Archive for the ‘Comparative Health Care’ Category

Important New Angle on Happiness Index: How Much Do We Suffer on Life’s Last Lap?

Friday, July 16th, 2010 by Mike Hartung

A recent post on the Wall Street Journal’s Health Blog by Katherine Hobson brought to light a fascinating new study on the Quality of Death around the world. The Singapore-based philanthropic Lien Foundation commissioned the Economist Intelligence Unit to study forty countries in depth to gauge how much suffering accompanies the final few months of life. Researchers interviewed doctors and experts on palliative care to help measure four sub-indices: 1) basic end-of-life healthcare environment; 2) availability of end-of-life care; 3) cost of end-of-life care and 4) quality of end-of-life care. The results and rankings are shown below.

Predictably, most of the richer nations scored relatively well. But the biggest findings do not seem to be driven so much by a nation’s GNP as by the “culture of curing” and the scarcity of painkilling drugs. The study notes that medical professionals are trained to implement curative rather than palliative strategies–so much so that of the 100 million people worldwide who could benefit from palliative care annually, only 8% receive it. Likewise, regulations to stop illicit use of opiates often make them unavailable for clinical use. The result is that availability of painkilling drugs is “woefully inadequate” all around the world. Taken together, the authors conclude, these issues cause an “incalculable surfeit of suffering” for patients and their loved ones.

Still, in relative terms, you are much better off in the U.K. and Australia than China, Brazil or India when your candle is burning low. Once we all admit that death is a part of life, we can begin to appreciate the importance of the availability of quality palliative care and unflinchingly incorporate quality of death into our happiness index.

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The World’s Blood Supply — How Safe Is It?

Thursday, June 17th, 2010 by Frank Gillingham, MD

While most were unaware of it, June 14th was “World Blood Donor Day”, celebrated internationally to encourage those eligible to donate blood at least once a year.  Indeed, although 95% of Americans either receive blood during their lifetime, or know someone who has, only about 8% of Americans currently donate blood.  The requirements are fairly simple: be 16 or older, weigh at least 110 pounds, and enjoy good health.  Apart from doing the right thing, donating blood includes free screening for infectious diseases such as HIV and hepatitis.

The need for “good” blood around the world is critical.  The World Health Organization (WHO) makes a strong statement on blood transfusion safety and places the responsibility for enforcing it on the health administrators around the globe to “galvanize entire communities towards regular and non-remunerated blood donations.”  Just yesterday, one of our clients in China inquired about the reliability of blood in that country.  In fact, some of the blood collected in China may still be contaminated with the HIV virus.  Over the past twenty years, hundreds of cases with dozens of deaths have been traced to blood collected from those in China willing to sell their blood.  Following a government ban on imported blood products in the mid 1980s, literally thousands of blood and plasma collection stations popped up in China offering remuneration for donors. 

These unregulated centers used an unusual method of collecting blood and then reinfusing donors with pooled red blood cells after the plasma had been removed.  The technique was practiced in order to speed recovery following donation but is thought to have infected hundreds of thousands of donors and those who received blood transfusions.  Although Chinese authorities have endeavored to ban this practice and close illegal blood donation stations, the problem has not gone away.  A report published in 2007 claimed that China’s blood supply is still not being properly monitored for HIV.  The demand for blood products is growing, and the supply is short which “creates an economic incentive for hospitals to rely on illegal, untested blood donations.”

China is not alone.  The World Health Organization estimates that 5 – 10% of all HIV infections in Africa occur as a result of unsafe blood transfusions.  In addition, countless thousands are infected with hepatitis and/or malaria due to the lack of proper screening.  The organization “Safe Blood for Africa” is attempting to correct the problem by encouraging voluntary blood donations from adequately screened applicants and discouraging facilities from using untested blood.

The United States, Canada, Japan, France and a host of other developed countries experienced similar problems with contaminated blood from for-profit centers in the late 1970s and early 1980s before adequate screening for HIV and hepatitis was available.  We can only hope that emerging countries learn quickly from the experience of others.  In the meantime, the international traveler must be aware that significant risks still exist from getting blood products in many parts of the world.

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Eyes Wide Shut? Know Your Destination’s Human Rights Record

Tuesday, June 15th, 2010 by Mike Hartung

We’ve linked tolerance with health in the past. Now the unexpected outburst of ethnic violence in the Kyrgyz Republic is a vivid reminder of how tenuous the grip we humans have on tolerance, dignity, survival and health. With the Kyrgyz atrocities as a backdrop, the U.S. State Department yesterday released its annual report on human trafficking around the world, highlighting especially those countries whose efforts fall far short of complying with the U.S. Trafficking Victims Protection Act of 2000. Of the 177 countries surveyed (including the U.S.), fifty six, or 32%, are on a watch list because recent progress toward compliance is deemed at risk. Another thirteen, or 7%, are making no compliance efforts whatsoever. The remaining 60% are either in compliance or moving steadily in that direction. See charts below for a listing of countries falling into these categories and see the State Department’s interactive map and the full report.

As our readers circle the globe, we hope they pause to understand their host countries’ human rights record. There are unpleasant realities in many destinations, and some surprises for me in the Caribbean, Central America and Asia. Even developed countries such as Russia, Singapore and Thailand are called out. We aren’t suggesting you should avoid travel to these countries. We are recommending that as your horizons expand they encompass a commitment to promoting tolerance and dignity. We will all be healthier for it.

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The Gender Gap Around the World: Implications for Health and Happiness?

Thursday, April 22nd, 2010 by Gina Pitcherella

One of our previous posts speculated that tolerance may be key to health and happiness based on a comparative study of states in the U.S.  That line of thinking prompted us to look for comparative data worldwide.  We came up with the Global Gender Gap Report, released in 2008 by the World Economic Forum, which rates countries on the disparity between men and women on four measures: economic opportunity, educational attainment, political empowerment and health and survival.  The report covers a total of 128 countries that represent 90% of the world’s population.

The smallest gap is “healthy life expectancy”, which takes into account years of health lost to violence, disease and malnutrition.  Across the 128 countries surveyed, women were expected to enjoy anywhere from 93% to 98% of the healthy years that men enjoy.  Compare these findings to the gaps that exist for economic opportunity (25-79%), educational attainment (47-100%) and political empowerment (0-53%).  Clearly health is a necessary but not sufficient condition for women to reach their potential.  Rolling these subindices together on an unweighted basis, we find Sweden, Norway, and Finland grabbing the top three spots worldwide (see our chart for the rest of the Top Ten).  A country that ranked surprisingly high was Cuba at number 22 in 2007 largely due to a high percentage of women in parliament and ministerial-level positions.  A few other countries that ranked relatively low were France at 51 and Italy at 84 due to low income ratios and the low percentage of women among professional workers.  Perhaps one of the most surprising rankings was the United States which dropped from 23 in 2006 to 31 in 2007 based on slippage in political empowerment and wage equality.

Why keep track of other countries’ progress towards closing the gap between men and women?  We think distinct second-class status for women is a sign of stress in a society that may give “ethical travelers” pause when setting their itineraries and may indicate the potential for discrimination against women when accessing health services.  Of course, women keep striving to overcome these disparities. In a study released by Education Week,  the gender gap in reading skills grew between 2000 and 2006 but in the other direction — girls have been continually outperforming boys with Argentina, Australia, Bulgaria, Greece, Iceland, Italy, Japan, Mexico, and Spain leading the way.  Perhaps these findings indicate that girls work harder in order to have the same opportunities as boys.  What do you think?

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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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Healthy Destinations: Tolerance Also a Key Indicator

Friday, March 26th, 2010 by Mike Hartung

Previous posts have highlighted happiness, the velocity of life, ethics and environmental factors as important characteristics of healthy destinations. Now a new analysis of Gallup poll data by researchers at Cambridge University isolates another key to health and happiness: tolerance. Working with data from 380,000 Americans polled in 2008, the Cambridge team found that “inclusiveness”—tolerance of bohemian and alternative lifestyles—raised the happiness index significantly in many states, including three that made the top ten: California, Minnesota and Massachusetts. It seems freedom of expression and lower pressure to conform give people the chance to pursue and perhaps fulfill their own definition of happiness. Health and well-being seem to walk hand-in-hand with a tolerant approach to life. Do you agree?

Photo info: http://www.flickr.com/photos/bike/ / CC BY-SA 2.0
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Toothless Healthcare Reforms May Boost Prospects for Medical Tourism

Tuesday, March 16th, 2010 by Frank Gillingham, MD

For many reasons, health insurers in the U.S. have been reluctant to jump on the medical tourism bandwagon.  They are concerned about taking business away from doctors and hospitals already resentful of payment rates virtually dictated by the plans.  Insurers realize that promoting medical treatment abroad would be perceived as a cost control measure at a time when politics is making cost containment an ever “dirtier word” with the public.  Finally, patients would likely hold insurance companies responsible for malpractice committed in the course of medical tourism. But overriding these serious concerns is the prospect of backbreaking costs brought on by the healthcare reforms now poised to become law.

We now understand that the proposed legislation would require health insurance companies to change the way they do business (by covering pre-existing conditions, accepting all applicants for coverage, e.g.), thereby eliminating avoidance of adverse risk and potentially increasing premiums dramatically. According to the Cato Institute, federal legislation that is working its way through Congress strongly resembles the reforms enacted in Massachusetts in 2006, which have accelerated costs significantly. As a result, despite the imposition of fines for non-compliance, many individuals and small employers may not be able to afford health insurance.  This outcome could, in the long run, actually increase the number of uninsureds, who must pay medical bills themselves and thus may seek less expensive care outside the U.S.

Unfortunately, current healthcare reform proposals do little to address the underlying reasons why healthcare costs are so high: defensive medicine, overutilization of specialists, the shortage of primary care physicians, excessive drug costs and patients’ expectations of heroic measures at the end of life, for example. These relentless price pressures bode well for the medical tourism industry, which will continue to represent a lower cost alternative to double digit annual increases in medical costs in the U.S.

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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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Health, Happiness and the Velocity of Life: Connecting the Dots Around the World

Friday, January 29th, 2010 by Mike Hartung

Our admittedly desultory investigation of comparative health and happiness around the world (Destination Happiness, Healthy Planet Index, and More Happiness Data) has been joined recently by New York Times columnist Nick Kristoff,  Freakonomics columnist Justin Wolfers and the staff at Glimpse magazine.

I don’t want to suggest that this line of inquiry is gaining urgency; on the contrary, I think the evidence is mounting that a key component of the health and happiness formula is a more leisurely pace of life. While Kristof and Wolfers highlight education and economic development, respectively, as “drivers” of happiness, the simpler, more fundamental factor may have been captured by Glimpse. Reporters polled their readership (students on international programs) to cull the Top 5 Health Tips From Abroad. Four of these tips clearly put the brakes on the American way of life: 1) Get out of the car, 2) Leave more time to eat, 3) Work less, 4) Nap more. And the examples of this lifestyle come from developed countries such as the Netherlands, Greece, Turkey and Spain.

Kristof taps two other important lines of inquiry we will pursue at our own pace: “environmental performance” and the “gender gap”. When we take the time to soak up our surroundings, it would be nice to find clean air, safe water and an abundance of tolerance. We think we’re starting to connect the dots. Do you think we are on the right track?

Photo info:  http://www.flickr.com/photos/48089670@N00/ / CC BY-NC-ND 2.0

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More Happiness Data by Destination: Study Ranks States

Tuesday, December 22nd, 2009 by Mike Hartung

Louisiana is one of the happiest states in the U.S.The latest investigation into happiness by destination comes from Andrew Oswald of the University of Warwick (UK) and Stephen Wu of Hamilton College (NY) who have ranked all fifty states and DC using two data sets. One from the Centers for Disease Control compiles responses from 1.3 million Americans who were asked this: “How satisfied are you with your life?” The other is research conducted at the University of Southern California on indicators of quality of life such as sunshine, crime and environmental health. Surprisingly, Louisiana came out on top even in the aftermath of the Katrina disaster. And Mississippi is in the top six. At the bottom of the list? New York and Connecticut. There’s clearly little or no correlation with income per capita. The authors found a high degree of correlation between the subjective survey responses and the more objective indices. They speculate that “liberal angst” might be playing a role.

I’ve spent time in both New York City and New Orleans, and if we could measure the velocity of life, I think it would go a long way toward explaining these findings.

Photo: http://www.flickr.com/photos/philippeleroyer/ / CC BY-NC-ND 2.0
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