HEALTH WHO –HEALTH IS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL- BEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY –HEALTH IS A STATE OF WELL-BEING AND THE CAPABILITY TO FUNCTION IN THE FACE OF CHANGING CIRCUMSTANCES
Health Curative Services (Health Care) Preventive Services (Public Health)
1900 LEADING CAUSE OF DEATH –PNEUMONIA –TUBERCULOSIS –DYSENTARY LIFE EXPECTANCY 49 YEARS 4-5% GNP EXPENDED ON HEALTH CARE
1960 LEADING CAUSES OF DEATH –HEART DISEASE –CANCER –STROKE LIFE EXPECTANCY 65 YEARS 4-5% GNP ON HEALTH CARE
2000 LEADING CAUSES OF DEATH –HEART DISEASE –CANCER –STROKE LIFE EXPECTANT ABOUT 75 YEARS 15% OF GNP ON HEALTH CARE $1.7 Trillion dollars
Is there a relationship with Economic Development?
Are there economic Costs for Poor Health? Smoking –Increase Absenteeism –Increase Insurance Costs –Increase Maintenance and cleaning costs –Decrease productivity PUD –$5 Billion Health Care Costs –$1 Billion Productivity Costs Nosocomial Post Surgical Infections –$5,155 in follow up costs –($1,773 for controls)
Health Care Expenditures result in Economic Development? WHO Sachs Report –10% increase in life expectancy –0.3 to 0.4% rise in growth rate Families USA –$1 Million Decrease in Medicaid $3 Million in lost Business $1.2 Million in wages 37 jobs Health Systems impacts on their communities
Relationship of Health to Economic Growth? Economic Growth Health Care Costs
Relationship of Health Care Costs to Economic Development?
Approach and rationale A guide to thinking about the determinants of population health NOTES: Adapted from Dahlgren and Whitehead, 1991. The dotted lines denote interaction effects between and among the various levels of health determinants (Worthman, 1999). Over the life span Living and working conditions may include: Psychosocial factors Employment status and occupational factors Socioeconomic status (income, education, occupation) The natural and built c environments Public health services Health care services IOM - 2002
Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Functional and Clinical Outcomes Delivery System Design Decision Support Clinical Information Systems Self- Management Support Health System Resources and Policies Community Health Care Organization Chronic Care Model
Informed Activated Patient Results from Education, Decision Support (Care Management) and Active Involvement Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Self- Management Support Decision Support
The success or failure of any government in the final analysis must be measured by the well-being of its citizens. Nothing can be more important to a state than its public health; the states paramount concern should be the health of its people. - Franklin Delanor Roosevelt (1932)
The value proposition for Health and Health Care?
WHAT A DIFFERENCE TWO YEARS MAKE! 2001: $127b. Surplus 2003: $401b. Deficit
WHAT HAPPENS BY 2014 IF WE DO NOTHING? With reasonable assumptions on: –Tax cuts –AMT –Growth of discretionary spending –Medicare Deficit = almost $700b. or >$1t. National debt = $5.7t.
ELIMINATING DEFICIT BY 2014: WHAT WOULD IT TAKE? Assume : –No cuts in defense –Minimize tax increases –Elimination of unified budget deficit
ALL THESE ACTIONS COMBINED WOULD BE INSUFFICIENT: –Turning all education, housing, urban development, manpower, environment, and law enforcement programs back to states –Eliminating or privatizing 80 commercial subsidy programs –Undertaking significant fraud and abuse initiatives –Ending manned space flight –Ending earmarks for local highway construction –Slowing growth of NIH spending –Capping other discretionary spending
health The next century will be dominated by economic rivalry between trading blocs, in Europe, North America, along the Pacific Rim, and in the Caribbean Basin. In this new order, winners and losers will be determined by the quality of a country's infrastructure, the stability of its economy, and the health and education of its workers. John Chancellor
He who has health has hope He who has hope has everything.