Tag Archives: Health

The despair and death of America’s middle-aged women

America’s insistence that health care is a private matter and not a public responsibility has finally delivered some clear policy results. The rise in a population’s death rate shows something is wrong.


April, 2016

As Donald Trump arouses humour, fear, and world skepticism about this fall’s American elections, new reports reveal a wild card in the political mix. People are dying to get out of middle America. Social supports have been so weak and wages have been so low that mortality rates for midlife rural Americans are increasing, after more than a century of decreasing. Let me say that again: while life expectancy is rising in the developed world and much of the developing world, heartland Americans are dying in their prime years, especially middle-aged white women.

“The statistics show decaying health for all white women since 2000,” wrote Joel Achenbach and Dan Keating in the Washington Post. “The trend was most dramatic for women in the more rural areas. There, for every 100,000 women in their late 40s, 228 died at the turn of this century. Today, 296 are dying. And in rural areas, the uptick in mortality was noticeable even earlier, as far back as 1990. Since then, death rates for rural white women in midlife have risen by nearly 50 per cent.”

A December 2015 report in the National Academy of Sciences in the United States of America compared this contrary trend to the AIDS crisis: “If [the white mortality rate for ages 45-54] had continued to decline at its previous (1979-1998) rate, half a million deaths would have been avoided in the period 1999-2013, [a number] comparable to lives lost in the U.S. AIDS epidemic through mid-2015.”

Worse, health surveys found that fewer U.S. rural folks reported excellent health than previous generations had done. Chronic illnesses were on the rise. For every one of those half million avoidable deaths, many live on with their disease or addiction, in pain and with limitations.

You may wonder how this could be happening in America. American experts blame bad habits. The NAS report and the extended Washington Post follow-up cited many prevalent health issues, such as obesity, heavy drinking, smoking and opioid addiction.

Certainly some kind of self-destructive behaviour is going on. In 2011, “Poisoning, Drug Poisoning and Drug Poisoning Involving Opiods” overtook lung cancer as the leading cause of death among Americans 45 -54, says the NAS report, with suicide a close third. Then come chronic liver diseases and, way at the bottom, diabetes.

Just as Canada has a fentanyl crisis, the U.S. has a catastrophic opioid crisis — which many believe was created by doctors dispensing Oxycondin for pain as liberally as they once prescribed Valium for depression. When they stopped, their patients had to find other, riskier, resources. Opioids are cheaper and more available than, say, knee replacement, for folks who live paycheque to paycheque and can’t afford health insurance.

Post reporters investigated geographic areas that showed very high-mortality rates. “In Victoria County, Tex.,” says the Post article, “a rural area near the Gulf Coast, deaths among women 45 to 54 have climbed by 169 percent [between 1999 and 2013], the sharpest increase in that age group of any U.S. county. The death rate climbed from 216 per 100,000 people to 583.”

Likewise, “A 2013 study at the University of Wisconsin looked at the geography of death and discovered that mortality for women of all races had risen in 43 per cent of U.S. counties between 1992 and 2006. Men’s mortality had risen in only 3 per cent of counties.”

Investigators found that about one-third of Victoria County’s population is obese, and one-fifth smoke cigarettes. The article quotes the health department medical director saying that she personally knows many, many white women with cancer. “It’s kind of weird,” she said.

The Post cited stress caused by women’s changing roles as causing obesity, smoking, and of course, heavy alcohol use. The NAS study cites these typical rural women’s health issues and allows that the 2008 financial crash might have played a role.

Apart from those mentions, I keep searching the reports in vain for some mention of social, economic and environmental factors. For example, Victoria County, Texas, is a major coastal crossroads that lies on a bay off the Gulf of Mexico, adjacent to a Texas county that received compensation for the BP Horizon underwater oil gusher. A cancer cluster might signal environmental contamination.

Let’s suggest a few other reasons that might expose poor women to potentially lethal risk of  poor health:

  • Before the Affordable Care Act was recently introduced, the U.S. was the only world power without universal health care coverage. If NAS repeats this study in five years, some findings may be different.
  • Contrariwise, the US is the only country with nearly universal access to guns. One report found that, “Someone with access to firearms is three times more likely to commit suicide and nearly twice as likely to be the victim of a homicide as someone who does not have access.”
  • The Republican party’s “War on Women” particularly attacked women’s ability to control pregnancy. Multiple pregnancies plus poverty plus insufficient health care equal poor prognoses for mother as well as child. The Post notes that the women who are dying are “of reproductive age,” (45 – 54), which is mostly true, although pregnancy and childbirth are riskier for women in their 40s.
  • Republican governments also instituted “workfare” programs that require welfare recipients (a majority of whom are white) to hold jobs or to perform community service — and that contain lifetime limits on single parents’ eligibility for benefits. Trapped in workfare jobs, single mothers had barely time to spend with their children, much less improve their education or prospects. They’re the ones who were hurt first by these welfare “reforms.”
  • Between the internet and international trade agreements, whole industries are disappearing from local job markets. People may re-train two or three times as their jobs are outsourced, and still never find a stable career.

In a sense, America’s insistence that health care is a private matter and not a public responsibility has finally delivered some clear policy results. I believe there’s consensus that when a population’s death rate rises, something is wrong. Here are my conclusions:

1) For-profit medical care fails massively. In other countries, people who get sick seek out medical help. They present themselves to the doctor, the nurse practitioner, the walk-in clinic, the ER, or the urgent care clinic, and they ask for help. There’s no shame and no expense.  When people have to worry about whether they can pay the doctor – especially for intractable chronic conditions like strained backs – they tend to avoid the effort and instead self medicate, as they get sicker and sicker.

2) Separation makes people vulnerable. U.S. policy emphasizes individualism as opposed to community strength.  People are expected to follow their work or their dreams, and not to settle down next to their parents. In countries that stress community rather than individuality, mortality rates are still holding steady or dropping.

3) Americans urgently need research to count up how many women were pregnant or post-pregnant when they died, in the states that passed regressive anti-abortion measures. Argentina has strict anti-abortion laws, which Human Rights Watch says “are the leading cause of maternal mortality in this country” for as long as Argentina has had statistics.  If women are dying in mid-life because of initiatives supposedly for “the sanctity of all life,” voters should know it.

4) Finally, women cannot carry the extra weight. The perennial policy of relying on women’s unpaid work to make up for scarcer and scarcer resources is totally bankrupt. Weak flesh can only take so much. America would be alarmed if middle-aged women were robbing banks or blowing up legislatures. But women dying? The response is, “What else is new?” With welfare payments restricted, the only safety valve seems to be disability payments, already attracting swelling numbers of people.

America’s heartland is in despair. The people there have been failed by the economy and the medical system. Desperate people will believe anything and do anything – maybe even vote for Donald Trump. They’re living in a tempest. The world will reap the whirlwind.

Copyright Penney Kome 2016

Contact:  komeca AT yahoo.com
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Penney KomePenney Kome is co-editor of Peace: A Dream Unfolding (Sierra Club Books 1986), with a foreward by the Nobel-winning presidents of International Physicians for Prevention of Nuclear War.

Read her bio on Facts and Opinions.

Contact:  komeca AT yahoo.com




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WHO report takes aim at Grim Reaper of “lifestyle”


Photo by Robyn Lee via Flickr, Creative Commons

Some 16 million people die prematurely each year because of preventable, non-communicable diseases. So-called “lifestyle diseases” affecting the heart and lungs, and stroke, cancer and diabetes, are among humanity’s biggest threats, warns a new report by the World Health Organization. Photo by Robyn Lee via Flickr, Creative Commons

By Alessandro R Demaio, Harvard University 
January 19, 2015

The World Health Organization (WHO) has just released its Global Status Report on Noncommunicable Diseases, the second in a series tracking worldwide progress in the prevention and control of cancers, lung disease, diabetes and cardiovascular disease. It focuses on how to reach the internationally agreed overarching target of a 25% reduction of premature mortality from these four major non-communicable diseases by 2025.

Outlined in 2013, the target is to be reached via nine goals including reducing harmful use of alcohol, increasing physical activity and lowering salt or sodium intake as well as tobacco use. They also include halting the rise of diabetes and obesity and improving coverage of treatment and prevention of heart attacks and strokes. There’s also a goal for improving the availability and affordability of technologies and essential medicines for non-communicable diseases.

For those who don’t follow the machinations of the WHO, this may all seem a little confounding, or even esoteric. But don’t let the almost innocuous title fool you – non-communicable diseases are one of the biggest threats facing humanity today.

Non-communicable diseases, which are sometimes called “lifestyle” or “chronic diseases”, are caused by common risk factors. The good news is that they can also be prevented by largely shared strategies. Tobacco control, for example, helps reduce cancers, heart disease, stroke and lung diseases – all of which are non-communicable diseases. Improving the diet of populations will help avoid obesity, cancer, diabetes and heart attacks – also all non-communicable disease.

Non-communicable diseases were of little public health concern as recently as a couple of decades ago, but their burden has since skyrocketed. The prevalence of diabetes in Australia, for instance, has more than doubled in the last 25 years, from about 2% to 4%. In the United Kingdom and United States, the number of people living with diabetes has more than doubled and tripled, respectively.

The picture is even grimmer in the developing world. Over the same period as above, the prevalence of diabetes in China rose even more starkly, from 1% in 1980 to almost 12% today – or 114 million people.

Non-communicable diseases now kill more people than any other cause across the world; they were responsible for 38 million (68%) of the world’s 56 million deaths in 2012. More than 40% of them (16 million) were premature deaths – that is, the people who died were under the age of 70 years.

Almost three-quarters of all such deaths (28 million), and the majority of premature deaths (82%), occur in the world’s low- and middle-income countries.

Today’s WHO report aims to outline the how to for governments around the world, providing the most effective methods for achieving these goals. But for those of us not in positions to make decisions that could stop the wave of non-communicable diseases, here are seven key lessons from this latest update.

1. Bad news for the poor

Non-communicable diseases cause poverty and poverty causes non-communicable diseases. The burden of these diseases is concentrated in poor and sometimes the poorest populations. It acts as a barrier to economic development and has the potential to undo the progress of the past few decades.

Even in developed countries, such as the United States, research shows a strong link between poor counties and higher risk of obesity and related diseases.

2. Some countries are doing better

While some countries are doing well in the fight against these illnesses, many are not doing much to address their risk factors and impacts. The report urges governments to take heed of the growing evidence base and proven case studies from around the world in the fight against non-communicable diseases.

These include Australia’s efforts in plain packaging tobacco, the UK’s food labelling laws and the growing number of nations with childhood junk food advertising bans and taxes on junk food.

It also points to the many gaps in national policies globally. This is particularly an issue in low- and middle-income countries, which often face fierce opposition and even legal challenge from the private sector, just as Australia is facing the challenge to its plain packaging law in the World Trade Organisation.

3. Governments need to start acting

Government inaction is often not a matter of a lack of money, but money ill-spent, according to this report. Cost-effective interventions are available for avoiding a third of all cancers and 80% of heart disease and diabetes. Governments just have to choose and invest wisely – and we have to demand this of them.

This challenge is not just a risk to health either. Research reported in the American Diabetes Association journal states that the links between obesity, inactivity and poverty may be too costly to ignore. Non-communicable disease including obesity-associated chronic disease already account for 70% of all US health costs.

4. Talk is cheap

The nine voluntary global targets for the prevention and mitigation of non-communicable diseases are an important start, but the WHO is calling on governments to also set local targets and ways of monitoring their achievements. This would allow countries to tailor their efforts and interventions for greater effectiveness. It would also help them target the non-communicable disease most affecting their populations.

5. Not just health

Non-communicable diseases are caused – and so can be solved – by collaboration across traditionally divided actors and sectors, including agriculture and food production, urban planning, water and air management, transport and engineering, among others.

For a new challenge, we need new platforms for change. Consider the EAT Stockholm Food Forum, which is a multilateral platform convening leading scientific, policy, private sector and civil society thinkers on the interrelated challenges of non-communicable diseases, food systems and climate change.

6. Investing in health systems

The report is a reminder that spending on health is an investment – both economic and social – and that it must be seen as such. Even countries with strong health-care systems can do better, and the key is prevention.

Investing in cost-effective strategies that will nip non-communicable diseases in the proverbial bud is our only hope if we are to afford an ageing population, the rising obesity burden and the greater expected burdens of chronic disease.

7. A new type of health worker

The report reinforces the idea that, as the major diseases affecting the population change, so too must the skills of doctors, nurses and other health staff.

Prevention, public health and public policies are the most effective responses to reducing non-communicable diseases without blowing health-care budgets, so we need to start teaching talking about them in courses that are not related to health. We need to start talking about the causes and ways to prevent these diseases with urban planners, food experts, agriculturalists and agronomists, and economists, to name just a few related professions.

Non-communicable diseases are a growing, urgent and universal health challenge affecting almost every one of us. These diseases and their environmental, commercial and social drivers are here to stay, unless we take local and international action. The WHO is urging governments – and those who vote them in – to prioritise action on this rising global burden.

Creative CommonsThe Conversation

Alessandro R Demaio

Alessandro R Demaio

Dr Alessandro Demaio is a Postdoctoral Fellow in Global Health and NCDs at Harvard Medical School and an Assistant Professor at the Copenhagen School of Global Health.

Click here for his website

This article was originally published on The Conversation. Read the original article.








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