“You’re not really going to eat that, are you?” my friend asked as our hosts left the living room.
I looked down at the luscious-looking mango and papaya and tried to ignore the dozen or so flies that were already enjoying them. “Well, we can’t offend our hosts” I replied. Looking over his shoulder, I could see through the open window the huge sow in the backyard, caked with mud and “sow stuff.” It wasn’t hard to speculate on where my little fly friends had enjoyed their previous meal.
We were on a church mission construction trip about an hour outside Havana, Cuba. On the way to our worksite that morning, piled eight people in a car built the year I was born, we had witnessed a street fight between two men with machetes. And just before we took our break, one of our guys was clearing away a large stone and found a scorpion the size of a child’s fist.
Cuba claims very impressive population health statistics. Not to be a skeptic, but I don’t believe them. Between the ever-present flies, the questionable running water, crumbling and sometimes-dangerous infrastructure, and other environmental hazards, this place was a public health nightmare. Yet critics of the U.S. health system love to tout statistics that place Cuba ahead of us in health status.
Let me be clear. Having spent 30+ years in the hospital sector, I am as aware as anyone else of our healthcare system’s foibles. The dysfunctionality is sometimes astounding. Yet I am weary of people citing statistics showing how lousy our system is when some of those numbers fail to consider factors outside healthcare that may be driving down our standing.
About 25 years ago, I heard a healthcare speaker point out that non-medical social services vary tremendously from country to country, and that this may be a significant factor in superior health outcomes for certain countries. Although I never further investigated this concept, that insight stuck with me.
Recently, a blog by my friend Kurt Mosely of Merritt Hawkins addresses this very issue and provides some interesting stats:
· The U.S. spends more (16.3% of GDP) on healthcare than any other country. France, Sweden, Switzerland, Japan, and Germany each spend about 9% of GDP on healthcare.
· The U.S. spends 9.1% of GDP on social services (food, heat, clean water, housing, job training, etc.) that help keep populations healthier. France, Sweden, Switzerland, Japan, and Germany spend twice that amount: about 18%.
This may point to what is referred to as the medicalization of social problems. I am not whitewashing the limitations of the U.S. health system. But I am disappointed that people (some of whom seem to be agenda-driven) often fail to acknowledge the multiple factors that ultimately roll up into health status statistics. The objective of this blog is merely to provide some perspective on the United States’ relatively poorer health numbers.
When I worked at a hospital outside Detroit, we regularly welcomed patients from across the Canadian border and sometimes from more distant countries because we were able to provide the care they couldn’t get in their home countries. My only point is that this dynamic should somehow be factored into international comparisons.