What About Health Care Everywhere Else?

The U.S. Congress passed a historic health care bill last night, hopefully ending the plight of the uninsured in the United States.  That number now includes over 30 million people but, over the next couple of years, should shrink to zero.  What about health care everywhere else? 

The news is both bad and good, as presented in this comprehensive 2008 World Health Organization report (PDF).  

In general, around the world, fewer people, especially children, are dying of disease. Compared to 1978 rates, in 2006 9.5 million fewer children died, a trend the WHO attributes mainly to technological advances.  

One example of success is Oman, which has invested serious resources in building a national health system since the 1970s. Almost all of the nation’s 2.2 million citizens now have health care, and their life expectancy has increased by 14 years (from 60 to 74). 

It should be no surprise that there have also been some disheartening trends. First, the gap between care available to the rich and the poor is widening, and, in some cases, the poor have worse health care than they did in the past.

Three distinct groups have emerged.  Two-thirds of the planet lives in countries that have experienced both impressive GDP and life expectancy growth since 1978. This includes some countries in Latin America, Asia, and northern Africa that have increased life expectancy by 12 years and GDP by a factor of 2.6, even while their combined population almost doubled to 2 billion. 

The second group, mainly Russia, its former republics, and China saw increased GDP but modest life expectancy growth.

The third group, representing 10 percent of the world population, saw stagnating GDP and life expectancy. Most nations in this group has seen debilitating conflict in the last 30 years, and, so, of course, the first step to better health and prosperity in these nations is peace. However, that somewhat obscures the fact that more money spent on health care has lead, almost universally, to longer lives.  In fact, every $100 per capita spent on heath corresponds to a 1.1-year gain in life expectancy. In 2005, 45 countries spent less than $100 per capita. Needless to say, it also matters what you spend that money on; the WHO saw a wide variance of success dependent on where nations spent their health care dollars, particularly on the lower end of overall expenditures, where government “inefficiencies” had a big effect.

Second, global “success” in general and our enhanced ability to keep people alive has presented new and difficult challenges:

Ageing and the effects of ill-managed urbanization and globalization accelerate worldwide transmission of communicable diseases, and increase the burden of chronic and noncommunicable disorders. 

The WHO points out that more children now die in traffic accidents in Africa than in the developed world, due in large part to the massive urban migration occurring in the developing world.  Needless to say, life in the slums presents many health issues and, if those areas are not properly governed, can lead to plummeting life expectancy rates. In Nairobi’s posh areas, under-five mortality is 15  per thousand. In the Emabakasi slum, it’s 454 per thousand. 

And, of course, the needs of the ageing are changing the face of health care, everywhere. By 2050, 2 billion people will be over 60, mainly living in cities in the developing world and carrying multiple, chronic conditions, which puts a crunch on available funds.

And finally: 

Unregulated commercialization is accompanied by a blurring of the boundaries between public and private actors, while the negotiation of entitlement and rights is increasingly politicized.

Anyone who has been following, even from a distance, the health care debate in the U.S. probably has an inkling of what the WHO means here. For those who haven’t, I suggest tackling the full WHO report (PDF), a great read that delves into detail beyond my pay grade.