1. FALLING BEHIND
USA Playing the
Game of Health
Without a Scoreboard
Stephen Bezruchka MD, MPH
Departments of Global Health & Health Services
School of Public Health
University of Washington
3. Health QUIZ
True False
A 15 year old girl in the US has a
smaller chance of dying before reaching
age 60 than a similarly aged girl in Sri
Lanka.
During the period of 1987 to 2007 life
expectancy for women declined in about
30% of US counties (which was not so
for the previous 20 years).
Maternal mortality in the US has
increased 50% over the last 15 years.
5. Health QUIZ
True False
A 15 year old girl in the US a smaller
chance of dying before reaching age 60
than a similarly aged girl in Sri Lanka.
During the period of 1987 to 2007 life
expectancy for women declined in
almost 30% of US counties (which was
not so for the previous 20 years).
Maternal mortality in the US has
increased 50% over the last 15 years.
6. US County Life Expectancy Trends 1987-2007
Female Male
Ezzati et. al 2008
7. Health QUIZ
True False
A 15 year old girl in the US a smaller
chance of dying before reaching age 60
than a similarly aged girl in Sri Lanka.
During the period of 1987 to 2007 life
expectancy for women declined in about
30% of US counties (which was not so
for the previous 20 years).
Maternal mortality in the US has
increased 50% over the last 15 years.
9. 790.5 667
2406 702.5
Time magazine July 30, 2012 + web update
10. How healthy is the US?
Health Olympics
Number one Gold 16-20 _______
1-5 _______ 21-25 _______
6-10 _______ 26-30 _______
11-15 _______ 31+ _______
11. HEALTH OLYMPICS 2011
5
expectancy
Life
10
15
20
25
30
United Nations Human Development Report 2011
14. Male Life Expectancies early 2000s
United States (white) 74.6
Sri Lanka 71.5
Journal of the National Medical
Association 98(4): 488-491 Ecuador 71.4
Malaysia 70.9
Occupied Palestinian territories 70.9
Iran 69.0
Colombia 69.3
United States (black) 68.8
Viet Nam 68.6
El Salvador 67.8
Iraq* 67.5
Nicaragua 67.3
15. Maternal Mortality Rates by Race/Ethnicity,
California Residents; 1999-2008
California Pregnancy-Associated Mortality Review (2011
20. Life Expectancy Race, Cuba, Brazil US
Country Whites Blacks W-B
Cuba (1981) 71.2 70.2 1.0
Brazil (1980) 66.1 59.4 6.7
USA (1980) 74.4 68.1 6.3
de la Fuente(1995): Race and Inequality in Cuba, 1899-1981
26. How healthy is the US?
Health Olympics
Number one Gold 16-20 _______
1-5 _______ 21-25 _______
6-10 _______ 26-30 _______
11-15 _______ 31+ _______
27. 1st & 4th yr US medical student
knowledge of Population Health
(2002)
Question INCORRECT
US has higher life expectancy 32%
than any other nation?
US has lower infant mortality 34%
than any other nation?
Agrawal, J. R., J. Huebner, et al. (2005). "Medical students' knowledge of the U.S. health care system and their preferences for
curricular change: a national survey." Acad Med 80(5): 484-8.
31. US MORTALITY RATES BY ZIP CODE INCOME
Wilkinson & Pickett 2009 Spirit Level
32.
33. Health and Social Problems are Worse in More Unequal
Countries
Index of:
• Life expectancy
• Math & Literacy
• Infant mortality
• Homicides
• Imprisonment
• Teenage births
• Trust
• Obesity
• Mental illness – incl.
drug & alcohol
addiction
• Social mobility
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
Time magazine July 30, 2012 http://www.london2012.com/medals/medal-count/
Source: Dying young Apr 25th 2012, 13:45 by The Economist online http://www.economist.com/blogs/graphicdetail/2012/04/daily-chart-14 ADOLESCENCE can be tedious all over the world. But in some countries it is dangerous too. Even within the rich world mortality rates for young people vary widely, as do the factors explaining these rates, according to data collected by George Patton of the University of Melbourne for an article published in the Lancet on April 25th. In Greece, suicides are rare but car accidents are common. In Finland it is the other way round. America stands out for having the highest mortality rate. It has a particularly high rate of traffic deaths, despite laws that ban drinking until 21. Where America is truly exceptional, however, is in its violence. At 8.9 per 100,000 population, the rate of violent death (such as from homicide or accidental shooting) is 18 times higher than in Britain. For young American men the risk is much higher. The death rate from homicide for 20-24 year olds is a staggering 28 per 100,000 population. Patton, G. C., C. Coffey, et al. (2012). "Health of the world's adolescents: a synthesis of internationally comparable data." The Lancet 379(9826): 1665-1675.
Godson, S. L. (2006). "The third world health status of black American males." Journal of the National Medical Association 98(4): 488-491.
The California Pregnancy-Associated Mortality Review (2011). THE CALIFORNIA PREGNANCY-ASSOCIATED MORTALITY REVIEW: Report from 2002 and 2003 Maternal Death Reviews. Sacramento, Department of Public Health, Maternal Child and Adolescent Health Division.
http://www.youtube.com/watch?v=WG7U1QsUd1g Bergner, G. (2009). "Black Children, White Preference: Brown v. Board, the Doll Tests, and the Politics of Self-Esteem." American Quarterly 61(2): 299-332.
De la Fuenta 1995 Table 5
Downloaded from http://www.kingcounty.gov/healthservices/health/healthofficer/presentations.aspx Saved as FlemingHealthOfKingCounty2012.pdf
Agrawal, J. R., J. Huebner, et al. (2005). "Medical students' knowledge of the U.S. health care system and their preferences for curricular change: a national survey." Acad Med 80(5): 484-8.
Halley Brunsteter
RGW Figure 1.3 2009
Kondo, N., G. Sembajwe, et al. (2009). "Income inequality, mortality, and self rated health: meta-analysis of multilevel studies." BMJ 339(nov10_2): b4471-.
