Global Health and Wealth

Masters of InterpretationFujian Normal University

Dr. Janet Sio 邵婉瑜May 8, 2013

Sayings and Quotes about Health and Well-being

• “It is health that is real wealth”

• “Early to bed and early to rise makes a man healthy, wealthy, and wise.”

• “You are what you eat.”

• What is the connection between

Health and Wealth?

Goals

• Explore connections between the health and wealth of nations via a statistics tool called Gapminder

• Investigate the impact of economics on global health care systems

• Learn about universal health care and the global state of health care delivery

Populations of richer nations are healthier than populations of poorer nations

Historically, as people became richer, they also became healthier (Deaton, A. Health and Wealth of Nations 2007)

Within countries, richer people are healthier than poorer people (Deaton, A. Health and Wealth of Nations 2007)

Gapminder.orgStockholm Sweden

a modern “museum” on the internetpromoting sustainable global development and achievement of the United Nations Millennium

Development Goals

Questions

Health = Wealth?

OR

Wealth = Health?

Why is there such a strong relationship between the two?

Why should we care about it?

Health = Wealth?

Questions:

Wealth = Health?

OR

What place does this sound like?• Larger rooms, with modern technologies• More natural light and spectacular views of the city• A state-of-the-art therapy area on each floor for easy access• An in-ground therapy pool • Bright, open dining rooms and common areas for visiting and

recreational activities• A cafeteria • Auditorium• retail shops• Library• internet café• rooftop garden• labyrinth terrace

Therapeutic Indoor Pool

Pet Therapy

Music Therapy

Why do we care about this?

• Global inequality is larger when measuring• income and health vs income alone

• Poor of the world are poorer, sicker and die earlier

• Reinforces the obligation to do something

• Income can be ONE determinant of health. However, governance of health care delivery can also be an influential determinant of health. See: • USA vs Australia• Ghana vs South Africa

“Macro” vs “micro” level impact of income on life expectancy

Why do poor people die so young?

• Most of the deaths are from diseases we know how to cure or prevent (except HIV/AIDS and cancer)

• So it is not new science we need, but better methods of delivering existing knowledge

• What prevents this?

Low incomes OR poor organization/governance?

Top Ten Deadly Diseases of the Developing World

Disease % of deaths

1 Lower respiratory infections 11.3

2 Diarrhea 8.2

3 HIV/AIDS 7.8

4 Heart disease 6.1

5 Malaria 5.2

6 Stroke 4.9

7 Tuberculosis 4.3

8 Prematurity 3.2

9 Birth trauma 2.9

10 Neonatal infections 2.6

Information provided by the World Health Organization, 2008

Ten Leading Causes of Death in the US (2011) vs China (2010)

Rank Cause - US Cause - China1 Heart Disease Stroke

2 Lung cancer Heart disease

3 Stroke Chronic Lower Respiratory Disease

4 Chronic Lower Respiratory Disease

Road injury

5 Road Injury Lung cancer

6 Self Harm Liver cancer

7 Diabetes Stomach cancer

8 Liver disease (cirrhosis) Self harm

9 Alzheimer’s disease Lower respiratory infections

10 Colon cancer Esophageal cancer

Sources: Global Burden of Disease Study, USA and China Profiles, 2010 www.healthmetricsandevaluation.org/

New Drugs 2012, FDA Approved

• 45 new medications approved • 14 for cancer and cancer related illness• 4 for cardiac or weight loss• 4 new vaccines (for illnesses like the flu)• 1st new tuberculosis medication in 40 years• 1 drug for HIV

“Show me the money”

Jellen, J (Ed). Pharmacist’s Letter, 2012

Global Healthcare Issues…Universal Health Care

• 1 BILLION people lack access to health care….

• All residents of a geographic/political entity have equal access to needed health services - prevention, promotion, treatment and rehabilitation - without the risk of financial hardship associated with accessing services

--WHO Health Report 2010--

Global Health Care Systems Definitions

• Universal healthcare/”socialized medicine” = basic health insurance provided to all

• Public sector = government supported/provided

• Private sector = for-profit businesses

• Single Payer = payment for healthcare costs comes from 1 source (usually the government)

• Out-of-pocket = payment must come directly from the patient

Universal Health CareAustraliaAustriaBelgiumBahrainBruneiCanadaCyprusCubaDenmarkFinlandFranceGermanyGreece(Hong Kong)IcelandIrelandIsrael

ArgentinaBrazilChileChinaColombiaCosta RicaEthiopiaGeorgiaGhanaGuatemalaIndiaIndonesiaJamaica

KenyaKyrgyz RepublicMexicoNigeriaPeruPhilippinesThailandTunisiaTurkeyVietnam(USA)

Sources: WHO Health Report 2008The World Bank Group, Feb 14, 2013 Press Release

ItalyJapanKuwaitLuxembourgNetherlandsNew ZealandNorwayPortugalSingaporeSloveniaSouth KoreaSpainSwedenSwitzerlandUnited KingdomUnited Arab Emirates

In Progress

Universal Health Care: Support• Health care is a right/entitlement.

• Ensuring the health of all citizens benefits a nation economically.

• Health care increasingly unaffordable for businesses and individuals.

• Reduces wastefulness and inefficiencies in the delivery of health care.

Universal Health Care:Support

• Reduces the severity of epidemics by reducing the number of disease carriers

• Aligns incentives for investment in long term health care productivity, preventive care, and better management of chronic conditions

• A centralized national database makes diagnosis and treatment easier for doctors.

• Medical professionals can concentrate on treating patients rather than on administrative duties

• Profit motive adversely affects the cost and quality of health care.

Universal Health Care: Opposition

• Increased waiting times

• Poorer quality of care, as opposed to private healthcare

• Unequal access and health disparities still exist

• Government agencies are less efficient due to bureaucracy

• Must be funded with higher taxes/spending cuts in other areas.

The US Health Care System• The US spends more on health care per capita (per person)

than any other country;

• The US spends more on health care as a percentage of GDP (Gross Domestic Product) than any other country in the world (> 15%; in contrast, Britain and Canada both spend about 10%)

• US life expectancy (78.5 years) is below that of most developed nations (Canada is 80.8, China is 73.3 years)

• The US is one of the few industrialized countries that does not guarantee access to health care

The US Health Care System

• Healthcare facilities (hospitals, clinics) – mostly private sector businesses, some government

• Health insurance – many people have some combination or mixture of private and public insurance

• Health insurance is provided by employers (the company you work for), the government, or yourself (private insurance)

Government programs directly cover about 30% of the population:

Low-income children and the Veterans Administration (for military and their families) don’t see the bill.

The government provides funds for their bill through general taxes

US Health Insurance

US Health Insurance

• 59% of Americans receive health insurance through their employer (private and public sector), which buys group insurance from a private insurance company which pays bills

• Employees and employers usually contribute to health insurance payments through their salaries, and often have family coverage (

US Health InsuranceThe largest government insurance programs are:

(1)Medicare

covers people over 65 years old and the disabled;

(2) Medicaid

covers low-income people

Everyone pays for an insurance plan run by the government through taxes.

Doctors and hospitals paid through a set fee schedule.

US Health Insurance

About 50 million Americans (~16%) are uninsured

US Health Insurance

• Few Americans (<10%) buy individual health insurance

• Applying for individual health insurance is difficult if you already have an existing disease (like diabetes)

• Even with insurance, when people require medical care, they may have to pay up-front a part of the cost (deductible

• )