[ExI] How to get a healthy country

[J. Andrew Rogers]

On Oct 16, 2007, at 4:20 AM, BillK wrote:
> OK, Japan, France, Iceland and Sweden, fine.
>
> But Cuba???? How did they do it?
> Cuba is a poor country and when people get sick, medicines and medical
> equipment are often in short supply.
>
> Their answer is low-tech preventive medicine. And it works.
> They have more doctors per capita than any other country.
> So better child care produces low infant mortality.
> Lots of doctors means early detection and prevention.


I was under the impression that prevention is greatly over-rated both  
in terms of cost effectiveness and actual value to health, at least  
when actually studied in economic terms.  The level at which it makes  
a difference is so low that it is not a substantial differentiator in  
the industrialized world.  That said, the reasons US disease survival  
rates are much better than the rest of the industrialized world have  
often been argued to be the result of excellent ubiquitous early  
detection technology and treatment.  So if early detection and  
prevention mattered, the US should be leading the pack but clearly  
the US is not.


> And, being poor, they can't afford the American diet.


Genetics and diet are probably responsible for the bulk of the  
difference in the industrialized world; when you look at the enormous  
variation in health and life expectancy across the individual US  
states (perhaps a better control than comparing individual countries)  
and correlate it with demographics and diet, the patterns make this  
more obvious.

If you remove things like accidents from the death statistics (which  
are atypically high in the US), you find that Americans are about the  
longest lived people in the industrialized world.  It is not because  
Americans are particularly healthy, but that the survival rates for  
many dangerous diseases (and particularly cancer) in the US often  
dwarf that of the rest of the industrialized world.  As an extreme  
example that was in the news recently, an average person with cancer  
in the US has a 30-35% higher survival rate than the average person  
with cancer in the UK.  As the population ages, factors like this  
will matter greatly.

Americans in many parts of the country have crap diets, but then  
compensate with superior early detection and treatment of significant  
diseases.  The healthiness of Americans has nothing to do with the  
healthcare available to them.

Cheers,

J. Andrew Rogers