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Health Disparities and Startling Similarities: Life and Death in Baltimore and Bangladesh

Posted By Prucia Buscell, Thursday, May 14, 2009
Updated: Tuesday, February 15, 2011
The United States ranks second out of 177 countries in per capita income—behind Luxembourg—but 34th in the survival of infants to age one. The United States spends $5.2 billion a day on healthcare, more than any other nation in the world, yet ranks 24th among the world’s 30 most affluent nations for life expectancy.

The US infant mortality rate is on a par with that is Croatia, Estonia, Poland and Cuba. If the rate were equal to that of first-ranked Sweden, 21,000 more American babies would have lived to see their first birthdays in 2005.

The US has five percent of the world’s population and 24 percent of the world’s prisoners.

Those numbers come from The Measure of America, 2008-2009, an extraordinary report produced by the American Human Development ProjectSarah-Burd Sharps, co-director of the project, explained the organization’s report maps the level of human development—described by life expectancy, access to knowledge, and a decent standard lf living—in terms of history, geography and congressional district. Ms. Burd-Sharps addressed last month’s Global Health Conference at Yale University sponsored by Unite For Sight.

It’s not only international disparities that are shocking: the report document stunning disparities within ethnic, economic and regional sectors of the US.

For example, Ms. Burd-Sharps said, Asian American women have a life expectancy of 88.6 years, whereas African-American women have a life expectancy of 76.3 years. Asian American men live an average of 83.6 years but the life-expectancy for African American men is 69.4, a difference of 14 years. The average life expectancy in Washington, DC, is 73.8years, whereas a person in Hawaii, where the life expectancy is 81.7 years, can expect to live eight years longer. The infant mortality rate in the nation’s capitol is 11.4 for every 1,000 live births. In Vermont the same rate is 4.7.

Ms. Burd-Sharps said US healthcare spending made up six percent of the gross domestic product in 2006, and 95 percent of that spending went to treatment rather than prevention. We ration care by who can pay rather than who is in need, she said, and the infant mortality rate suggests we do a poor job protecting future generations.

Rebecca Onie, JD, is co-founder and CEO of Project Health, an organization she helped create to break the link between poverty and poor health. The Project maintains family help desks in clinics in Boston, Providence, New York, Baltimore and Chicago, where trained volunteers work with healthcare professionals to identify conditions that impact patients’ health. They have food pantries and offer help, and follow-up, with applications for employment, food stamps or better housing. We tend to think of serious problems existing abroad, she observed, yet some challenges in US healthcare are strikingly similar to those in the developing world. Policymakers need to understand the need for infrastructure changes, she said. "Doctors know they are prescribing inhalers and antibiotics to children when there is no food in the house,” she said, adding that a February 9 article in the McKinsey Quarterly discusses the need for clinical leadership in healthcare.

In comparative terms, she said, "We have one doctor per 20,000 villagers in Sub-Saharan Africa, and domestically we have one social worker for every 16,000 visits to Harlem’s children’s hospital, and on the south side of Chicago 60,000 patients a year get the services of one social worker.”

She offered some dramatic parallels between Bangladesh and Baltimore:

In Bangladesh, life expectancy is 63.1 years. In Baltimore, it’s 62.5. In Bangladesh, there are 20 low-birth-weight babies—those who weigh under five pounds, eight ounces—for every 1,000 life births. In Baltimore, there are 15. In Bangladesh, the adult illiteracy rate is 52 percent, and in Baltimore it is 40 percent.

The Measure of America Report has a section examining the social, economic and environmental reasons for the infant mortality rates and life expectancy in Baltimore. A Baltimore Sun story by Annie Linskey reports a 20 year difference in life expectancy difference between an impoverished Baltimore neighborhood, where it is 63, and a wealthy section of town where it is 83. The Southwest Baltimore Health Profile 2008 published by the city department of health and the Johns Hopkins Bloomberg School of Public has similar analysis. The figures in different reports vary slightly because they are compiled differently, but similar stories emerge.

Tags:  buscell  complexity matters  culture  health 

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