dreday

Yet another interesting study I’ve been forced to digest. It shows that during temporary economic downturns, health outcomes actually get better. Particularly, smoking rates and obesity decrease and physical activity increases. A 1% rise in unemployment has been shown to reduce the total death rate (for all causes) by 0.5%. This finding has been backed up by similar studies in Spain, Germany and a macro-study looking at all OECD (ie, rich) countries.

An unexpected finding is that there are bigger variations in excess body weight for males and minorities than for females and non-hispanic whites. The decrease in tobacco use is highest for the heaviest smokers; the reduction in body weight is highest for the heaviest people; and the increase in physical activity is highest among the laziest subgroup.

Overall, a 1% drop in employment is estimated to reduce smoking by 0.6%, obesity by 0.4%, physical inactivity by 0.7% and multiple health risks by 1.1%.

Specifically, a 1% drop in employment is correlated with the following percentage declines in a variety of health problems:

0.4% - cardiovascular disease

0.7% - influenza + pneumonia

0.4% - liver ailments

3.9% - acute morbidities

1.6% - reduction in “bed-days” per two week periods

4.3% - ischemic heart disease

8.7% - intervertebral disk disorders

Econometric models were designed to control for all the usual stuff… Some possible explanations, a decrease in the amount of “work-time” frees up opportunity for physical activity; lower discretionary income raises the relative cost of tobacco products and increases home-prepared meals.

Check out the whole study here.

Within the United States, the data STRATFOR finds most complete comes from New York City, one of the most immediately impacted regions when A(H1N1) erupted in April. The city’s health department estimates that 800,000 people — 10 percent of the population — contracted the virus in the early weeks of its spread. But so far only 930 required hospitalization and only 54 have died.

Bottom line: While A(H1N1) is as communicable as the traditional flu strains, it has shown no inclination to be more deadly. In fact, from what can be discerned from the New York City data, the mortality rate lingers on the edge of the statistically insignificant — a 0.00675 percent mortality rate among those contracting the virus, translating into a 0.00064 percent mortality rate among the general population.

via Stratfor (Strategic Forecast - a pretty badass source for all sorts of cool shit)

According to one study, there are health disparities between Blacks and Whites evident at all socioeconomic levels. In other words, no matter how rich or poor, Blacks are less healthy than Whites. The disparity gets more pronounced the older a person gets and adversely affects females more than males.

Researchers used what is called an allostatic load score which measures the cumulative wear and tear on a person owing to repeated exposure to bodily stressors. They used 10 different biomarkers including blood pressure, levels of norepinephrine, epinephrine, creatinine clearance and cortisol. Abnormal levels of each biomarker are generally associated with a poor health outcome in some form or another. For each person in the study they assigned one point for every biomarker that was measured as being either below the 25th percentile (for creatinine clearance) or above the 75th percentile (for all other biomarkers). The points were then summed to obtain the allostatic load score, with a maximum score of 10. They considered 4 or more points a high score. The results were… bad.

They broke the results down into 5 age groups, separated by race and gender. In all cases, mean scores for Blacks were statistically significantly higher than mean scores for Whites. Black women had consistently higher scores than Black men. Scores get higher with age for all groups, but more so for Blacks, especially for Black women.

Click on the picture for a full table:

This disparity could be explained away by socioeconomic factors like income, access to health care, diet, exercise, ect. But a disturbing finding was that once they controlled for income level, the disparity still existed. Predictably, scores for rich Blacks and Whites were lower than for both groups living in poverty. Not so predictably, scores for rich Blacks did not go down as much as for rich Whites. Most shockingly, scores for Rich blacks were still higher than they were for poor Whites. In other words, rich Blacks are less healthy than even poor Whites (at least according to allostatic load scores).

On the Y axis is the probability of having a allostatic score higher than 4. PIR is the poverty income ratio. They considered having a PIR >1.85 as “living in poverty.”

A couple controversial things to think about:

According to allostatic load scores (which admittedly more accurately measure the “weathering” effect on a person due to stress than actual health, but are a very powerful predictor of poor health) Black women are healthiest/least stressed when they are young. Particularly, before they are 24. Does that mean teenage/young adult pregnancies for Black women are actually preferable? It’s a stretch to make such a blanket statement based on this one study, but it’s something to consider…

Economic wealth doesn’t equal better health, at least for Blacks relative to Whites. So what explains the disparity? According to these researchers, it might be related to living as a minority in a race sensitive society. Even a rich Black person has to deal with racism, maybe even more so than a poor Black person, and so might lead a more stressful life than an economically equivalent White person. Or does it have something to do with Black culture? Is a typical Black person’s lifestyle simply more stressful than a White’s, no matter how rich or poor? Who knows.

If you’re still reading this, you’re probably bored shitless… but if you’re interested, or happen to be in the same class as I am (which is a retarded statement, because neither of the two or so people who read my blog, aka josh or ashkan, are in my class) and consequently HAVE to learn about this study, then check out the whole real detailed deal: here.

NGO efforts to improve health in low to middle income countries can translate to less recipient government spending on health care. WHO estimates a 10% increase in off-budget (NGO) donor funding generates a 0.87 percent reduction in domestically funded government health expenditures. In other words, NGO work takes the burden off of the recipient government and so reduces local efforts to improve health care.

Increases in wealth in many cases doesn’t correlate with better health (at least when it comes to infant mortality). The poorest 20 percent of Vietnam has a higher child survival rate than the richest 20 percent of India. India has the same child survival rate as Eritrea even though its GDP per capita is three times higher. Economic growth has been shown to count for less than half of the health gains in low and middle income countries between 1952 and 1992. Instead, technological innovation and diffusion of knowledge have been the main drivers for improved and prolonged lives in even the most impoverished settings.

Poor health costs a lot. The commission on Macroeconomics and Health at the WHO (what I wouldn’t give to work there) estimates that 8 million lives saved from the leading causes of death in sub-Saharan Africa -infectious disease and nutritional deficiencies- would save approximately $186 billion per year. China, India and Russia will each forego between $200 and $550 billion in national income during the next ten years as a result of heart disease, stroke and diabetes.

Without a sustained effort in prevention of HIV/AIDS, the cost of treatment will go up, even as the cost of medicine goes down. Since anti-retroviral drugs are effective at prolonging the lives of HIV/AIDS victims, those patients now require life long treatment (in crude terms, once a patient dies, they no longer cost anything -and patients are now living longer.) New HIV infections continues to outpace the number of people receiving treatment.  And, a portion of those on first-line drugs, for which dramatic price reductions have been attained, will require more costly, second-line therapies as their disease progresses.

The US conducts at least 50% of health research worldwide. While our health care system is admittedly less than perfect, we continue to hold the number one spot in technological innovation and the generation of new knowledge.