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Inequality In Healthcare Services Linked To Low Life Expectancy

Healthcare inequality leading to low life expectancy

The inequality of health care services and programs may be the culprit in the life expectancy rate for Americans. This was revealed in the study made by The National Research Council and Institute of Medicine (NRC/IOM).  Studies show that Americans are the least healthy among its European counterparts – even as the government spends more on healthcare programs. Further, the mortality rate among Americans due to diseases, accidents or injuries are even becoming higher than those in other affluent countries.

Contributing factors like geographical location, county by county and the level of urbanization revealed a disparity in the delivery of healthcare services across the population. The study also  bared that US males and females in almost all age groups—up to age 75 years—have shorter life expectancies than their counterparts in 16 other  wealthy, developed nations, namely: Australia, Austria, Canada, Denmark,  Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom. (Source: National Research Council/Institute of Medicine Report by Steven H. Woolf, MD, MPH, Laudan Y. Aron, MA).

“US patients are more likely than patients elsewhere to report lapses in care quality and safety outside of hospitals”

Factors linked to the leading causes of death of most Americans are cancer, stroke, heart disease. Other trigger factors such as opioid and heroine overdose, smoking, drinking,  obesity, depression and suicide have also been cited as causes of deaths of white Americans, ages 30 to 55 years old.  However, in terms of occurrence and mortality rate for multiple diseases, other risk factors and injuries, the United States ranks at the lower rung or near the bottom. (Source: US Department of Health and Human Services. Healthy People 2020 Framework)

The same study also revealed that the United States “…lacks universal health insurance coverage, and its health system has a weaker foundation in primary care and greater barriers to access and affordable care. Care coordination also is a problem. In multiple surveys of patients with chronic illnesses in up to 11 countries, The Commonwealth Fund has shown that US patients are more likely than patients elsewhere to report lapses in care quality and safety outside of hospitals. US patients appear more likely to require emergency department visits or re-admissions  after hospital discharge, perhaps because of premature discharge or problems with ambulatory care than those in other countries. Confusion, poor coordination, and miscommunication between clinicians and patients are reported more often in the United States than in other countries”.

While undoubtedly an affluent nation, the United States has experienced serious economic downturn that bore adverse impact on its health care programs. This inequality in the delivery of health care was further aggravated by low income and a distressing rise on the poverty level of many American households.  Yes, health is determined by more than health care, according to the NRC/IOM panel after they have  explored the differences beyond health care to explain the US health disadvantage.

Linking the findings of the NRC/IOM panel to a study done by Currie and Schwandt, earlier analyses of county-level variation in longevity was expanded by examining mortality risk by age, in addition to life expectancy.  “There were substantial geographic inequalities in the risk of death in each age group considered; however, the trajectory of inequalities over time differed by age: absolute geographic inequalities in the risk of death declined over the study period for children and adolescents, and increased for adults, especially those aged 65 to 85 years. This is broadly consistent with the recent findings by Currie and Schwandt who analyzed age-specific mortality rates among counties grouped by income and ascertained that inequality among income groups decreased for children and adolescents but increased for older adults  from 1990 to 2010”.  (Source: Chetty  R, Stepner  M, Abraham  S,  et al.  The association between income and life expectancy in the United States, 2001-2014.  JAMA. 2016;315(16):1750-1766. doi:10.1001/jama.2016.4226PubMedArticle)

Low life expectancy in the US

From 1980 to 2014, life expectancy at birth for both sexes combined in the United States increased by 5.3 or about 95% in a matter of five years for men. For women it reaches up to 95%. Substantial variation counties in central Colorado, Alaska, and along both coasts experienced much larger increases, while some southern counties in states stretching from Oklahoma to West Virginia saw little, if any, improvement over this same period.  Between 1980 and 2014, life expectancy at birth increased. Although there is a distinct gap when it comes to mortality risks on the aspect of age,  the difference between the 1st and 99th among counties in the U.S. had declined by 42.9% (95% UI, 40.4%-45.1%) among children (ages 0 to 5 years),  18.9% (95% UI, 15.2%-22.7%) for adolescents (ages 5 to 25 years), and increase by 10.1% (95% UI, 6.4%-14.1%), 15.0% (95% UI, 11.6%-18.4%), and 48.2% (95% UI, 42.7%-53.7%) for age groups 25 to 45 years, 45 to 65 years, and 65 to 85 years, respectively. Relative inequality rose for all age groups, most likely due to the overall decrease in mortality risk over this period.

These divergent trends depicted an increase in geographic inequality in life expectancy over the past three decades having been driven largely by increases in geographic inequality in the risk of deaths among the elderly.

“Even non-Hispanic white adults or those with health insurance, a college education, high incomes, or healthy behaviors appear to be in worse health in the United States than in other high-income countries”

Now, why is it that the US health disadvantage is more pronounced among vulnerable populations and even among more privileged groups?  The NRC/IOM panel also found that although US adults are less likely to smoke or drink alcohol,  they have a greater propensity for other unhealthy behaviors.  “Even non-Hispanic white adults or those with health insurance, a college education, high incomes, or healthy behaviors appear to be in worse health (eg, higher infant mortality, higher rates of chronic diseases, lower life expectancy) in the United States than in other high-income countries”.

Americans are getting sicker and die younger than most people in other wealthy nations, according to the NRC/IOM Report. Which is why the panel recommends a robust outreach in its efforts to alert the public about the scope of the US health care services and programs that they can avail. Issuing a stern warning, the NRC/IOM committee reiterates that unless prompt action to implement proven strategies, such as those outlined in Healthy People 2020,  and the recommendations of the National Prevention Council, which target the conditions responsible for the US health disadvantage and inequality in the delivery of many health programs to will address various health issues – from infant mortality to injuries, obesity, and chronic diseases – the life expectancy and mortality of many Americans regardless of age, socio-economic condition may only worsen with time.

Hope springs eternal.  Institute for Research and Medicine (IRM), underscored that  awareness is key to the foreseeable decline in high mortality incidents that affect life expectancy.  The IRM study also pointed out that  vigilance and consistency in promoting awareness of  the government’s health care programs to  the American public steps up the prevention and early detection of potential medical concerns that may require appropriate medical treatment, and would thus yield better healthcare management and consistent monitoring to help ensure an improved quality of health. A consistent and efficient delivery of health care programs to American households traversing different cities, counties, from the rural and remotest areas to the highly urbane locales  will vastly improve life expectancy – lower mortality risks and enhance the quality of life, in the long run.

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