By Jody Heymann and Douglas Barthold, Special to CNN
Editor’s note: Dr. Jody Heymann is dean of the UCLA Fielding School of Public Health, an elected member of the Institute of Medicine, and Distinguished Professor of Epidemiology, Medicine and Public Policy at UCLA. Douglas Barthold is an economics doctoral candidate in economics, and a doctoral fellow at McGill University's Institute for Health and Social Policy. The views expressed are their own.
Worried about what your new mandated health insurance will cost next year? We should all be worried, but it has little to do with the Affordable Care Act. Over the past two decades, the United States has run near the top of the pack in a competition no country wants to win – spending the most while getting the least.
The American Journal of Public Health published the results of our study examining health systems of 27 high income countries over 17 years, and their efficiency at turning dollars into extended lives. The United States was near the bottom, ranking 22nd. Every hundred additional dollars spent in the United States was associated with a gain of less than half a month of life. In Germany, more than four months of increased life expectancy were associated with every additional hundred dollars spent.
Not everyone does equally poorly in the United States. Our new study has the U.S. ranking 18th when it comes to the efficiency of investments in reducing men’s deaths. Worse yet, when it comes to reducing women’s deaths, the U.S. ranks 25th.
By Tom Frieden, Special to CNN
Editor’s note: Dr. Tom Frieden is the director for the Center for Disease Control. The views expressed are his own.
Today’s interconnected world means we’re all linked by the air we breathe, the water we drink, the food we eat – and the antibiotics we use.
Global travel speeds the rate at which infectious disease threats can be delivered to our doorstep. We’ve seen antibiotic resistance travel the globe. Take Carbapenem-resistant Enterobacteriaceae or CRE. This really is a nightmare bacteria, resistant to most, and in some cases all, antibiotics. These microbes are especially deadly, and they can pass their resistance to other microbes through “jumping genes” or plasmids. One type of CRE was first seen in one U.S. state. Now it’s spread to 44. It’s also a recognized problem in other countries.
Right now, CRE are found primarily in hospitals. But if these microbes become more common in the community, then urinary tract infections, wounds and other common infections will be extremely difficult or even impossible to treat. It’s a terrible scenario – one that puts all of us at risk.
By Samba Sow, Special to CNN
Editor’s note: Samba Sow is director general of the Center for Vaccine Development in Mali, a collaborative enterprise between the Ministry of Health and the University of Maryland School of Medicine. He is also a professor of medicine at the University of Maryland School of Medicine. The views expressed are his own.
Power outages. Strikes. Security concerns. Equipment shortages. Rumors. These are the routine challenges of conducting scientific research in the developing world. And while researchers are used to working with these challenges, these difficulties are compounded when political instability is added to the equation.
In the past year, my colleagues at Center for Vaccine Development Mali and I have faced immeasurable challenges in keeping research efforts going while an insurgency threatened the capital city of Bamako, where our research center is located. We strive to train Malian health workers and scientists to conduct world-class research through clinical trials and other studies aimed at better designing life-saving interventions, such as new vaccines.
But leading our already complex research projects became even more difficult after the coup in March 2012. A curfew mandated that all activity occur between the hours of 6:00 a.m. and 6:00 p.m. Looting forced petrol stations to close, limiting car travel and transport of supplies. Sporadic gunfire kept most Malians indoors. My family was outside the country when the conflict began, and could not return home, nor could I visit them. Each day brought uncertainty and new dangers, and it was difficult to secure even the most basic supplies, such as kerosene.
By Russell J. Andrews, Special to CNN
Editor’s note: Russell J. Andrews is a neurosurgeon who has been a U.S. Army flight surgeon, a clinician and researcher in both academia and private practice and a medical device developer with NASA. He is the author of ‘Too Big to Succeed: Profiteering in American Medicine.’ The views expressed are his own.
Medicine is big business in America. Nearly one fifth of our GDP is spent on health care – 50 percent more than any other developed country. Yet by many measures we are not getting value for money. Even nearby Cuba, which spends less than one-tenth as much as the U.S. per capita on health care, has outcomes that are as good or better: life expectancy is just as long, and the infant mortality rate is actually lower. Health care in the U.S. is on an unsustainable course, and costs cannot continue to increase while outcomes continue to deteriorate.
This crisis has been blamed on greedy malpractice lawyers, drug companies, health care insurance companies and doctors who over treat patients by practicing defensive or wasteful medicine – unnecessary tests are ordered and unneeded operations are performed. And there is something to all of these. Doctors have failed to address this health care crisis, so other groups offer solutions – notably economists and political commentators. Not surprisingly these proposals represent the expected economic or political views, namely: “Which reform will rein in burgeoning health care costs?” and “Which reform will be politically acceptable?”
By William A. Haseltine, Special to CNN
Editor’s note: William A. Haseltine is president of ACCESS Health International, a non-profit that aims to improve access to health care worldwide, and the author of ‘Affordable Excellence: The Singapore Healthcare Story.’
The American health care system is failing. Despite spiraling costs compared with other highly developed nations, the outcomes or results we are getting for all of our expenditures often don’t compare favorably. We spend almost 18 percent of our gross domestic product on health care – an astounding amount of money translating to $2.8 trillion dollars per year. In contrast, Japan spends just over nine percent of GDP; France is below 12 percent; and the United Kingdom spends 9.5 percent.
Some argue that we pay more but get the best health care in the world. Unfortunately, that just is not true – we are most definitely not getting what we are paying for. A recent survey by the National Institutes of Health looked at health care outcomes in high-income countries around the world, and we simply did not measure up. We had the highest rates of mortality for newborns and for children less than five years of age. We had the shortest overall longevity rates, and the highest rates of death from lung and heart disease. There are many other comparisons I could cite, but the unavoidable conclusion is that our system simply does not deliver.
By Thomas J. Bollyky, Special to CNN
Editor’s note: Thomas J. Bollyky is senior fellow for global health, economics, and development at the Council on Foreign Relations and author of ‘Preventing Pharmageddon.’ You can follow him
@TomBollyky. The views expressed are his own.
“No intellectual property should stand in the way of you, the countries of the world, protecting your people. Do you agree or not?”
Margaret Chan, the director general of the World Health Organization (WHO), made international news when she departed from her prepared remarks to ask this question of the national health ministers gathered at last month’s World Health Assembly, the annual WHO meetings. Chan was referring to the contractual restrictions and patent application that some governments and scientists complain are undermining efforts to develop a vaccine against the Middle East respiratory syndrome coronavirus (MERS-CoV), a deadly new virus now emerging in Europe and the Middle East. Chan’s question, however, would apply with equal force to any number of the other controversies over intellectual property (IP) now raging in the global health community.
A long simmering fight over patented cancer medications in emerging markets is escalating. Last month, the Indian Supreme Court rattled the multinational drug industry by refusing to grant a patent application on Gleevec, a leukemia drug that costs $70,000 per year in the United States. Indonesia followed suit, issuing a compulsory license that enables local drug firms to produce low cost generic versions of a liver cancer-causing hepatitis B treatment. China and the Philippines amended their pharmaceutical patent laws, making it easier to issue such licenses. Brazil and South Africa are reportedly pursuing similar amendments.
By Mahshid Abir, Special to CNN
Editor’s note: Mahshid Abir, M.D., is an adjunct behavioral and social scientist at the nonprofit, nonpartisan RAND Corporation. The views expressed are the author’s own.
Last Monday, a massive tornado devastated Moore, Oklahoma, leveling or largely destroying hundreds of homes, businesses and two elementary schools. Plaza Towers Elementary School, where 75 students and faculty had taken shelter, was in the direct path of the tornado. Moore Medical Center lost an entire floor of its facility, requiring many of the injured, including children, some with severe injuries, to be taken to other area hospitals. At least 24 people were killed and hundreds more injured.
The tornado struck only days before the two-year anniversary of the deadly EF5 tornado that hit Joplin, Missouri, causing significant devastation and 155 fatalities. That twister lasted only minutes, but its toll on the mental health of Joplin’s residents lingered much longer. And the incident holds some important lessons for Moore and future disaster areas as they try to recover.
"Fareed Zakaria GPS," Sundays at 10 a.m. and 1 p.m. ET on CNN
Fareed speaks with Kenneth Cukier, data editor of The Economist, and Viktor Mayer-Schonberger, a professor at Oxford’s Internet Institute, about the applications of “big data.”
So, what’s the big story here? I mean, we’ve always had data. Why is big data a quantum leap?
Cukier: Well, first we have vastly more data than we ever had before. That’s new. But secondly, we have more data on things that we never had rendered into a data format before. It was always informational, but not data. So you can take where you are, a location, as one example. Words in books that are now digitized and also datafied, is another. When you think about social media platforms like Facebook, it “datafies” our friendships. LinkedIn datafies our professional contacts. And we can do new things with that.
You have an example about the flu that’s fascinating, how Google and big data allowed people to figure out where flus were breaking.
Mayer-Schonberger: Yes, indeed. Think back at the H1N1 flu crisis that we had. And the Center for Disease Control in Atlanta wanted to find out where the flu was. And they asked doctors to report every flu case. But, by the time they had collected all the information and tabulated it, two weeks went by. And that’s an eternity if you have a pandemic at hand. And Google, at that time, thought that they could do better just by looking at what people searched for online.
By Rebecca Schleifer and Darby Hickey, Special to CNN
Editor’s note: Rebecca Schleifer is the advocacy director for Human Rights Watch’s Health and Human Rights Program. Darby Hickey is a policy analyst with the Best Practices Policy Project, which promotes the human rights of people doing sex work. The views expressed are their own.
The Supreme Court is expected to rule next month in a case about whether the U.S. government can require organizations to denounce prostitution as a condition of funding for their international HIV/AIDS work.
As those on the ground who work in programs trying to stop the spread of HIV have reported, this “anti-prostitution pledge” makes it harder to reach out to sex workers, the very people whose cooperation is needed to make these efforts work.
Since 2003, U.S. law has required organizations receiving U.S. anti-AIDS funds to have a specific organization-wide policy “explicitly opposing prostitution.” This requires organizations to censor their speech on prostitution, or sex work, even when using their own private funds in separate programs. The government contends the pledge is a way to identify the best organizations to carry out HIV/AIDS work and that the provision does not violate free speech because groups can set up parallel organizations not bound by the pledge. The Alliance for Open Society International, which brought the Supreme Court case, says that the pledge not only violates its First Amendment rights but also undermines the very public health goals that the government is providing the money to achieve.
By Richard Pearshouse, Special to CNN
Editor’s note: Richard Pearshouse is a senior health and human rights researcher at Human Rights Watch and author of Toxic Tanneries: The Health Repercussions of Bangladesh’s Hazaribagh Leather. The views expressed are his own.
Last year, I spoke with a 40-year-old woman working in a Bangladesh leather tannery in the Hazaribagh neighborhood of Dhaka. The Hazaribagh tanneries, which export hundreds of millions of dollars in leather for luxury clothes, shoes and boots around the world, spew noxious pollutants into surrounding communities. They can also make their workers very ill.
Much tannery work involves measuring and mixing chemicals, adding chemicals to hides in drums, or hauling hides saturated in chemicals out of pits. Fungal infections, scabies, hives, and contact dermatitis are common. Others suffer from respiratory illnesses and chest pains.
Asked what she thought of the possibility that Hazaribagh’s tanneries might eventually move out of the city, the woman told me, “It would be very good…They could start garment factories. This would be cleaner work with a better salary.”
By Carter C. Price, Special to CNN
Editor’s note: Carter C. Price is a mathematician at the nonprofit, nonpartisan RAND Corporation. The views expressed are the writer’s own.
Over the past several months, Governors Chris Christie of New Jersey, Rick Scott of Florida, and John Kasich of Ohio – all Republicans – have announced support for the Affordable Care Act’s (ACA) Medicaid expansion. They join 22 other states and the District of Columbia in expanding the health insurance program for low-income Americans.
But more than a dozen of their counterparts in other states have decided against implementing the expansion, and the fight goes on in several states including Florida and Ohio where Scott and Kasich face hurdles in getting expansion through their state legislatures. Many have said these decisions are based on fears that expansion will cost states money in the longer-term. Yet, recent RAND research suggests that the economic arguments against state implementation may be questionable, especially for some lower-income states.
By Laurie Garrett, Special to CNN
Editor's note: Laurie Garrett is a Pulitzer prize-winning journalist and senior fellow for global health and the Council on Foreign Relations. The views expressed are her own.
This week, millions of Chinese visited family cemetery plots for the annual Tomb Sweeping Festival. They left or burned objects they thought their deceased ancestors could use in the afterlife, including chickens, pigeons and other food delicacies. Mao Zedong banned tomb sweeping because he thought it a decadent symbol of China’s Confucian past. But this year, China’s Communist Party had a different concern for tomb sweepers: Don’t handle live birds for your ancestors, or you just might be joining them in the afterlife.
It’s bird flu.
The emergence of the H7N9 avian influenza, mutated into a humanly infectious form, would be cause for concern even if it were a one-off event in a remote Chinese farm village. After all, this class of flu virus has never before infected, sickened or killed human beings – it’s a bona fide bird flu. But the disease drama now is unfolding in five large eastern China cities with a combined population of 48 million. This is a decidedly urban flu, its human victims identified to date span from ages 4 years to 87, and for most of the cases there is no obvious explanation for how they contracted their infections, or why their loved ones, co-workers and neighbors apparently did not.