reclaiming the commons: our health and our education stephen bezruchka, md, mph departments of...
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Reclaiming the Commons: Our Health and Our Education
Stephen Bezruchka, MD, MPH
Departments of Global Health & Health ServicesSchool of Public HealthUniversity of Washington
POP HEALTH QUIZTrue 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
According to the Central Intelligence Agency, Bosnia and Herzegovina has a longer life expectancy than the United States of America.
A survey in US medical students in 2002 found that one third of them thought the US had the lowest infant mortality of all nations.
POP HEALTH QUIZTrue 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
According to the Central Intelligence Agency, Bosnia and Herzegovina has a longer life expectancy than the United States of America.
A survey in US medical students in 2002 found that one third of them thought the US had the lowest infant mortality of all nations.
Sri Lanka US Adult Female Mortality 1970-2010
POP HEALTH QUIZTrue 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.
X
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
According to the Central Intelligence Agency, Bosnia and Herzegovina has a longer life expectancy than the United States of America.
A survey in US medical students in 2002 found that one third of them thought the US had the lowest infant mortality of all nations.
POP HEALTH QUIZTrue 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.
X
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
According to the Central Intelligence Agency, Bosnia and Herzegovina has a longer life expectancy than the United States of America.
A survey in US medical students in 2002 found that one third of them thought the US had the lowest infant mortality of all nations.
Ezzati et. al 2008
Female Male
US County Life Expectancy Trends 1987-2007
POP HEALTH QUIZTrue 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.
X
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
X
Maternal mortality in the US has increased 50% over the last 15 years
According to the Central Intelligence Agency, Bosnia and Herzegovina has a longer life expectancy than the United States of America.
A survey in US medical students in 2002 found that one third of them thought the US had the lowest infant mortality of all nations.
POP HEALTH QUIZTrue 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.
X
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
X
Maternal mortality in the US has increased 50% over the last 15 years
According to the Central Intelligence Agency, Bosnia and Herzegovina has a longer life expectancy than the United States of America.
A survey in US medical students in 2002 found that one third of them thought the US had the lowest infant mortality of all nations.
Australia, Canada, Japan, Sweden US Maternal Mortality 1970-2010
POP HEALTH QUIZTrue 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.
X
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
X
Maternal mortality in the US has increased 50% over the last 15 years
X
According to the Central Intelligence Agency, Bosnia and Herzegovina has a longer life expectancy than the United States of America.
A survey in US medical students in 2002 found that one third of them thought the US had the lowest infant mortality of all nations.
POP HEALTH QUIZTrue 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.
X
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
X
Maternal mortality in the US has increased 50% over the last 15 years
X
According to the Central Intelligence Agency, Bosnia and Herzegovina has a longer life expectancy than the United States of America.
A survey in US medical students in 2002 found that one third of them thought the US had the lowest infant mortality of all nations.
POP HEALTH QUIZTrue 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.
X
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
X
Maternal mortality in the US has increased 50% over the last 15 years
X
According to the Central Intelligence Agency, Bosnia and Herzegovina has a longer life expectancy than the United States of America.
X
A survey in US medical students in 2002 found that one third of them thought the US had the lowest infant mortality of all nations.
POP HEALTH QUIZTrue 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.
X
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
X
Maternal mortality in the US has increased 50% over the last 15 years
X
According to the Central Intelligence Agency, Bosnia and Herzegovina has a longer life expectancy than the United States of America.
X
A survey in US medical students in 2002 found that one third of them thought the US had the lowest infant mortality of all nations.
1st & 4th yr US medical student knowledge of Population Health
(2002)Question INCORRECT
US has higher life expectancy than any other nation?
32%
US has lower infant mortality than any other nation?
34%
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.
POP HEALTH QUIZTrue 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.
X
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
X
Maternal mortality in the US has increased 50% over the last 15 years
X
According to the Central Intelligence Agency, Bosnia and Herzegovina has a longer life expectancy than the United States of America.
X
A survey in US medical students in 2002 found that one third of them thought the US had the lowest infant mortality of all nations.
X
POP HEALTH QUIZTrue 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.
X
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
X
Maternal mortality in the US has increased 50% over the last 15 years
X
According to the Central Intelligence Agency, Bosnia and Herzegovina has a longer life expectancy than the United States of America.
X
A survey in US medical students in 2002 found that one third of them thought the US had the lowest infant mortality of all nations.
X
Playing Game of Health
without a scoreboard
Measures of health of populations?
How healthy is the US?Health Olympics
Number one Gold 1-5 _______6-10 _______11-15 _______
16-20 _______21-25 _______26-30 _______31+ _______
HEALTH OLYMPICS 2011
Life
expectancy 5
15
10
25
20
30
United Nations Human Development Report 2011
Ezzati et. al 2008
US County Life Expectancy Trends 1961-1983
Female Male
Ezzati et. al 2008
Female Male
US County Life Expectancy Trends 1987-2007
Trends FEMALE life expectancy age 50 from 1955-2007
Glei et al. 2010
SCF State of the World's Mothers 2004
A fifth of 20-yr old womenin the US gave birth in their teens
In Phillips County,Arkansas, the birth rate among teenage girls in 2000 was 127 births per 1,000 women aged 15 to 19 - a rate higher than in 94 developing countries.
0 2 4 6 8 10 12
Japan
France
Germany
Spain
Greece
UK
Czech Republic
Portugal
Belgium
Hungary
Italy
Denmark
Netherlans
Australia
Poland
Canada
Korea
New Zealand
USA
*Austria, Finland, Ireland, Norway, Sweden and Switzerland had fewer than 20 deaths reported and therefore rates were not calculated.
Youth violence Olympics—Homicide rates among youth aged 10-29 (most recent year available) from the World Health Organizations’ World Report on Violence and Health, 2002*
checking indicators
Population Health Concepts
Health has been improving most of the last century
Health improvements are not shared equally
Poorer people have poorer health
Early life is most critical period for health
Population Health Concepts
Health has been improving most of the last century
Health improvements are not shared equally
Poorer people have poorer health
Early life is most critical period for health
Wilkinson & Pickett 2009 Spirit Level
US MORTALITY RATES BY ZIP CODE INCOME
Survival Rate on the Titanic
60 % 40
% 25 % 24 %
Index of: • Life expectancy• Math & Literacy • Infant mortality• Homicides• Imprisonment• Teenage births • Trust• Obesity• Mental illness – incl.
drug & alcohol addiction
• Social mobility
Health and Social Problems are Worse in More Unequal Countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
"more egalitarian societies (i.e., those with a less steep differential between the richest and the poorest) have better average health" pg. 59
Kondo et al. 2009
Deaths attributable to excess income inequality
1 / 3
Health and Education
Education – an epiphenomenon, not root cause– (we have most education of all countries)– Marsh, J. (2011). Class dismissed : why we
cannot teach or learn our way out of inequality. New York, N.Y., Monthly Review Press. Introduction Unintended Consequences: 9-23
World Bank WDR 2006
Data are for 2000 and line tracks changes 1985-2000
BETTER HEALTH
World Bank WDR 2006
Data are for 2000 and line tracks changes 1985-2000
BETTER HEALTH
