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About Chrissy Donovan:

Chrissy Donovan is a guest contributor to the Healthy Travel Blog. She recently graduated from Carleton College in Northfield, Minnesota, where she majored in mathematics. While in school, she spent a semester studying in Budapest. Here, she learned firsthand some of the differences between American and Hungarian health care when she became alarmingly sick one day (but quickly recovered).

Urban Air Around the World: An Overview

Monday, April 5th, 2010 by Chrissy Donovan

If we apply the air quality standard for particulates adopted by the European Union (20 micrograms per cubic meter), urban air pollution is nearly ubiquitous around the world. Of course, air pollution levels vary widely. In some parts of the world, air pollution might go unnoticed.  In other places, people can be seen wearing face masks.  As travelers, we need to know what we are getting into.

We’ve been digging into data compiled by the World Health Organization for nearly 140 countries, looking specifically at particulate levels in cities with a population of at least 100,000. This widely used measure of air pollution—called PM10 — counts both unnatural and natural particles less than 10 micrograms in diameter. We’re talking about things that are suspended in the air (both liquids and solids) and are less than 1/7th of a strand of hair in diameter.

Why keep track of particles of this size?  The reason is that the smaller a particle is, the deeper it can settle in a person’s lungs.  And the deeper it gets, the more damage it can do.

And a lot of damage is being done.  Of the countries surveyed, only twelve met the EU air quality standard (see Table 1).  The U.S. tied for seventeenth with Denmark and South Africa with a relatively clean score of 24.  But in many countries around the world, the average urban particulate levels are two, three or four times higher.  We put together Table 2 to highlight some frequently visited countries whose levels are a multiple of the U.S. reading.  Short visits to urban areas of these countries could cause moderate to severe discomfort or a dangerous flare up of chronic respiratory problems.  Long-term stays or relocations portend serious health risks.

We’ll expand our discussion in the coming days. Have you had breathing distress in a destination? How did you manage?

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Know Your Destination: Environmental Performance Ranked Worldwide

Monday, March 15th, 2010 by Chrissy Donovan

Releasing a wealth of new data, researchers at Yale and Columbia have ranked 163 countries by their success in meeting ten different environmental goals.  Their report, The 2010 Environmental Performance Index,  is intended to aid policymakers evaluate how well countries are meeting the environmental goals set out in international agreements, but we think “ethical” world travelers would be interested in how some of their favorite destinations fared.  Once again, some of the outcomes are intriguing.  If you don’t know the difference between Mauritius (ranked #6) and Mauritania (ranked #161), you might want to follow along as HTB investigates the findings.

In order to generate the ranking, the researchers analyzed mounds of data and weighted each goal to arrive at a single value capturing each country’s progress.  At a high level, the researchers separated their findings into two categories: 1) Ecosystem Vitality and 2) Environmental Health–or, cutting through the jargon:  1) the quality of the country’s environment itself and 2) the health status of its citizens.  In constructing the ultimate ranking, researches assigned 50% of a country’s EPI score to Ecosystem Vitality and 50% to Environmental Health. 

It’s no surprise that in general a country’s EPI correlates with its economic standing.  Wealthier countries tend to have higher scores.  However, wealth is not the sole determinant of the score: Costa Rica outperforms most developed countries while the United States ranks 61st in spite of its tremendous wealth.

The EPI researchers found that many countries fall outside of their peer group.  They conclude that government policy, while not necessarily as powerful as economic, demographic and geographic factors, influences the EPI score to a significant degree.  To the extent that human will power is directed toward promoting a healthy environment, this is a hopeful message.

The EPI is arguably the most thorough study to date of environmental performance on an international scale.  HTB intends to mine the riches of EPI by digging into the details to produce more insights that we can share.    But don’t wait for us. See for yourself at http://epi.yale.edu.

Photo info: http://www.flickr.com/photos/christianhaugen/ / CC BY 2.0

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What’s Holding Back Happiness In Russia?

Monday, February 8th, 2010 by Chrissy Donovan

If you are a regular reader, you know we’ve been hunting for happiness. But sometimes on our travels, if we look closely, we gain insights into deeply rooted cultural sources of unhappiness.

We recently introduced our Healthy Planet Index, a ranking of 141 countries that is based on a measure called happy life years—a combination of life expectancy and satisfaction with life.   For instance, in Costa Rica, life expectancy in 2005 was 78.5 years and satisfaction with life (on a scale of 0 to 10) was 8.5; we used these figures to create a Happy Life index value of 66.7, which tops the Healthy Planet Index. 

As we reviewed the results, one country that caught our eye is Russia.  With 38.1 happy life years, Russia ranks 91st.  Russia is 75th when our 141 countries are ranked by happiness and 97th when they are ranked by life expectancy.  The question is, what problems are behind these low figures?         

The answers are numerous.  A substandard system of medical care, the prevalence of tuberculosis (a disease of poverty) and overindulgence in alcohol are some of the bigger pieces to the puzzle.  Let’s take a closer look at alcohol.  Everyone knows the stereotype that Russians are heavy drinkers.  We did some research to see how much truth is in this generalization.  First, we’ll give you the numbers.  According to the World Health Organization in 2003, 10.3 liters of pure alcohol were consumed by each Russian person over the age of 15.  10.3 liters of pure alcohol translates into 580 shots (1.5 oz. drinks) of 80 proof vodka (and yes, we chose vodka because we‘re talking about Russia).  That’s an average of 1.6 shots per day.  It should be said that 10.3 liters was not the highest figure for a country in 2003.  In Ireland, which was at the top of the list, the average was 13.6 liters.  Russia is not the only place where lots of alcohol is consumed.  On the other hand, the situation in Russia is said to be even worse than the official numbers portray because of the large black market for alcohol.           

There is more to the story than these raw numbers, and it’s something visitors to Russia should heed:  alcohol in Russia is often consumed more dangerously than in other countries.  History books, newspapers, Russian officials and ordinary Russians all say the same thing:  Russians tend to drink in binges.  And, of course, they tend to drink vodka, a highly distilled alcohol.  This is the Russian way of drinking.  And it is the kind of drinking that can kill in the span of a night.   Bootleg alcohol that has toxic ingredients is not an uncommon thing in Russia.   All of these circumstances add up to a high rate of death due to alcohol poisoning in Russia.        

That’s nothing to take lightly; however, it’s the smaller, more sensational side of the story.  Much of the self-destruction from over-drinking takes more time to show.  We’re talking about heart disease, alcoholism, cancer, violence, weakened immune systems, lost days of work, to name a few.  These ills are the larger villains.

The bottom line? Russia’s problems with alcohol are real, not just stereotypical.   Russia is certainly not the only country that faces a struggle with booze (hint hint Western world). But misery with company is still misery.

Photo info:  http://www.flickr.com/photos/atbaker/ / CC BY 2.0
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Introducing the Healthy Planet Index: Exploring What Produces Long Happy Lives

Friday, December 4th, 2009 by Chrissy Donovan

Here at HTB we’ve taken an interest in what we’re calling comparative healthcare with an eye toward what we can learn from lifestyles and cultures around the globe.  Now that the healthcare reform debate in Congress is reaching a crescendo, we think it’s a good time to ask this: “How do you measure the effectiveness of a healthcare system?”

We think there are two fundamental dimensions that should be considered.  While there is no doubt about the importance of physical health, “well-being” includes happiness too.  To gauge the strength of a healthcare system, we need to somehow measure both.  A population’s health can be gauged by life expectancy, but we have to look harder to find a measure of a population’s happiness.

For this reason, we literally took a page from The Happy Planet Index which respected economists have devised to measure and rank how efficiently (in terms of environmental impact) nations produce “the good life.”  This ranking relies on life expectancy figures and surveys of life satisfaction, as well as a country’s carbon footprint.  We focused on the first two numbers to isolate what they call “Happy Life Years” of the citizens in each country.  The result is a ranking of countries that emphasizes a basic human goal: long, happy years of life. The accompanying chart shows the results for 25 of the 141 countries we evaluated. (Happy life years are determined by multiplying life expectancy and satisfaction with life.)

There are some surprises: Costa Rica heads the list; the U.S. comes in 14th with Mexico not far behind. China and Egypt rank far ahead of Turkey and Russia.  But we were even more surprised when we tried to find variables that correlate with Happy Life Years.

A quick scan of the chart confirms our statistical analysis that there is very little correlation between Happy Life Years and the number of doctors per capita.  This finding calls to mind Voltaire’s maxim that the role of a doctor is “to amuse the patient while nature takes its course.”  Of course, the geographic distribution of doctors and medical technology (i.e., access to care, maybe the sheer size of the country) must play a very large role.

Likewise, government’s share of spending on healthcare exhibits almost no correlation with Happy Life Years.  Even when the dependent variable is reduced to life expectancy, the results still indicate that there is no relationship between how involved the government is and how healthy the people are.  Clearly there are no simple conclusions to be drawn and rationally applied to cool the heated discourse that is unfolding in Congress.

We did find something worth remembering when we looked at total healthcare spending per capita.  Here the relationship between Happy Life Years and how much is spent per person is not what one might expect.  There is a positive correlation with the Happy Life Years; however, the relationship is logarithmic, rather than linear.  This means that there are rapidly diminishing returns on spending.  Our analysis shows that spending $1,000 per person per year rather than $500 can have a huge effect, but spending $3,000 per person rather than $2,500 is not very meaningful.  This finding calls into question the benefits of increased spending — certainly at the levels the U.S. has attained ($6,714 per person).  Are these costs truly necessary?  If not, what are we paying for that is not as essential as we think?  

There is, of course, a moderate correlation with Gross Domestic Product (GDP), but that’s not the end of the story. We’ll continue to wrestle with this topic to gain more insight into how important variables such as environment (air and water quality) and culture (drinking, smoking, obesity, hunger, attitudes toward work, leisure, prison population, size of military force) affect a country’s score.    In the meantime, let’s consider how redistributing some healthcare spending might raise the planet’s health quotient.  As we’ve seen, $500 spent on the have-nots goes a long, long way.  For some, it’s a drop in the bucket, for others, it’s the whole kitchen sink.

HPI

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