The LA Times on comparisons of American and Canadian Healthcare

[cryofan]

This is vitally important that we increase awareness of what this article is saying:


An impressive array of data shows that Canadians live longer, healthier lives than we do. What's more, they pay roughly half as much per capita as we do ($2,163 versus $4,887 in 2001) for the privilege.

Exactly why Canadians fare better is the subject of considerable academic debate. Some policy experts say it's Canada's single-payer, universal health coverage system. Some think it's because our neighbors to the north use fewer illegal drugs and shoot each other less often with guns (though they smoke and drink with gusto, albeit somewhat less than Americans).

Still others think Canadians are healthier because their medical system is tilted more toward primary care doctors and less toward specialists. And some believe it's something more fundamental: a smaller gap between rich and poor.

....

"There isn't a single measure in which the U.S. excels in the health arena," says Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle. "We spend half of the world's healthcare bill and we are less healthy than all the other rich countries." "Fifty-five years ago, we were one of the healthiest countries in the world," Bezruchka continues. "What changed? We have increased the gap between rich and poor. Nothing determines the health of a population than the gap between rich and poor."


http://www.latimes.com/features/health/la-he-canada23feb23,1,6443349.column?coll=la-headlines-health


Spead the word!

[indepat]

1. And Republicans since Reagan have done everything in their power

to hold down wages and benefits and to much further the concentration of wealth among a relatively few: this is the essence of their being, but tens of millions of Americans are bamboozled into supporting and voting for them because of gun, abortion, religious, or other issues not germane to governance.

[FlaGranny]

2. A kick to stay one page 1

a tiny bit longer.
:kick:

[IrateCitizen]

3. There may be an interesting corollary here...

"Fifty-five years ago, we were one of the healthiest countries in the world," Bezruchka continues. "What changed? We have increased the gap between rich and poor. Nothing determines the health of a population than the gap between rich and poor."

I have read from several sources that the greatest determiner of the general "happiness" of a society is not simply how much people have, but rather how much people have RELATIVE to one another.

IOW, a society such as the United States in which a minority holds a significant amount of wealth and the majority see their living standards declining is not a happy society. OTOH, the social democratic policies of most Western European nations tends to produce a much happier populace -- in spite of the fact that it is more difficult to get "rich", but rather that the overwhelming majority of people don't have to worry about the kitchen-table issues that weigh on the minds of increasing numbers of American families.

Could it be that this general unhappiness and feeling of unease actually helps contribute to physical illness? For quite some time it has been theorized in medical circles that perhaps the mind plays more of a role in physical well-being than almost any external force.

[cryofan]

7. yes: there may even be biochemistry that helps or hurts us based on...

....our perceived social status and other social environment factors. This may explain why EU citizens live longer and seem happier.

I read one article not too long ago and how in many EU countries, a fancy expensive car will be vandalized on the streets, and sometimes a message left on the car, saying to the effect, "Who do you think you are...", etc. Now, we Americans would look down on that, but THEY LIVE LONGER AND ENJOY THEIR LIVES MORE. There are many things about the human mind and body that we do not yet come close to understanding.

[iverglas]

9. income disparity

It does indeed seem to be a determinant of lots of things that go into "general happiness".

A comparative study of homicide in Canada and the US has found that higher income inequality is one of the factors that correlates most closely with higher rates of homicide:
http://www.science.mcmaster.ca/Psychology/dalywilson/iiahr2001.pdf
a review of
Daly, Wilson, & Vasdev, Income inequality and homicide rates in Canada and the United States, Canadian Journal of Criminology, April 2001: 219-236
http://www.ccja-acjp.ca/en/cjc43a2.html

Previous research showing that income inequality (assessed by the Gini index) is a predictor, and hence a possible determinant, of homicide rates, whether at the cross-national, state or city level, has been inconclusive because of a negative relationship between economic inequity and average income. Comparison across the Canadian provinces provides a test case in which average income and the Gini are instead positively correlated, and we find that the positive relationship between the Gini and the homicide rate is undiminished. Temporal change in the Gini is also shown to be a significant predictor of temporal change in provincial homicide rates. When Canadian provinces and U.S. states are considered together, local levels of income inequality appear to be sufficient to account for the two countries' radically different national homicide rates.

(Of course, higher income equality also tends to correlate closely with stricter firearms controls ... .)

Could it be that this general unhappiness and feeling of unease actually helps contribute to physical illness? For quite some time it has been theorized in medical circles that perhaps the mind plays more of a role in physical well-being than almost any external force.

I suspect it's less ethereal than that. (And remember, a recent study found that "positive attitude" had no positive, and possibly a negative, effect on cancer patients' outcomes.)

Where income disparities are greatest, generally the rich just aren't richer, the poor really are poorer. It can be hard to separate the effects of poverty from the effects of income disparity. And poverty is about the best predictor of ill health and shortened life expectancy that there is.

But income disparity does seem to be more closely correlated with numerous outcomes than levels of poverty itself. It's a funny thing -- it's an excellent predictor, but it's really hard to explain what the cause-and-effect relationship might be!

This is just a bit of a kick, too, because that L.A. Times article is really worth reading.

.

[ArkDem]

4. All the people that can afford it are now going to

Canada when they have health problems.

[cryofan]

8. Yes, I have my mother's birth certificate (born in Canada)

I should be able to get Canadian citizenship because she was born in Canada.
But you need to be living in Canada 6 months before you can get care.

[Killarney]

5. Great article!

[Kanary]

6. I'm guessing it's a combination of those reasons

And probably mostly the health care system being available to all, plus the smaller gap between rich and poor.

What we have is shameful.

Kanary

[camero]

10. The big difference

In the EU, people say, "Who do you think you are?". In America, people say, "Do you know who I am?". Very telling of the differences in the societies.

[Bandit]

11. "There isn't a single measure in which the U.S. excels in the health arena

This is the one that says it all. It doesn't matter what the reason or reasons are. I'm sure it is a multitude of reasons but the key here is everything the right-wing has been saying for years is false.

[loyalsister]

21. Not exactly true

We DO have the best technology in the world. That makes the whole thing even more obscene.

[iverglas]

31. and interestingly

We DO have the best technology in the world. That makes the whole thing even more obscene.

That is the factor on which the right wing in Canada (known as the Fraser Institute -- think "Heritage Foundation) judges Canadian health care to be worse than in the US. In a recent paper, it used three indicators (a whole three!), two of which involved access to technology, as its basis of comparison.

As far as I know, Fraser didn't include a consideration of access to technology by the 1 in 7 USAmerians without health care coverage in its calculations ...

.

[Columbia]

12. Although it'd be nice to pay less to get more

A less spurious reason for Americans health being poorer than Canadians is simply lifestyle - Americans just do not take care of themselves. Our obesity rate is 31% and Canadians are half that at 15% (http://www.oecd.org/dataoecd/20/2/16494895.pdf). Obesity is a high risk factor for hypertension, heart disease, and other health problems and is arguably the most significant factor affecting life expectancy.

[iverglas]

14. yes ... and ...

A less spurious reason for Americans health being poorer than Canadians is simply lifestyle - Americans just do not take care of themselves. Our obesity rate is 31% and Canadians are half that at 15%

Obesity is also a disease of the poor in North America, so there we have that chicken-and-egg thingy again. Higher levels of poverty / greater income inequality correlates positively with ill health. Yes indeed. Obesity is one aspect of/contributor to ill health.

Seems to me that this just amounts to arguing in a circle. "Obesity" is to a significant extent a proxy for "poverty". There are obviously many ways in which poverty contributes to negative health outcomes, and the propensity toward obesity in the poor is one of them.

Obesity is a high risk factor for hypertension, heart disease, and other health problems and is arguably the most significant factor affecting life expectancy.

And if the poor have regular access free of charge to primary health care, maybe they're more likely to have some guidance toward more healthful "lifestyles". (I'm calling the nutritional choices made by people with low disposable incomes, and subject to the most intense manipulation by suppliers of the doughnuts and french fries they consume, "lifestyle" choices, here, against my better judgment.)

Or at least detection of the problems that result, like hypertension and diabetes, and treatment.

A fer instance: my local "community health services" organization serves the largely low-income, largely immigrant population of my neighbourhood. My co-vivant is a patient there, I've stayed at the one in the neighbourhood where I used to live. (We go there by choice, as an alternative to going to a physician in private practice.) The clinic provides complete medical care, as well as a range of social services for clients and their families.

My co-vivant developed Type II diabetes three years ago -- Type II diabetes is increasingly common in the poor, being associated with obesity and high-sugar diets (he's more of a fluke case). The clinic offers him a family counselling program for that "lifestyle" stuff, consultations with a nutritionist and foot-care clinics, and every three months he has the battery of necessary tests and a check-up by his staff physician there, plus referrals to the appropriate specialists (ophthalmologist, audiologist, cardiologist) as needed for regular monitoring.

How many low-income people in the US have access to that kind of healthcare? How many, if they did, would "take care of" themselves better?

.

[Columbia]

15. I'm not arguing against healthcare

Only that the article linked to is not really comprehensive in covering factors directly related to its subject. Obesity transcends all income levels and is an epidemic that is a primary reason why our healthcare costs are so high (also end-of-life care). Preventive care is always more cost effective and preferred versus a reactive, urgent care model, but a lot of responsibility still falls on the individual to take care of themselves (through exercise and healthy dieting).

edit for grammar

[iverglas]

16. well ...

Preventive care is always more cost effective and preferred versus a reactive, urgent care model and a lot of that responsibility falls on the individual (through exercise and healthy dieting).

Then what's a girl to conclude?

That USAmericans are stupider and lazier than Canadians?

http://www.sciencedaily.com/releases/2004/01/040105071229.htm

Researcher Links Rising Tide Of Obesity To Food Prices

Obesity in the United States is in part an economic issue, according to a review paper on the relationship between poverty and obesity published in the January 2004 edition of the American Journal of Clinical Nutrition. The article suggests that the very low cost of energy-dense foods may be linked to rising obesity rates.

The paper is by Dr. Adam Drewnowski, director of the Center for Public Health Nutrition in the University of Washington School of Public Health and Community Medicine, and Dr. S.E. Specter, research nutrition scientist at the U.S. Department of Agriculture Human Nutrition Research Center in Davis, Calif. ...

http://www.sciencedaily.com/releases/2001/10/011023071814.htm

Unique UNC Study Confirms Suspected Worldwide Epidemic Of Childhood Obesity

"Chinese children from more affluent families were more likely to be obese, but in the United States, children from poorer families were at higher risk," Wang said.

http://www.bread.org/institute/obesity.html

In fact, hunger or the risk of hunger in the United States persists. More than one in 10 households experience food insecurity. In 2001 a total of 33 million Americans - including 13 million children - were not always sure when or where they would get their next meal. In most cases, parents skip meals so their children have enough to eat. And many families scrape by with enough to avoid real hunger, but still lack the money to buy the healthy, nutritious foods needed for a balanced diet.

Because people associate the state of hunger or food insecurity with eating too little and being overweight and obese with eating too much, most people see hunger and obesity as mutually exclusive. But in the United States, where most people's experience with hunger or food insecurity is sporadic or episodic (as opposed to continuous or chronic), hunger and obesity can and do coexist.

... Recent work from Cornell University and the University of California at Davis suggest that obesity among poor women may be linked to their habit of periodically going without food so that their children can eat.

... Others factors also increase poor people's risk of obesity. Many low-income Americans more likely are consuming foods low in nutritional quality and high in calories, fats and sugars because these are the cheapest foods. Healthier foods such as meat, fish, fresh fruits, vegetables and whole grains often are more expensive in low-income neighborhoods than alternative junk food. Cash-strapped families increasingly rely on fast food chains, which promote "value" meals, such as oversized burgers, extra-large servings of fries and buckets of soda.

Moreover, poor neighborhoods often lack large grocery stores that typically offer the lowest prices and greatest range of brands, package sizes and quality choices, and farmers markets that sell locally grown fresh fruits and vegetables. Transportation to these large grocery stores and farmers markets also may be unavailable or expensive. Consequently, many mothers in low-income neighborhoods depend on their corner convenience stores - stocked with mostly high-cost processed, pre-packaged foods - to feed their families. Exacerbating this problem, poor families, especially those living in urban areas, often do not have safe areas for physical activity: Burning calories or exercising is half of the weight control solution.

And those are just from the first half-page of Google's results from a search for poverty obesity "united states".

Maybe it's just the poor who are lazy and stupid ...

.

[Columbia]

17. What are you arguing here?

I'd say it is indeed more cultural than anything else. Socioeconomic status does plays a role as it does in everything. However, obesity still transcends race, class, and gender and combating it will need to focus on all groups and not just the poor.

[camero]

18. That you're blaming the victim

I've been to both places and the Canadians that I saw have about the same lifestyle as those here in the US.

One it's colder, so people tend to stay indoors in the winter meaning less exercize. Two, the smoking rates are about the same.

The difference is the levels of poverty and the fact that there is better care up north. There is also more regulation as it pertains to food safety. A point which noone has brought up yet.

The food tastes alot different up there and I'm willing to bet that their food is not as processed as the food here is.

[Columbia]

19. Pulling that card eh?

"I've been to both places and the Canadians that I saw have about the same lifestyle as those here in the US."

So have I and I disagree. More people in the US eat at fast food restaurants than make dinner at home and that trend is growing.

"The difference is the levels of poverty and the fact that there is better care up north."

I never said poverty was not a factor in obesity, but to say that and universal health care are the ONLY factors is spurious at best. The poor may have slightly higher rates of obesity, but that does not hide the fact obesity is prevalent in Americans as A WHOLE as well.

I'm all for reducing poverty too, but why do people jump down my throat just for pointing out deficiencies in an article. Geez, I thought we're all on the same team here.

[camero]

20. What card?

It's been going on for so long that you don't even see what you're doing. Iverglas raised good points. You never said poverty never played a factor in Obesity but your post sure implies it.

And how about the issue of regulation of the food supply? Do you discount that also?

[Columbia]

22. Look again

"You never said poverty never played a factor in Obesity but your post sure implies it."

I wrote this, "Socioeconomic status does plays a role as it does in everything" which I think is quite clear in accounting it as a factor.

"And how about the issue of regulation of the food supply? Do you discount that also?"

I'm not sure what you mean by this, do you mind going into further detail?

[camero]

23. That food is safer in Canada

With more regulation. I don't know where you went up there but I'm sure it wasn't the real world.

When you're ready to question what the big boys are doing to us, you're arguments of individual responsibility may resonate more.

[Columbia]

24. Got a credibility link?

[camero]

26. ah, strawman

ask a question to a question. oldest trick in the book.

[Columbia]

27. Uh no.

More like asking for supporting documentation... :eyes:

[iverglas]

30. and the fact is

I never said poverty was not a factor in obesity, but to say that and universal health care are the ONLY factors is spurious at best.

... that NOBODY said any such thing.

You raised obesity/lifestyle as a contributing factor. The question then arises: what causes the difference between USAmericans and Canadians on that front?

The entire point of the article that started the thread was that there is a complex web of factors that contribute to USAmericans' poor health as compared to the health of comparable societies. Neither the article nor anyone here attempted to attribute the differences to any one factor. And I would assume, myself, that a wide range of possible contributing factors was examined by the people whose ideas were discussed, and I'd be very surprised to learn that they ignored the phenomenon of obesity.

My point was that obesity is at least in part a proxy for poverty. (That is, it is at least in part an effect of poverty, and it is poverty that is the causal factor in ill health where obesity results from poverty.) It is also arguably, in part, a proxy for lack of access to primary health care, since people with access to such care will have access to information and advice about the causes of their obesity. Similarly, deaths from hypertension and heart disease, and negative health outcomes associated with diabetes, are *also*, in part, proxies for poverty, since they are diseases of the obese and the poor are less likely to have access to treatment (or, again, to the information and counselling that would assist in preventive action).

I'm all for reducing poverty too, but why do people jump down my throat just for pointing out deficiencies in an article. Geez, I thought we're all on the same team here.

I didn't see you pointing out any deficiencies in the article, I saw you talking about something that is arguably more an effect of poverty and lack of access to health care than a cause of ill health.

Me, I've learned not to assume that we're all on the same team here.

.

[Columbia]

33. One more time.

Actually, Camero did say that.

And my point is that obesity is much more pervasive in all Americans than can be easily allocated as an effect of poverty. Sure, it plays a role, but that doesn't mean everyone else doesn't also have unacceptably high levels of it as well.

"I saw you talking about something that is arguably more an effect of poverty and lack of access to health care than a cause of ill health."

Not a cause of ill health? I think you're reaching here to find an explanation that supports your political views.

[burrowowl]

29. Many don't have or take the time

to cook decent food.
Processed food is deadly and a small example of how the Fla. sugar industry is kept up is that sugar is used as a perservative in such things as canned spinach, beans, etc. Sugar is not needed to preserve canned goods.
Excess salt, I had a can of Cambell's soup upon returning from France and it was so salty it burned my mouth.
Ham here is water ham sugar and 38 or so other ingrediants, just adding water to ham in Europe, it is considered adulterated, let alone all the other junk.

[iverglas]

32. and may I point out

what you said:

A less spurious reason for Americans health being poorer than Canadians is simply lifestyle ...

-- clearly implying that you regard the contributing factors cited in the article as "spurious" reasons.

I would assume that you are a bit of an amateur in the field of public health, hm? It does seem a bit presumptuous for an amateur to be substituting his/her "opinion" for the very considered and learnèd opinions of the professionals who have actually studied the matter professionally.

When I see things like that, I always wonder about agendas.

How would you try to solve the problem of obesity? -- assuming that you believe that poor public health is a problem that should be addressed, and based on your identification of obesity as a cause of it.

Jerry Springer's audience would blame the victims. Fat people are lazy and stupid and the authors of their own misfortune, and so nobody has any responsibility to try to solve that problem at all?

.

[Columbia]

34. I do regard those factors as spurious

From the article:

"Exactly why Canadians fare better is the subject of considerable academic debate. Some policy experts say it's Canada's single-payer, universal health coverage system. Some think it's because our neighbors to the north use fewer illegal drugs and shoot each other less often with guns (though they smoke and drink with gusto, albeit somewhat less than Americans).

Still others think Canadians are healthier because their medical system is tilted more toward primary care doctors and less toward specialists. And some believe it's something more fundamental: a smaller gap between rich and poor.

Perhaps it's all of the above. But there's no arguing the basics."

These are the reasons "experts" give for Canadians living two years longer. All of these supposed explanations have an agenda behind them and I'm sure the LA Times does as well. They say there is no arguing the basics, but they don't even cover the basics at all!

All I'm saying is that those factors are minimal when compared to the culture of fast-food and overeating and a sedentary lifestyle that Americans are prone to - all of which affects all Americans, not just the poor.

What's my solution? I don't know, maybe more education to people about the dangers of unhealthy living? Preventive care, like I mentioned before, would be nice too. However, it's not hard to know that eating Supersize Big Macs everyday and plopping down in front of the TV for hours at a time is not the best thing for your body. I still stand by my statement that it is ultimately up to the individual to be responsible for their health - it is their body and life after all.

[ninkasi]

13. Important article

Kick...lots of good ammo here to argue for universal health care here.

[Cleita]

25. It will never happen unless we have a health care revolution.

This is why we need to get rid of the facist right wing in our government so we can get health care like the Canadians do for everyone. Yet the very institutions who contribute to Bush and other Republicans are the ones who will prevent this from happening because they are the corporate health care and drug companies who make money from the misery of others.

I used to live on the Canadian border so we got a lot of Canadian tourists. They always complained about how expensive things were here and how their dollar didn't buy as much as the Canadian dollar, yet unlike the poor service workers, like myself, who worked in the resorts, they could afford vacations and toys like boats and RV's and they were so more obviously healthy and well taken care of.

This information has been out there for more than a decade so it's nothing new, yet our government has done everything it can to stifle these facts. Propaganda agencies have been hired to spread disinformation everytime a discussion about this begins. I'm waiting for them to start infiltrating this thread as I type.

[camero]

28. I think they already have

I've found some others to put on ignore. You're right Clieta. The problems with American Health Care to too many people are obviously the fault of the users of the health care system and not the acessibilty of the system.

I'm sorry. I'm just tired of arguing with these types. Time for a break I guess.