Population Health


 

"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?"

 In the words of Dr. Steven Schroeder in 2007 in the assigned piece titled, We Can Do Better — Improving the Health of the American People.

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."   N Engl J Med 2007;357:1221-8. 

Fast forward to today and few things have changed. In comparison to other highly developed nations we do poorly on many measures, especially for persons under age 50 years.

Consider the following two graphs that depict the causes of death of women and men in the U.S. before the age of 50, compared to peer countries.

 

 

Source: U.S. Health in International Perspective: Shorter Lives, Poorer Health

 

The recent Institute of Medicine publication US Heath In International Perspective: Shorter Lives. Poorer Health described how Americans have worse health status and die earlier than peers in other nations.   Income is known to be linked to poor health, but does not account for the differences.  Persons with low income do worse, but when you compare within income groups we are still sicker and die sooner.

Think About These Issues Throughout the Course

There is a recognized need for change. The system is fragmented. Costs continue to rise.

Overall, increased costs are not leading to improved health outcomes.

Can we increase access to care without increasing cost to the system?  Not in the short term.

Can we increase quality without increasing costs to the system?  Hopefully, yes.  This is a growing interest area for providers and researchers.  How do we get the most value from our heath care resources.

How do we tackle health disparities given the known socio-economic barrier to access to care?