Archive for the ‘Comparative Health Care’ Category

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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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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Destination Happiness: Which Places Point the Way to a Happy Planet?

Friday, October 2nd, 2009 by Mike Hartung

Why do we travel?  Are we trying to find a better path forward for ourselves and our children?  There are many ways to pursue happiness, and close encounters with new cultures often lead us to reconsider what happiness means.  When we hear fellow travelers asking, “What is the best way to live?” and “Where does this path lead?” their answers often swing between the material and the spiritual.  How do we balance the two?

Now there’s an interesting new perspective emanating from respected economists that weighs factors such as health, a positive experience of life and the natural resource requirements to attain them.  It’s all rolled up into something called the “Happy Planet Index,” measuring “the ecological efficiency with which healthy and happy lives are supported”.  The New Economics Foundation devised this measure for 143 countries around the world (covering 99% of the population).  The results, displayed online via an interactive map of the world, show that less wealthy countries with significantly smaller ecological footprints have high levels of life expectancy and satisfaction.  In fact, nine of the top ten countries are in Latin America or the Caribbean (see our chart of the top twenty).  The 64-page downloadable report describes the methodology and shows index scores in full.

Where does the U.S.come in?  At 114th sandwiched between Madagascar and Nigeria.  The planet’s richest nation is dragged down by its voracious and unsustainable appetite for natural resources.  According to the HPI data, if all the peoples of the world were American, it would take more than four planets to support them.

A world traveler’s perspective and habits may dovetail with the values on which the HPI is based.  You can calculate your personal HPI using an online questionnaire.  I answered the series of questions fairly honestly and scored a 66.8-that’s about halfway between the world average of 46 and the target score of 83.  The results are accompanied by tips for improving your performance.  Maybe I’ll start by moving to Costa Rica.

Of course, it may take generations for the human species to arrive at the destination known as a Happy Planet.  For the immediate future, I take comfort that simply pursuing happiness is often enough.  To paraphrase Robert Louis Stevenson, “It is sometimes better to travel hopefully than to arrive.”

hpitop202

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Looking Abroad to Begin the Healing of America

Tuesday, September 15th, 2009 by Mike Hartung

thehealingofamerica1An important new contribution to the health care reform debate adds some much needed global perspective to the pervasive political rancor. Author T.R. Reid’s newly published book, The Healing of America, has been cited by reviewers as a series of serious and lucid insights into how medicine is practiced around the world and how different countries have crafted a mix of private and public resources to achieve broad if not universal coverage.

Reid sought treatment for a chronic shoulder ailment in ten different countries with ten different medical cultures and healthcare financing systems. The resulting medical advice spans a spectrum of treatment plans and personal choices. T.R. Reid has also begun fielding questions in the blogosphere. We think this global view is vital to surfacing policy alternatives that should be debated in Congress, and we hope our elected representatives can rise above the fray by taking the time to learn what Mr. Reid is reporting based on his worldwide experience with comparative healthcare.

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World Health Care Follow Up – The Perils of Custard Creams

Friday, September 11th, 2009 by Andy Orr
coffeebreak1In other timely world news, the Telegraph posted this stimulating bit, revealing that coffee and tea breaks can be hazardous to your health.  It also taught me about the all-important Biscuit Injury Threat Evaluation (BITE) measure.  I am not sure if this is peculiar to the UK, where tea time may make up a greater proportion of one’s time, or if it is a global phenomenon.  What is amazing to me is the variety of injuries occurring during these perilous breaks.  The research undertaken by Mindlab International on behalf of Rocky*, a chocolate biscuit bar,  produced this list of potential mishaps:
  • getting poked in the eye with a biscuit
  • falling off a chair
  • being bitten by an animal
  • getting stuck in wet concrete

It also found that Custard Creams are the riskiest of all biscuits.  From now on I will stick with Jaffa Cakes, the safest of all.

Have you been injured by a biscuit or, more seriously, have you experienced the health care system of the UK personally?  We would love to hear your stories.

*Not to be confused with a brand of Viagra® in India also called Rocky.  As TV viewers in the U.S. well-know,  this product carries its own unique risks.

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Comparative Health Care: What can Britain teach the U.S.?

Friday, September 11th, 2009 by Andy Orr

british_flag_and_planeHealthy travel usually requires some understanding of how health care systems work in different parts of the world.  This post is the first in a new series to help broaden our understanding by looking at practices outside the U.S.  Of course, the current health care reform efforts in the United States make this information more topical than usual and help to increase awareness about instructive differences between countries.

The United Kingdom is our location today.  A post recently appeared on the New England Journal of Medicine’s web site titled “British Lessons on Health Care Reform.”  This article tries to dispel myths about socialized medicine and the often maligned National Health Service (NHS) with facts about improvements that they have implemented in the last decade.  It specifically calls to attention the importance of having strong primary care physician practices in place as well as the pivotal role of NICE (National Institute for Health and Clinical Excellence), an organization “established to provide a unifying national framework to offer guidance in public health, new health technologies, and clinical practice.”

While nothing is perfect, it’s common sense that having good primary care doctors that know their patients and their family history should result in improved health care at a lower cost.  Good preventative care, better patient compliance with medications and other therapies and right-sizing treatment (no trips to the ER for something that can wait or be treated somewhere else) are all outcomes of a stronger primary care system.

NICE helps to determine best practices in a forum that includes all stakeholders and tries to find solutions to tough issues where costs are measured against quality of life issues.

How does this impact a world traveler visiting the U.K.?  Well, it should give you confidence that there is quality health care available in the country.  Sometimes that care can be free:

  • Treatment given in an accident and emergency department (excludes emergency treatment given elsewhere in the hospital)
  • Treatment given in a walk in center providing similar services to those of an accident and emergency department of a hospital
  • Treatment for certain communicable diseases (excluding HIV/AIDS where it is only the first diagnosis and connected counseling sessions that are charge free)
  • Compulsory psychiatric treatment
  • Family planning services

In most cases, the traveler will need to pay for treatment;  the NHS was established for UK residents.

Stay with us as we continue to explore health care systems around the globe.

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