‘Failure of an American ideology’: why Covid has an outsized impact on the US | US healthcare

David Rosner continually talks to colleagues who are distraught about the American response to the Covid-19 pandemic.

“When you are in a school of public health and a public health environment, people really feel when they are failing,” said Rosner, who studies public health and social history at the Columbia University Mailman School of Public Health.

That defeated feeling is compounded by the fact that 1 million people in the US have died from Covid-19 – the highest Covid death rate among large wealthy countries.

According to public health experts, the virus’s outsized impact on the US can be attributed in part to underinvestment in long-term care, in primary care and in public health departments. As a result, some people were more vulnerable to Covid and had little connection to – or trust in – the healthcare providers who urged them to socially distance, to wear masks and to get vaccinated.

It was a disconnect, they say, that was only exacerbated by misinformation – particularly by Republican leaders’ undermining of scientists’ recommendations.

“This is more than just a failure of a health system,” said Rosner. “It’s a failure of an American ideology.”

A history of poor healthcare quality and access

The problems in US society and healthcare that lead to the high death toll predate the pandemic.

In 2018, the country spent an average of $10,637 on healthcare per person, almost twice as much as other large and wealthy countries, according to data from the Kaiser Family Foundation. And yet, compared with those countries, the US had a significantly lower life expectancy and the worst healthcare quality and access.

Almost $4,000 of that additional spending comes from higher payments to hospitals for inpatient and outpatient hospital care. Meanwhile, over the last decade, US spending for state public and local health departments decreased by 16% and 18% respectively.

“We have really valued the hospital care to the exclusion of public health and community healthcare in this country,” said Sheila Davis, CEO of the non-profit Partners in Health, which tries to bring healthcare to the world’s poorest places.

She argues that reimbursement patterns in the US focus on care delivered at hospitals, “which is the most expensive place to deliver care, with the most expensive providers”, she said.

As an alternative, she points to a comprehensive model, “which has excellent hospital care but also has a strong public health department, as well as community care”, such as federally qualified health centers in underserved communities.

The one health area where the US spends significantly less than other countries is on long-term care, including nursing homes. In 2018, the country spent $516 a person on long-term care, less than half of what comparable countries spent, according to KFF data.

The pandemic exposed these disparities. About three-quarters of Americans who died from Covid were 65 or older – including more than 150,000 nursing home residents, according to Centers for Disease Control and Prevention data.

A majority – more than two-thirds – of

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Climate change: The impact on health

The consensus among scientists is that we are in an era of global heating and extreme weather events, primarily due to the devastating effects of human action on the environment. Why are researchers concerned, and what are the implications for health?

The Lancet Countdown team is a group of over 120 leading experts on climate, public health, economy, and political science — among others — who have committed to monitoring climate change, particularly its impact on global health.

Since 2015, the year of the Paris Agreement, the experts affiliated with the Lancet Countdown commission have published yearly reports assessing this situation and keeping signatory governments and decision-makers accountable for the commitments they have taken on following the Agreement.

The latest report, which appeared in The Lancet in October 2021, records “deepening inequities” across all regions as global heating remains a concern. The report discusses the impact of climate change in the context of the COVID-19 pandemic, and it emphasizes the concern caused by extreme heat events and related natural disasters that have occurred over the past 2 years.

Among the issues outlined in the Lancet Countdown report 2021, there is the impact of climate change on the livelihood of communities around the world, its direct and indirect effect on mental and physical health, and the way in which it contributes to the spread of infectious diseases.

These findings largely coincide with those outlined by another set of landmark reports on climate change — those of the Intergovernmental Panel on Climate Change (IPCC).

According to the IPCC 2022 reports, at present, extreme weather events caused by human action are surpassing the resilience of some ecological and human systems, sometimes with irreversible effects.

The reports show that weather extremes related to climate change have affected the productivity of various food sectors — including agricultural, forestry, and fishery sectors — around the world, thus exacerbating food insecurity.

They also emphasize the impact of climate change on mental health, and the ways in which it contributes to the spread of vector-borne communicable diseases.

In our latest installment of the In Conversation podcast, we discuss these aspects at length with two key experts. One of them is Prof. David Pencheon, honorary professor of health and sustainable development at the University of Exeter in the United Kingdom, and founder of the Sustainable Development Unit for National Health Services England and Public Health England.

Our other interviewee is Dr. Marina Romanello, a research fellow at the University College London Institute for Global Health, research director of the Lancet Countdown on Health and Climate Change, and one of the co-authors of the latest Lancet Countdown reports.

You can listen to our podcast in full below, or on your preferred streaming platform.

According to the Lancet Countdown report 2021, “[t]he world is now 1.2 [degrees Celsius] warmer than in the pre-industrial period (1850–1900),” with the past few years recorded as the hottest yet — 2016 has seen the highest levels of heat around the world.

The

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