NBC: We're unhealthier than everyone else – and it's our own fault

[JMS]

I'm struck by the fact that nothing you posted actually says anything about access to the system.

I'm rather dumb struck by your suggesting access to the services for inner city poor aren't an issue... given one of the articles I gave compared 4 different cities; 3 with universal coverage systems of different types against our for profit system and explicitly stated income and infant mortality rate was strongly in our city?.

Is it your contention only our poor are too dumb to seek out a doctor? Or is it your contention that barriers to services are not an inherent property of our system?

Is it really a failure of our healthcare system if infants die because people have babies they don't intend to have?

I would argue in a country where people have a choice to have children or not, none of the mothers are going through pregnancies with the intention of killing their babies.
And thus all the deaths of babies are a failure of some sort or another. The fact those failures break down along socio economic grounds and inner city demographics reflect a societal failure
rather than an individual failure. A societal failure because the deaths have less to do with the individual but are predictable due to their location and income.

My wife and I never recieved any family planning input from our private insurance..

I wouldn't say family planning is the issue.. I did say prenatal care as well as infant care are the issues. You didn't select a doctor before your child arrived? You didn't visit your doctor regularly throughout the pregnancy? Your wife just woke up one day and went to the Hospital?

Typically folks expecting a baby will select their doctor and have a first visit with 8-12 weeks from conception. In this meeting:
medical history that is taken; questions about your health, your medical history, menstrual history, lifestyle, and your family's medical history. are discussed.
People often want to discuss nutrition, sexual relations, exercise, what limitations they have. Doctors also will give out direct telephone numbers so if any questions come up during the process you can call them up to discuss it. In addition to this the following exams are typically given..

• Pelvic Exam (Pap Smear, bimanual exam, GC)
• Blood Work (Rubella titer, Hematocrit/Hemoglobin, HIV/AIDS)
• Blood pressure
• Urine Screen
• Weight
• Breast Exam

some of these done at every visit (blood pressure, urine screen, weight, and later they will add a fundal height check and listening for the baby heartbeat (About 12 weeks is average to hear the heartbeat with a Doppler.)

After the initial visit... Doctor appointments for most women fall along the following lines.

• Every 4 weeks until 28 weeks of pregnancy
• Every 2 weeks until 36 weeks of pregnancy
• Every week until 41 weeks
• Every few days until you give birth

So in all many women will see a doctor they selected personally as many as 21 times before they give birth and have thousands of dollars worth of tests and hours of consultations. Most all of this is paid for by private insurance.

[PeterMP]

I would argue in a country where people have a choice to have children or not, none of the mothers are going through pregnancies with the intention of killing their babies.
And thus all the deaths of babies are a failure of some sort or another. The fact those failures break down along socio economic grounds and inner city demographics reflect a societal failure
rather than an individual failure. A societal failure because the deaths have less to do with the individual but are predictable due to their location and income.



Family planning isn't the issue.

JMS it was a quote DIRECTLY from the study YOU posted.

I'm accessing it freely from home w/o logging onto a library web pages so I KNOW you can read it yourself.

If you don't like what the things the study says, don't post it in an effort to support your position.

Typically folks expecting a baby will select their doctor and have a first visit with 8-12 weeks of conception. In this meeting:
medical history that is taken; questions about your health, your medical history, menstrual history, lifestyle, and your family's medical history. are discussed.
People often want to discuss nutrition, sexual relations, exercise, what limitations they have. Doctors also will give out direct telephone numbers so if any questions come up during the process you can call them up to discuss it. In addition to this the following exams are typically given..

Of the relevant things, which aren't covered by Medicare, Chip programs, and other programs designed to increase access to healthcare amongst the poor.

[JMS]

JMS it was a quote DIRECTLY from the study YOU posted.

I'm accessing it freely from home w/o logging onto a library web pages so I KNOW you can read it yourself.

If you don't like what the things the study says, don't post it in an effort to support your position.

You aren't reading the article you are clipping out of context sentences and drawing your own narrow conclusions. that's what I object too.


As for your continued vacuous assertion access to prenatal care isn't the driving issue for mortality crisis in low income urban communities...

Primary care, infant mortality, and low birth weight in the states of the USA

Conclusions: In US states, an increased supply of primary care practitioners—especially in areas with high levels of social disparities—is negatively associated with infant mortality and low birth weight.
http://www.ncbi.nlm.nih.gov/pmc/arti...v058p00374.pdf

Prenatal Care

A number of studies have indicated a relationship between the use of prenatal care services
and birth outcomes (2–16). Adequate use of prenatal care has been associated with improved
birth weights and the amelioration of the risk of preterm delivery (5,6,15). Inadequate use
of prenatal care has been associated with increased risks of low-birth-weight births, premature
births, neonatal mortality, infant mortality, and maternal mortality (1–4,9–11,13,14). Several
researchers have suggested that the beneficial effects of prenatal care are strongest among
socially disadvantaged women (7,8,12,16).

http://www.cdc.gov/reproductivehealt.../pdf/rhow8.pdf

Disparities in Infant Mortality and Effective, Equitable Care: Are Infants Suffering from Benign Neglect?

Quality care for infant mortality disparity elimination requires services that improve health status at both the individual and the population level. We examine disparity reduction due to effective care and ask the following question: Has clinical care ameliorated factors that make some populations more likely to have higher rates of infant mortality compared with other populations? Disparities in postneonatal mortality due to birth defects have emerged for non-Hispanic black and Hispanic infants.

http://www.annualreviews.org/doi/abs...-031811-124542

Improving access to early prenatal care is essential to promoting the health of New Jersey mothers, infants, and families. Early prenatal care is an important component for a healthy pregnancy because it offers the best opportunity for risk assessment, health education, and the management of pregnancyrelated complications and conditions.
http://www.state.nj.us/health/fhs/do...rce_report.pdf

---------- Post added January-11th-2013 at 12:22 PM ----------

Good stuff JMS and you're absolutely right. The profit part, combined with the lack of competition and the reality that every single one of us WILL be their customers. I have no problem with researchers, scientists, doctors, ect being compensated well, especially given the schooling required, but there should not be giant companies making so much money as a result of the work by those aforementioned parties. Our individual health is all we have in the end and if we continue to allow profit to be the primary goal of the system as a whole, instead of people's health we all lose, imo.

I agree I don't have a problem with compensating researchers, scientists, and doctors. The problem is with the for profit infrastructure which support these folks which is a hybrid of socialism and capitalism borrowing from my mind the worst of both to maximize profits, remove accountability and most importantly reduce the net benefit for consumers.

[Ludomaniac]

Thats what makes this country so damn great. I can drive anywhere i want, eat anything i want, do anything i want.

God bless America and buffets

[Koolblue13]

Thats what makes this country so damn great. I can drive anywhere i want, eat anything i want, do anything i want.

God bless America and buffets

I think this is the perfect post for this thread.

Thank You.

[PeterMP]

You aren't reading the article you are clipping out of context sentences and drawing your own narrow conclusions. that's what I object too.


As for your continued vacuous assertion access to prenatal care isn't the driving issue for mortality crisis in low income urban communities...

1. I read the whole thing. My biggest issue, which I also directly quoted was they didn't address the issue of access. While the other point wasn't a major point of the article, I thought it was interesting and was an indication that your over all conclusion wasn't necessary correct.

As for what you've else you've posted, I can't easily access the last from home so I won't read it. Of the other two, the second piece by the CDC seems the most relevant though they mostly focus on USAGE (not access). I did find this relevant when talking about use/access:

"Six barriers to care were significantly related to the Kessner Index: financial problems, transportation problems, time conflicts, ambivalent feelings about pregnancy, the belief that prenatal care is not important, and a lack of knowledge about prenatal care."

The transportation/time issues is why my mom goes to the homes, but I don't think we can blame that on the healthcare system. The financial problems should be aided by medicaid and why Chip programs have been started (the study is from 1990 so pre-dates the creation of chip programs), and I'm not sure that the ambivalent feelings about pregnancy or the belief that prenatal care are not important is an issue with our health care system. The last might be tied to primary physicians and regular visiting the doctor or it could be something else, which could then be related to the other study.

(And looking at the underlying study (link below) those issues aren't in order of importance. In order of importance they are financial issues, ambivalent feelings, transportation/belief that care not important (a tie as near as I can tell), lack of knowledge, and time is the least important.)

They also find that race is a factor when the control for everything else. I had to actually go and read the underlying study to see why (http://content.healthaffairs.org/con.../4/91.full.pdf). They don't know. They speculate it is because of issues with doctors in the area where the women live or an issue with doctors being less willing to take on non-white and in particular African American women as patients.

So what we see is that access of healthcare is tied to many things, including things like the feeling the mother has about the pregnancy, race, and yes costs was also an issue, but that was prior to creation of the chip programs so w/ the chip programs, it would potentially be less of an issue.

(Again, this is a study you posted. Don't get mad at me if you don't like what you posted actually says.)

[JMS]

(Again, this is a study you posted. Don't get mad at me if you don't like what you posted actually says.)

As I said I disagree that your quotes reflect the thrust of any of the articles I posted... but I'll bite.

To your mind, what Non US healthcare related issue explains the high mortality in minority children in poor American inner cities? Given the evidence that this is an American healthcare phenomena relative to others in the industrialized world as demonstrated by the National Institute of Health study posted.

Infant Mortality and Income in 4 World Cities: New York, London, Paris, and Tokyo

Conclusions. In stark contrast to Tokyo, Paris, and London, the association of income and infant mortality rate was strongly evident in Manhattan.

.......

First, after controlling for births, Manhattan was the only city with a statistically significant association (at the 5% level) between infant mortality rate and income (or deprivation) indicator in both periods. Second, the magnitude of the infant mortality rate gap was dramatically greater in Manhattan than in any of the other cities.

.........

what characteristics of high-infant-mortality, low-income neighborhoods, other than insufficient income, contribute to raising infant mortality? Are such neighborhoods characterized by inadequate provision of family planning, prenatal care, and other health care services leading to low levels of maternal health?

The New York Department of Health and Mental Hygiene (DHMH) recently introduced several new initiatives all of which suggest an affirmative answer to this question.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449857/

Only US poor people want to kill their babies? Aren't interested in getting care for their babies? Don't take care of themselves?

[Special K]

Regarding infant mortality rates, I know previous studies did not correct for varying gestational viability ages between different countries (eg. in the US, we have determined gestational age viability to be at 28 weeks, whereas other nations had gestational viability ages that occured further on in pregnancy, like 33-35 weeks). Therefore, those statistics were a bit skewed as obviously it is more likely that a baby born at 28 weeks is more likely to suffer morbidity and mortality than babies born later. Infant deaths at 28-33,34, or 35 weeks were counted in our statistics, but not their's, thereby inflating our numbers and making us look worse than we actually were.

Now, I'm not claiming that this is the case in studies conducted recently; to be honest I haven't really read through recent studies on infant mortality because I work in a different public health sector. I'm not saying these numbers are wrong, nor do they account for the significant difference in US infant mortality rate among various socioeconomic groups, I'm just curious if these studies are able to correct for the difference in our gestational viability age and other developed nations'...

I've making the point about us having more deaths from accidents and HIV to JMS for what is probably years now.

Looks like your efforts this time have been more fruitful...

people being murdered by guns add to mortality rates and hold down average life expectancy rates, but they don't contribute to the expense of our healthcare system..

Facepalm

[JMS]

people being murdered by guns add to mortality rates and hold down average life expectancy rates, but they don't contribute to the expense of our healthcare system..

Facepalm

What are you confused about?

The United States has 31,000 young men die violently in our inner cities annually, something which is unique to the United States. The fact that these guys are young skews our average life expectancy averages.. Thus low US average life expectancy is not a good metric to use for overall health or unhealthiness of our population and cannot be used to explain why our health care costs per capita are double, triple or in some cases 20 times what other industrialized countries endure for similar or even superior healthcare results per population.

More than 31,000 people a year in the United States die from gunshot wounds.1 Because
victims are disproportionately young, gun violence is one of the leading causes of premature
mortality in the U.S.

http://www.jhsph.edu/research/center...02512_CGPR.pdf

Stated another way.... 10 guys here... 10 guys in Italy... everybody is expected to live until say 80 years... If two guys here in the United States get shot at the age of 18, that brings down the average life expectancy of the American population to 68 but doesn't mean the US population is vastly less healthy than the folks in Italy... Nor does it explain why we pay $7,960 for every person while covering only 80% of our people (17.4% gdp) for healthcare... while Italy spends $3,137 per citizen, while covering all their people (9.5% gdp).
http://en.wikipedia.org/wiki/List_of...%29_per_capita

[PeterMP]

As I said I disagree that your quotes reflect the thrust of any of the articles I posted... but I'll bite.

To your mind, what Non US healthcare related issue explains the high mortality in minority children in poor inner cities? Given the evidence that this is an American healthcare phenomena relative to others in the industrialized world as demonstrated by the National Institute of Health study posted.

Only US poor people want to kill their babies? Aren't interested in getting care for their babies? Don't take care of themselves?

I don't know. I do know that the one study that you posted that actually addresses the issue said that financial issues were only one of the relevant issues in terms of accessing healthcare for expecting mothers, and that study was done before the Chip programs, which were at least attended to help address that issue for babies, kids, and expected mothers.

In addition, I know there are people that are eligible for government assistance that don't sign up for it:

http://aspe.hhs.gov/health/reports/2...akeup/ib.shtml

Are those people reporting that financial issues are why they don't access healthcare when that isn't really the problem?

The issues could be the ones that you listed, but also could include other environmental/societal factors. Maybe there is something in the enviroment in NYC as compared to those other cities.

There was recently something posted about lead in the US cities from leaded gasoline remaining in the environoment. How much were cars with leaded gasoline used in those cities?

Generally, I don't see the need to speculate.

[JMS]

I don't know.

You just disagree with the studies I posted but don't feel the need to suggest an alternative explanation?

I do know that the one study that you posted that actually addresses the issue said that financial issues were only one of the relevant issues in terms of accessing healthcare for expecting mothers, and that study was done before the Chip programs, which were at least attended to help address that issue for babies, kids, and expected mothers.

I posted 5 studies but lets just discuss the one...

The NIH Study from 2005. The one which said only in the United States was income a direct indicator of disproportionate infant mortality.

In addition, I know there are people that are eligible for government assistance that don't sign up for it:

So only American poor people don't take advantage of government assistance? That's your belief?

Are those people reporting that financial issues are why they don't access healthcare when that isn't really the problem?

No they are reporting a lack of access.. Add more doctors, put more money into it..

The issues could be the ones that you listed, but also could include other environmental/societal factors. Maybe there is something in the enviroment in NYC as compared to those other cities.

Except the problem in NY isn't an isolated one... It's the same across all US Inner cities.

Generally, I don't see the need to speculate.

I guess pete when I post a study which says.. Improving access to prenatal care would address infant mortality for poor inner city mothers, and you come back with
it's the "unleaded gasoline" not access to the care.... you are specualting.. and you are equating your speculation with my studies... at least 6 that I posted..

Improving access to early prenatal care is essential to promoting the health of New Jersey mothers, infants, and families. Early prenatal care is an important component for a healthy pregnancy because it offers the best opportunity for risk assessment, health education, and the management of pregnancyrelated complications and conditions.
http://www.state.nj.us/health/fhs/do...rce_report.pdf

[China]

100% cranberry juice isn't real.

What do you mean it isn't real? If you're referring to the 100% Juice Cranberry flavor that Ocean Spray sells, then you're correct it isn't 100% Cranberry juice, it is actually a blend of 4 juices. But you can get 100% cranberry juice from Trader Joe's that is just cranberry juice. It's very tart and not sweet and most people won't like it.



http://www.bloglander.com/juicing/tr...ranberry/2006/

[PeterMP]

You just disagree with the studies I posted but don't feel the need to suggest an alternative explanation?

I don't disagree with anything you've posted in terms of the studies.

I don't agree that the problem is neccessarily the ABILITY to access care and therefore directly related to are healthcare system in the manner you suggest. That there is a relationship between income is clear, but we subsidized lower income people to help them access health care and even have special programs that cater to them and lot's of thing besides the ability to have the money to go see a doctor are related to income.

Do they access it? At what rate? If they don't, why not?

How does that compare to what happens in other countries?

Nothing, you've posted has addressed those issues (except the one that was from 1990 and before the Chip programs that said they didn't for a number of issues, with financial being one of them (but that should have been helped with Chip), and it didn't mention any other countries.

From your most recent link:

"Efforts to improve access to early prenatal care must also focus on women before they become pregnant through the promotion of preconception care and family planning services. Essential to the health and wellbeing of all women is adequate preconception and interpregnancy care. (7) Nationally, about 60% of all pregnancies are unintended, mistimed or unwanted. (8) In New Jersey, this figure is about 32%. To address this reality, there is a need for reproductive education, with an emphasis on timely and adequate prenatal care, to ensure and optimize the health of women and children in New Jersey."

Again, are we going to say that people having unwanted children is a function of our health care system?

"Mothers with continuous FamilyCare coverage, meaning they had FamilyCare coverage both before and during the
pregnancy, had a first trimester prenatal care rate of 78%."

FamilyCare coverage is a state of NJ program (http://www.njfamilycare.org/).

That means that 22% of the people with PRE-EXISTING coverage from the state didn't get first trimester prenatal care.

"Mothers with Private Insurance, the largest group at an estimated 69,000 mothers per year, had the highest
rate of first trimester prenatal care at nearly 96%."

For people with private insurance that same number was 4%.

I'd be curious to know what the difference was between the people in terms of actually USING their coverage before they were pregnant (what percentage of the people with private insurance regularly go to the doctor vs. what percentage of people covered by something like NJ FamilyCare). That isn't in the link.

**EDIT**
Look JMS, I'm likely done in this thread. But part of what I do is look at data and figure it out what it means. I've been telling you here for years that you are over simplifying the differences between us and Europe and pointed to things like the number cases of AIDS and deaths by accidents and guns, and now we've got the National Academy of Sciences telling you the samething.

Here, you are potentailly STILL over simplifiying things by trying to claim the differences are based on the potential ability to access healthcare due to costs (not based on their actual usage or other issues). Your links are all talking about things that I don't think, and you don't seem to think, should really be directly related to the health care system- like basic family planning. Your links don't really address the differences between us in Europe with respect to the the potenial ability to access healthcares. I also think using doctors to deliver basic family education is not a good use of resources so I'd be against moving in that direction (i.e. it isn't something that should really be part of our healthcare system).

[Thiebear]

You can if it's the stupid who are opposing single payer.

• The stupid who believe what we currently have is free market.
• The stupid who believe the free market has anything to do with US healthcare.
• The stupid who believe inefficiency crushing the US consumer which go to private industry is better than crushing inefficiencies by the government they are irrationally afraid of.
• The stupid who believe our healthcare system is still the best in the world.
• The stupid who believe our healthcare system still functions.
• The stupid who believe the golden age of the United States was at the dawn of the industrial revolution(1880-1900), when 90% of the people lived below the poverty line, and 1 out of 11 industrial workers could expect to die on the job in any given year (steel industry).
• The stupid who believe the government can't do anything right, and thus spend every opportunity to ensure it doesn't.

This is about overeating and everything else: neither current healthcare, nor single payer will matter as long as seat belt extenders become normal.

[jnhay]

Yank serving sizes are so big

Went to one meal at Five Guys and asked for normal fries and got a huge batch in my bag

Mercy

Was nearly full from one normal batch of fries

If you were only nearly full, you're at least as bad as the average American. That's a lot of food.