ideology and more on effective and efficient health care. Australia has some bizarre funding arrangements with little relation to the eventual health care. It will be interesting to see if anything is done with the opportunity to improve that.

[chickenfeet2003.livejournal.com]

Cost benefit analysis is brutally difficult in healthcare as I have found on many occasions. Ultimately it's all about boundaries. That said, using reasonable boundary conditions it can be shown that things like smoking cessation programs and clean needle programs reduce the direct cost of treating smoking related diseases or HIV respectively by many times the program cost. Unfortunately, as with all successful health interventions, the total lifetime cost to the system probably increases since the 20 year old who doesn't die of HIV ends up needing a coronary bypass 60 years later.

[kittenexploring.livejournal.com]

Goes some way toward explaining how the world of Logan's Run might come about.

[chickenfeet2003.livejournal.com]

Indeed!

[a-d-medievalist.livejournal.com]

I think I would have to catch up on the original discussion to offer an informed opinion!

[arcana-mundi.livejournal.com]

I'm very curious to find out what you conclude - I volunteer to be assistant research monkey! I've got access to JSTOR. If you tell me what searches you want run, I can email you the PDFs of the articles that result.

[chickenfeet2003.livejournal.com]

That would be great.