Framing Health Care Reform

We are not usually prone to post discussion of health insurance reform but this well-articulated op-ed in the Portland Oregonian discusses important rhetorical lessons that are just as applicable to the struggle for equality in health itself:

"Thomas Pynchon wrote in "Gravity's Rainbow," "If they can get you asking the wrong questions, they don't have to worry about answers." Those looking to reform health care have taken on, as their central question, the issue of controlling cost: How can we bend the cost curve? For the opponents of reform, there could be no better question to occupy the do-gooders." (Read full post)

Maybe a welfare state isn't so bad after all....

The New York Times Magazine discusses how the Netherlands moves beyond universal health care to provide early life support, safe housing, and family-friendly policies. Apparently living in a so-called "welfare state" is not be so bad! Read the article to learn more about how the Dutch government works with other institutions to promote health, and whether or not such policies could be incorporated in the United States.

"[There is] something that seems to be overlooked when Americans dismiss European-style social-welfare systems: they are not necessarily state-run or state-financed. Rather, these societies have chosen to combine the various entities that play a role in social well-being — individuals, corporations, government, nongovernmental entities like unions and churches — in different ways, in an effort to balance individual freedom and overall social security." One Dutchman noted: "My American friends say they live in the best country in the world, and in a lot of ways they are right. But they always have to worry: ‘What happens to my family if I have a heart attack? What happens when I turn 65 or 70?’ America is the land of the free. But I think we are freer.” (Read full post)

Beyond Health Care

"The Robert Wood Johnson Foundation’s Commission to Build a Healthier America has just released a new report: Beyond Health Care. At a time when all eyes are trained on the debate over providing access to medical care for all Americans, the report looks beyond health care, to the health of the population. As it turns out our health—public health—has less to do with health insurance than one might think."

- Maggie Mahar "Taking Note: A Century Foundation Group Blog" April 07, 2009

Apologies for the late posting. While it still misses out on maternal leave, early childhood, and tends to focus some on health behaviors, it makes a good start in dissociating health from health care. It is a critical report which, without active dissemination, will most likely fall by the wayside while pundits continue to debate health care, hog flus, and housing finance. Tell everyone you know. (Read full post)

Together, We Make Better Decisions

For advocates of population health, its often difficult to get an audience to see in the same scale (e.g. long-term consequences of unequal societies) when discussing health. More specifically, it is difficult for some to grasp that something good for society will ultimately be good for oneself. Environmental advocates deal with the same problem (often with the same implications)!

A New York Times Magazine article entitled, "Why Isn't the Brain Green?" describes what some social and behavioral researchers have discovered about the way people think and make decisions (arguably a "rediscovery" of things we used to know before the advent of Modernity).

A key finding is when people discuss issues and come to a consensus as a group, they are more willing to take short-term sacrifices for long term gain. Also, being identified as a group and being physically located at the same table increases participation appreciably. Importantly, researchers acknowledge that there is no such thing as true preference. That is, information and perspectives presented as a group naturally affects what an individual values.

The article also discusses the principles of "frames" and "nudges" as tools to help guide people into making decisions that are in their best interest and in the best interest of the community. When queried about the potential coerciveness of these tools, in addition to the necessity of choice, researchers noted first:

“Remember when New York tried to enforce its jaywalking laws?” “You can’t enforce stuff that people don’t believe should be done.”

But more critically:
“I think you have to take it as a given that whatever we do, whether it’s what we currently do or what we plan to do, has some value judgment built into it.”

It is a large step to hear scientists acknowledging the limits of science in decision-making and realizing the essential need for broader human input. At the very least, when decisions are made they should reflect what is truly desired by the people. And, that, according to this and other research, is a good decision.
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Use the economic stimulus to raise our I.Q.!

Nicholas Kristof of the New York Times writes about how social determinants lower the I.Q. of children living in poverty and thus contributes to a collective drain on our intellectual resources . A researcher cited in the column notes, "“Bad environments suppress children’s I.Q.’s,”and Kristof concludes, "The implication of this new research on intelligence is that the economic-stimulus package should also be an intellectual-stimulus program. By my calculation, if we were to push early childhood education and bolster schools in poor neighborhoods, we just might be able to raise the United States collective I.Q. by as much as one billion points. That should be a no-brainer." Read the full column here. (Read full post)

Does the stress of poverty cause the "acheivement gap"?

In a study published this week in the Proceedings of the National Academy of Sciences, scientists from Cornell University found that the reduced capacity of the working memories of the poor is almost certainly the result of stress affecting the way that brains develop during childhood. In other words, the chronic stress of long-term poverty seems to be responsible for the "achievement gap" that contributes to poverty passing from one generation to the next. This article in this week's Economist refers to the Marmot studies and notes, "The main reason poor people are stressed is that they are at the bottom of the social heap as well as the financial one... So, it may not be necessary to look any further than their place in the pecking order to explain what Dr Evans and Dr Schamberg have discovered in their research into the children of the poor." (Yes, the Economist actually printed that!) The study authors showed that the relationship between childhood poverty and reduced working memory was mediated through chronic stress in childhood, measured through "allostatic load" -- a "biological marker of cumulative wear and tear on the body that is caused by the mobilization of multiple physiological systems in response to chronic environmental demands." If you're up for it, you can find the full text of the original research article here. (Read full post)

Inequality is Unhealthy

PHF's own Stephen Bezruchka recently paid a visit to Democracy Now! In a segment especially pertinent during this time of recession, Stephen explains how inequalities in wealth have contributed to America's poor health outcomes. As President Obama tries to "fix" both our health care and economic systems, what would you suggest he do to help America make a comeback as a contender in the Health Olympics?

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