Friday, December 18, 2009

Healthcare no cure for poverty and war

New research from Italy and Kenya lends support to one of the central tenets of public health: That healthcare cannot cure the ravages of social or political inequity.

The Italian study looked at over 9,000 hospitalizations, mostly among men in Rome, and compared the rates of hospitalization among different income groups. Compared to the richest, the poorest Italians were over four times more likely to end up in the hospital for COPD (a serious lung disorder), and twice as likely for angina (or serious chest pain associated with increased risk of heart attack). Italy has a health system that provides free access to medical care regardless of income, so these differences cannot be attributed to differential access to healthcare. Other studies over the decades have come to similar conclusions, though few have been performed in Europe.

The American researchers, meanwhile, looked at another area where healthcare likely has a relatively small role to play in the health of populations facing strife. Studying nomadic herders in Kenya, researchers have noticed consistent changes in social behavior and health status that reflect the stress of constant low level conflicts. Where men once carried hunting rifles, they now tote AK-47 assault weapons. The numbers of young men has declined as they are killed by violence. Nutritional status has declined, especially among women. While men keep close to the abundant protein source of their migrating herds, older women forgo food to feed younger women, and mothers will go hungry to feed their children. As a result women’s nutritional status is a good barometer for the health of the community. Amazingly, despite so many conflicts and so many health researchers, the true links between armed conflict and health are relatively poorly understood.

While many health experts advocate for nationalized healthcare systems that are free for people of all income levels, these study illustrates one of the central flaws in that logic. Health or disease state is essentially what is produced from an individual’s interaction with their environment. It is the output of highly complex inter-functioning social and biological systems. While healthcare is the principle way of addressing undesired outputs, such as poor health or disease, preventing disease and promoting good health require attention to the inputs. Healthcare can help out somewhat, providing vaccinations against certain diseases, or detecting the need for changes in diet or lifestyle, for example. But healthcare does nothing to address the numerous other effects on our health, such as relative poverty or armed conflict. We need social, political and economic solutions to those core problems, often provided by people in white shirts and laptops rather than white coats and stethoscopes.

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