As this year draws to a close, I find myself thinking about the politics that have polarized our nation in a way that is unfamiliar to those of my generation.
People of my generation (Gen X) have not seen a time where the public has been so vocal and so divided on matters which effect our daily lives. Perhaps the last time was in the late 1960s, with the Vietnam War as the lightning rod. That era was defined by the war, but also by conflict around civil rights, women’s rights, the burgeoning of a new and pervasive drug culture, and health care. The Medicare Amendment to the Social Security Act was passed in 1965. (Of note, the Children’s Health Insurance Program (CHIP) was not passed until 1997.) Now, almost 50 years later, our news is peppered with stories of a startlingly similar nature, and health care remains a very hot topic.
The skyrocketing costs of American health care have been well documented in news publications, emphasizing the point that we spend the highest amount per capita on health care but have the lowest quality metrics amongst industrialized nations, specifically life expectancy (LE), neonatal mortality (NeoM), mortality under 5 years of age (M<5) and maternal mortality (MatM). Neonatal mortality is the death of a baby between birth and 1 month of age. Globally, leading causes of death in children under 5 years are pre-term birth complications, pneumonia, birth asphyxia, diarrhea and malaria. The most recent statistics available on the World Health Organization website are from 2014-2015.
In the U.S., we spend 17 percent of our Gross Domestic Product (GDP) on health care, and our average life expectancy is 69 years; France spends 11 percent, and has a life expectancy of 72. Germany also spends 11 percent and has a life expectancy of 71. So, why do we spend almost twice as much as other developed countries, but see worse outcomes in our most vulnerable patients? Is it nutrition, immunizations, trauma, violence, access to health care?
A closer look at the issue by doctors and economists suggests that the post-natal period is an opportunity for intervention and improvement. While the neonatal period is the most vulnerable period in a child’s life, the differences in our statistics compared to Europe’s seem to be attributable to differences in the post-natal period, between 1 month and 3 years of age.
Though difficult to prove, many doctors, academics and analysts feel that disparities in access to health care play a significant role. In other words, people with lower incomes and a lower educational level who live with less resources and more violence in their communities tend to have higher rates of babies who die under the age of 5.
Medicaid patients also tend to experience more breaks in insurance coverage than do privately insured children, and discontinuities in insurance coverage have been associated with lower vaccination coverage, which impacts deaths related to vaccine-preventable illnesses such as pneumococcal pneumonia, meningococcal meningitis, influenza, pertussis, measles, diphtheria and rubella.
So how do we protect our children, and their future children, in this turbulent landscape? What do we teach them about health care? How do we teach them that a healthy, educated workforce is the engine that drives a successful economy? What do we teach them about their responsibilities to themselves versus others? What is the right forum for these conversations, and at what age should they start?
While writing this article, I got a text from my young friend “ML”. She is 15 years old, bright, kind and in good health. The world is her oyster. I asked her how we should approach health care in America. She said, “I think everyone deserves medical treatment. Even people who are coming into the country illegally are still human, and every human life deserves to be treated and taken care of.” Her words come from a place of love and hope, something I hope all children are able to experience.
Anjali Subbaswamy is a Pediatric Intensive Care Physician at UNM. Please send your questions to her at firstname.lastname@example.org