Health, Medicine and Justice
Designing a Fair and Equitable Healthcare System

By Joshua Freeman, M.D.

Buy the book HERE at Amazon

Joshua Freeman is a leader in primary care, both as a practitioner and as an academic, being the Chair of the Department of Family Medicine at the University of Kansas Medical Center.

He has an excellent understanding of our disorganized health care system and of the social determinants of health and health inequities. He has studied extensively medicine and social justice, and shares his views through his blog.

This book brings to print the basis of his passionate activism in support of equitable health care for all.

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Contents

Chapter 1:  Why Do We Have a Healthcare System?

Chapter 2:  The U.S. Healthcare System: Best in the World?

Chapter 3:  The Social Determinants of Health and Health Inequities

Chapter 4:  Impact of the U.S. Health System on the Health of the Public

Chapter 5:  Primary Care: The Essential Basis for an Effective Healthcare System

Chapter 6:  The Role of Medical Education in Perpetuating the Health System

Chapter 7:  Graduate Medical Education

Chapter 8:  Assessing Appropriate Healthcare: Sometimes the Best Thing to Do Is Nothing

Chapter 9:  The Role of Profit in U.S. Health Care

Chapter 10:  Solutions and Projected Outcomes

We know that living in a poor community makes you less likely to live a long life. New evidence suggests that living in a community with high income inequality also seems to be bad for your health.

For original article and interactive U.S. map, click on link:

A study from researchers at the University of Wisconsin Population Health Institute examined a series of risk factors that help explain the health (or sickness) of counties in the United States. In addition to the suspects you might expect — a high smoking rate, a lot of violent crime — the researchers found that people in unequal communities were more likely to die before the age of 75 than people in more equal communities, even if the average incomes were the same.

“It’s not just the level of income in a community that matters — it’s also how income is distributed,” said Bridget Catlin, the co-director of the project, called the County Health Rankings and Roadmaps.

Many factors besides inequality affect health, of course. How much people smoke, whether they are obese, and the safety of air and water, among many other factors, make a difference. But the effect of inequality was statistically significant, equivalent to a difference of about 11 days of life between high- and low-inequality places. The differences were small, but for every increment that a community became more unequal, the proportion of residents dying before the age of 75 went up.

The research on inequality at the county level is new, but existing literature suggests there are relationships between income inequality and life expectancy among countries in the world. “Inequality effects, over and above average income, are pretty well established,” said S.V. Subramanian, a professor of population health and geography at Harvard, who has studied the phenomenon. We know that inequality tends to concentrate income in fewer hands, creating more low-income households — and people in low-income households don’t live as long. But what causes the drop in life expectancy is debatable.

One theory is that while money does tend to buy better health, it makes a bigger difference for people low on the income scale than those at the top. That means that having fewer very poor people in a community will improve average health more than having fewer very rich people will diminish it.

But another, more sociological theory, has to do with the communities themselves. The researchers think that places where wealthy residents can essentially buy their way out of social services may have less cohesion and investment in things like education and public health that we know affect life span. There is also literature suggesting that it’s stressful to live among people who are wealthier than you. That stress may translate into mental health problems or cardiac disease for lower-income residents of unequal places.

The researchers measured inequality by comparing the incomes of people in a given place who earned the 80th percentile in the county with the incomes of those in 20th percentile. Then they measured life expectancy using a custom measurement they developed — it counts the “potential life years lost” in each community by measuring all those who died before the age of 75, and the age at which they died. So someone who died at age 70 would have five years of potential life lost. Then they adjusted the numbers according to how old people were in the county, so counties with more old people wouldn’t look sicker than counties that were younger. The study looked at only the average life span and not that of higher-income versus lower-income residents.

For every one-point increase in the ratio between high and low earners in a county, there were about five years lost for every 1,000 people. That’s about the same difference they observed when a community’s smoking rate increased by 4 percent or its obesity rate rose by 3 percent. Researchers said that inequality effect persisted even when they compared communities of similar average income and racial composition.

Here’s what that means in some real counties. The researchers compared the adjoining Park and Fremont Counties in Wyoming. Both have relatively small populations and are predominantly white. Both include parts of large national parks. But the Fremont inequality ratio is 4.6, compared with Park’s 3.6. And, in Fremont County, there are 13 years of potential life lost for every 1,000 residents, compared with only 7.5 in Park.

February 26, 2015

Banksy’s Gaza Kitten Is Shaming Your Internet Habits

By Claire Landsbaum

http://www.vulture.com/2015/02/new-banksy-video-features-cute-gaza-kitten.html?om_rid=AABuUy&om_mid=_BU74lVB8-nFeI0

No one throws a guilt trip quite like Banksy.

Case in point: The street artist just released a two-minute video (see link below)  that shows him sneaking into Gaza to embellish the area’s bombed-out ruins. The video satirizes travel ads in typical heavy-handed Banksy style.

It also features three new pieces: a man knelt in grief, children using an Israeli guard tower as an amusement-park ride, and a kitten with an enormous pink bow. “A local man came up and said ‘Please — what does this mean?”” Banksy writes in the kitten’s caption. “I explained I wanted to highlight the destruction in Gaza by posting photos on my website —but on the internet people only look at pictures of kittens.” He isn’t subtle, but he gets his point across.

  SEE VIDEO:     http://youtu.be/3e2dShY8jIo

“Income inequality” has already become a buzz phrase for the campaigns leading up to the 2016 elections. Likely candidates and pundits on both ends of the political spectrum have begun to talk about how fairness, social justice and—even after the implementation of the Affordable Care Act—the cost of health care insurance are contributing to the large and growing gap between the rich and poor.

February 26, 2015
by Mark Wheeler
http://medicalxpress.com/news/2015-02-income-inequality-wages-toll-health.html

But a commentary by researchers at the UCLA Fielding School of Public Health points out another disturbing impact of income inequality: its effect on people’s health. The article appears in the current online edition of the American Journal of Public Health.

America’s most typical adults would be three-times richer if the United States distributed wealth as equally as France does.

Posted on January 12, 2015
by Sam Pizzigati

http://inequality.org/putting-pricetag-inequality/#sthash.dqyGeCBH.dpuf

How much does inequality cost the average American family? What price do we pay, in actual dollars and cents, for tolerating an economy fixated on pumping our treasure to the top?

That question has no simple answer. Inequality, after all, imposes upon us a wide range of costs that don’t easily reduce to dollars and cents.

How much, for instance, should we value an added year of life? We know — from literally hundreds of research studies over the years — that people live longer, healthier lives in more equal nations.

France and the United States have about the same wealth per adult. But France’s more equal wealth distribution makes a huge difference for average families.

We also know that more equal societies have lower levels of mental illness and fewer teenage pregnancies, fewer homicides and higher levels of trust. How do we place dollar signs on quality-of-life indicators like these? That can get complicated.

On the other hand, dollar signs do come easy when we’re talking about income and wealth. So let’s limit our exploration into the price we pay for tolerating inequality to just these two yardsticks.

The Economic Policy Institute has gone through one exercise along this line. How much income would middle class Americans be making today, EPI researchers asked, if the United States had the same distribution of income today as our nation had back at the end of the 1970s?

The difference between now and then could hardly be starker. Since 1979, households in America’s top 1 percent have more than doubled their share of the nation’s income, from 8 to nearly 20 percent.

What if this increase in inequality had never happened? What if middle class American households were taking in the exact same share of the nation’s income they took in four decades ago?

Economic Policy Institute researchers focused their calculations on 2007, the last year before the Great Recession. In that year, the average middle class income in the United States — the average for the middle 60 percent of American households — amounted to $76,443.

But if middle class households in 2007 lived in an America as equal as the America of 1979, that average income would have been $94,310. In other words, inequality is costing the average American middle class family about $18,000 a year.

That’s comparing, remember, America today with America yesterday. But the global economy, some might argue, has changed fundamentally over the past four decades. We live in a different world. Simple comparisons of then vs. now no longer tell us much.

The United States ranks as the world’s most unequal major developed nation.

For argument’s sake, let’s accept this rather dubious claim — and make a different comparison. Let’s compare the wealth of ordinary Americans today with the wealth of ordinary people in more equal nations.

France makes for a good comparison. France and the United States, the research institute of the Swiss bank Credit Suisse reported last fall, have about the same total wealth per adult.

If you divide the wealth of the United States by our adult population, you end up with $347,845 per adult. If you do the same computing with France’s wealth and population, you end up with $317,292 per adult. The average American would have, in sum, slightly more wealth than the average person in France if both nations divvied up their wealth on a totally equal basis.

But total equality, of course, reigns in neither France nor the United States. The United States ranks as the most unequal major developed nation in the world. France ranks as more equal than nations like the United States and Britain, but less equal than nations like Japan and Sweden.

In France today, “median” adults — those with more wealth than the poorest half of France’s adult population but less wealth than the richest half — have $140,638 in net worth to their name.

In the United States, by contrast, median adult wealth stands at a mere $53,352.

The bottom line? If the United States had as equal a distribution of wealth as France, typical American adults today would have almost triple their current net worth.

So how much does inequality matter to America’s middle class? More than we realize. Much more.

Sam Pizzigati edits Too Much, the Institute for Policy Studies monthly on excess and inequality. His latest book: The Rich Don’t Always Win: The Forgotten Triumph over Plutocracy that Created the American Middle Class, 1900-1970.