Alarming U. S. public health statistics raise big questions

In 1848, Rudolf Virchow, famous medical scientist and author of “Cellular Pathology,” studied a typhus epidemic in Upper Silesia. He discussed treatment but focused on prevention. “Such an epidemic dissemination of typhus could only have been possible under the wretched conditions of life that poverty and lack of culture had created,” he concluded, adding that “the outbreak could not be solved by treating individual patients with drugs or with [other] minor changes, but only through radical action to promote the advancement of an entire population.”

For Virchow, health care carried political overtones. “Politics is nothing more than medicine on a large scale,” he wrote. Right now, deteriorating U. S. public health may require Virchow-type thinking.

In 1960 combined male and female life expectancy in the United States ranked fifth in the world. In 2000 it had fallen to 24th place, and 10 years later, on September 23, 2010, to 49th.

A Columbia University team exploring this trend “found that unusually high medical spending is associated with worsening, rather than improving, 15-year survival in two groups,” men and women at age 45 and at age 65. They speculated that “the nature of our health care system – specifically, its reliance on unregulated fee-for-service and specialty care – may explain both the increased spending and the relative deterioration in survival that we observed.” They discounted effects of obesity, smoking, traffic deaths, homicides, and physical inactivity.

The maternal mortality ratio (MMR) is the number of pregnancy-related deaths per 100,000 babies born. The U.S. MMR for 1987 was 6.6, and for 2006, 13.3. Between 1998 and 2005, complications of pregnancy serious enough to almost cause death increased by 25 percent. In its recent report on U.S. maternal mortality, Amnesty International (AI) said, “Women in the USA have a greater lifetime risk of dying of pregnancy-related complications than women in 40 other countries.”

AI suggested that “women who are marginalized or living in poverty” are at particular risk for maternal death, or near death. Of women of reproductive age, 20 percent lack health insurance. Minority women make up over half of uninsured women. Georgia’s MMR in 2006 was 20.5, that of Washington, D.C., 34.9, and for black women in New York City the MMR was 83.6. The Centers for Disease Control (CDC) views half of all U.S. maternal deaths as preventable. AI identifies increased U.S. maternal mortality as a human rights issue.

U.S. Amnesty International head Larry Cox says, “Mothers die not because the United States can’t provide good care, but because it lacks the political will to make sure good care is available to all women.”

According to the National Center for Health Statistics, the U.S. infant mortality rate as of 2009 ranked 30th in the world. (The infant mortality rate represents the number of babies dying during their first year of life for every 1000 babies born.) The CDC put the rate for 2007 (the last year its data are available) at 6.5. The ranking again was 30th place, down from 12th place in 1960, 23rd in 1990, and 24th in 2004. Infant mortality reflects families’ education, income, nutrition and access to care, and is widely regarded as a marker of social well-being.

It’s recently been reported that, as of 2009, 21 percent of American children – one of four rural children – were growing up in poverty. That and pervasive unemployment contribute to a social context setting the stage for ill health. Italian journalist Gennaro Carotenuto took these reports of falling U.S. life expectancy and rising infant mortality rates as signs of “a country plunging rapidly downward” and the “decadence of an empire.” He noted other indicators such as high U.S. imprisonment rates, local government cutbacks on public schooling and paved roads, shrinking public transportation, and waning academic achievement.

Physician Virchow, however, would look into causes. Writing for, historian Higinio Polo does go deeper as he surveys a worldwide spectrum of social disintegration. Sickness, extreme poverty and hunger are rampant, yet rich countries are failing to back the UN Millennium Goals of social restoration, set for 2015. Even in “opulent Europe,” he notes, “80 million people [are] living in extreme poverty and social exclusion.” The problem comes down to “a capitalist system that fleeces the natural resources, destroys life, and condemns to poverty a good part of humanity.”

Photo: Rosser321 CC 2.0



W. T. Whitney Jr.
W. T. Whitney Jr.

W.T. Whitney Jr. grew up on a dairy farm in Vermont and now lives in rural Maine. He practiced and taught pediatrics for 35 years and long ago joined the Cuba solidarity movement, working with Let Cuba Live of Maine, Pastors for Peace, and the Venceremos Brigade. He writes on Latin America and health issues for the People's World.