New Horizons in Health An Integrative Approach (2001) / Chapter Skim
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Population Perspectives: Understanding Health Trends and Evaluating the Health Care System
Population Perspectives: Understanding Health Trends and Evaluating the Health Care System
Pages 118-147
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From page 118... ...
An important crosscutting research priority, among several others delineated below, is to account for population health processes by linking them via multilevel analyses to behavioral, psychosocial, and environmental factors described in earlier chapters. TIME TRENDS AND SPATIAL VARIATION IN POPULATION HEALTH Brief summaries are provided below of health trends in life expectancy and disability, both within the United States and in other countries.
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From page 119... ...
A major international data source on health trends is the set of Demographic and Health Surveys.i An overarching theme is that the maintenance and improvement of population health have been and continue to be due as much to changes in broader socioeconomic and environmental forces as to more microscopically based biobehavioral science. Understanding and facilitating improvements in socioeconomic conditions, general public health and sanitation, and private and public policies affecting lifestyle have accounted for the bulk of historical changes in population health and very likely recent advances as well (Rose, 1992~.
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From page 120... ...
, suggesting the trend is not an artifact of this particular sample. Sketchier evidence suggests that the decline in elderly disability has occurred throughout the developed world.
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From page 121... ...
Behavioral, environmental, and psychosocial factors are, as we argue throughout this report, key routes to such health promotion. Communicable Diseases Sexually transmitted diseases (STDs)
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From page 122... ...
The introduction of protease inhibitors may increase the number of prevalent infections by extending the life of HIV-infected people. Approximately half of the incident and three-quarters of prevalent infections were estimated to have been sexually transmitted.
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From page 123... ...
. Considering infectious diseases more generally and on a longer time scale, infectious disease mortality declined during the first eight decades of the twentieth century from 797 deaths per 100,000 people in 1900 to 36 deaths per 100,000 in 1980.
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From page 124... ...
124 Cal Cot .~= · ~ o .
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From page 125... ...
Infectious disease mortality increased in the 1980s and early 1990s in persons aged 25 years and older, due mainly to the emergence of AIDS in 25to 64-year-olds and to a lesser degree to increases in influenza and pneumonia deaths in persons aged 65 and older. Although most of the twentieth century was marked by declining infectious disease mortality, substantial year-to-year variations and recent increases emphasize the dynamic nature of infectious diseases and the need for preparedness to address them.
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From page 126... ...
Asthma is the most common chronic disease of childhood, affecting an estimated 4.8 million children. It is one of the leading causes of school absenteeism, accounting for over 10 million missed school days each year (U.S.
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From page 127... ...
Cerebrovascular disease Hardening of the arteries Varicose veins of the lower extremities Hemorrhoids Selected respiratory conditions: Chronic bronchitis Asthma Hay fever or allergic rhinitis without asthma Chronic sinusitis Deviated nasal septum Chronic disease of the tonsils or adenoids Emphysema 16.3 30.7 15.4 5.3 43.3 2.7 15.1 15.8 8.0 21.0 7.9 83.6 28.1 35.9 8.7 19.5 7.6 19.6 108.3 13.2 7.0 30.0 39.8 54.3 51.4 93.4 146.7 7.0 11.0 7.6 1.9 1.5 8.6 5.4 13.2 0.2 4.7 3.4 2.6 1.2 20.3 0.3 14.9 0.4 14.1 0.5 5.0 3.1 1.0 0.6 0.2 59.3 71.6 56.7 79.6 0.7 26.4 0.7 SOURCE: Data from NCHS, 1993.
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From page 128... ...
Among people without a high school diploma, in contrast, prevalence had fallen by only one-sixth (to 30.4 percent; CDC,1999c; Warner, 2000~. Although considerable speculation has been put forth about the reasons for this disparity, this is an important future research direction, directly linked to those of Chapter 6 and Chapter 7, where the social and behavioral sciences are particularly prominent.
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From page 129... ...
Understanding these interactions as part of a more mechanistic characterization of predisease pathways (Chapter 2 ~ to a range of cardiovascular diseases and cancers is an important research direction requiring integrative perspectives (see Chapter 1~. Alcohol and illicit drug use are associated with violence, injury (particularly automobile injuries and fatalities)
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From page 130... ...
Life Expectancy The dramatic increase in life expectancy in the United States during the twentieth century is attributable largely to primary prevention interventions (Bloom, 1999) , such as improved sanitation, housing, nutrition, and new technologies for food preservation.
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From page 131... ...
The national trends described above are accompanied by enormous variation within countries. County-specific analyses of historical trends in the adoption of primary prevention strategies and shifts in average socioeconomic status levels relative to those for a given state, or for the country at large, could provide a useful baseline for the formulation and targeting of future health promotion and disease prevention strategies.
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From page 132... ...
Analyses of the impact of policies such as these are frequently undertaken by specialinterest groups. Monitoring such programs over long periods of time is, however, necessary to establish trends and deviations from them, as illustrated with the case of smoking and its much later disease sequelae (lung cancer, chronic bronchitis and emphysema, cardiovascular diseases; Warner, 2000~.
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From page 133... ...
A second advance has been the implementation of longitudinal population surveys collecting information on socioeconomic status, early life resources, work conditions, family stress and support, physical and mental health, and medical care received that are also linked to earnings records from Social Security systems and medical care utilization from health insurers. Longitudinal data are essential because changing disability will be fully understood only by following the same people over time.
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From page 134... ...
STD and tuberculosis rates can now be measured overall and at the level of particular communities, which will significantly increase our ability to understand the role of community factors in these health outcomes. Changes in Child Health Rates of infant mortality and low birth weight are each driven by a confluence of conditions that include low socioeconomic status; poor or no prenatal care; high-risk health behaviors (e.~., smoking, drinking, and drug abuse by pregnant mothers i; and chronic exposure to violence, poverty, and nonsupportive social networks.
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From page 135... ...
Thus, the income gap between more and less healthy countries is increasing over time. Recent research indicates that life expectancy is a powerful predictor of national income levels and subsequent economic growth (Fogel, 1999~.
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From page 136... ...
Health improvements have hidden costs if they lead to difficulty financing public-sector programs for the elderly. However, recent evidence of rectangularization of survival curves, not only for mortality but for the age-specific onset of disability and chronic diseases (Vita et al., 1998)
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From page 137... ...
Research on heart attack patients shows that intensive procedures are used up to five times more frequently in the United States than in Canada, but mortality rates are the same in the two countries (Rouleau et al., 1993; Mark et al., 1994; Tu et al., 1997~. Indeed, within the United States, people who live close to high-tech hospitals receive intensive services more frequently than people who live farther away from such hospitals, but again health outcomes are essentially the same (McClellan et al., 1994~.
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From page 138... ...
Their study estimated the costs of acquiring and using 11 contraceptive methods appropriate for adolescents, treating associated side effects, providing medical care related to an unintended pregnancy during contraceptive use, and treating sexually transmitted diseases (STDs) and compared them with the costs of not using a contraceptive method.
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From page 139... ...
In addition, primary prevention with a statin may not be cost effective for younger men and women with few risk factors, given the option of secondary prevention and of primary prevention in older age groups. Secondary prevention with a statin seems to be cost effective for all risk subgroups and is cost saving for some high-risk subgroups.
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From page 140... ...
. People with managed care insurance typically have more restrictive access to providers and high-tech care than do people in traditional indemnity insurance.
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From page 141... ...
In summary, the phenomenal change in the medical system encompassed by managed care, coupled with the availability of rich sources of data, make this topic a prime candidate for future research. Understanding the economic and health consequences of managed care has great import for informing public policy pertaining to the health care system.
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From page 142... ...
population suggest a 47.3 percent increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all U.S. primary care physicians.
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From page 143... ...
Economic, social, and medical systems differ greatly across countries, and thus international work is a natural laboratory for analysis. RECOMMENDATIONS We urge NIH to invest new resources in research to identify linkages between population health trends and the behavioral, environmental, and psychosocial factors emphasized in preceding chapters.
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From page 144... ...
Brown AD, Garber AM. 1998 "Cost effectiveness of coronary heart disease prevention strategies in adults" Pharmacoeconomics 14/1:27-48.
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From page 145... ...
1998 Sexually Transmitted Diseases in America: How Many Cases and at VDbat Cost? (Menlo Park: Kaiser Family Foundation)
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From page 146... ...
1994 "Does more intensive treatment of acute myocardial infarction in the elderly reduce mortality? Analysis using instrumental variables" Journal of the American Medical Association 272/1 1:859-866.
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From page 147... ...
Shaw J 1997 "The cost-effectiveness of a cardiovascular risk reduction program in general practice" HealtI7 Policy 41/2:105-119.
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