Health Progress--and Problems

Health expenditures in the United States reached $1,721 per capita in 1985, the highest inthe world and almost double the mean for 21 industrialized nations studied by the magazine Health Affairs. Only Sweden and Canada came close to the American expenditure. Since 1982 the United States has been spending more than 10% of its gross national product each year on health care--a higher percentage than any other nation.

What is all that money buying? Substantial progress, the Department of Health and Human Services reported the other day. There is "a cause for optimism."

Progress was measured in a mid-point assessment of 226 public health goals that had been set by the federal government for 1990. The optimism was based on achievement ahead of schedule on 29 goals, including a reduction of work-place deaths, and the likelihood of achieving on schedule an additional 78 goals, including the immunization of at least 90% of all children against infectious disease.

There also has been progress in "awareness about life-style factors and their contribution to health," Dr. Otis R. Bowen, secretary of health and human services, commented. Tobacco use is down to 30% of the adult population, and less alcohol is being consumed. There are, however, serious life-style problems, with 25% of adults overweight, and no more than 20% engaged in the kind of regular exercise that assures cardiovascular fitness.

Among the other serious problems that remain are hepatitis B, pertussis (whooping cough), tetanus and influenza, which "continue to defy public health efforts to reduce their spread." Acquired immune deficiency syndrome (AIDS) has become a major national problem that was not even identified when the goals were set. Increasing use of cocaine, up 13% from 1984 to 1985, has countered progress in reducing the use of other drugs. And there seems little likelihood of reaching the target for vastly reduced pregnancy among girls 14 and under.

Inadequate resources would appear to be a problem with many of the unresolved problems, and certainly in reducing infant mortality. Progress has been made, but the inadequacy of prenatal programs for poor mothers virtually assures failure to achieve the infant-mortality target for 1990. That is certainly the case in California, where the fees paid by Medi-Cal fail to attract the participation of most obstetricians because the funds do not cover the doctors' expenses, including liability insurance.

Americans need to ask why some nations, such as Sweden and Canada, provide better health care for less money.

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