“the American government remains the single-most important entity in global health. The US spent nearly $13 billion on global health programs in its 2023 fiscal year. It provides one-third of the funding to and has a permanent seat on the board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, an organization also started during the George W. Bush administration, which supports prevention and treatment for some of the world’s most deadly diseases in 130 countries.
The US iso the single largest contributor to the World Bank’s newly established Pandemic Fund. And along with the United Kingdom and the Bill and Melinda Gates Foundation, the United States underwrites much of the budget for Gavi, the Vaccine Alliance, which largely supports vaccine programs in developing countries and has contributed to the vaccination of nearly 1 billion children since its founding in 2000.
But the failure to reauthorize PEPFAR signals growing ambivalence among some US political leaders about funding health programs around the world. The internationalist “compassionate conservatives” of yesteryear, perhaps best embodied in George W. Bush’s presidency, have been pushed out of the Republican Party, replaced by Trump acolytes less interested in public health domestically or abroad. Donald Trump’s “America First” nationalism and the ferocious conservative backlash against public health authorities during Covid have unmoored a field that long viewed itself as above politics.”
“So why did U.S. life expectancy trends slow and then peak in 2014? And what, if anything, can policy makers and politicians realistically do to make increasing it a priority? As noted above, the big recent dip largely resulted from the COVID-19 pandemic. A 2023 Scientific Reports article “estimated that US life expectancy at birth dropped by 3.08 years due to the million COVID-19 deaths” between February 2020 and May 2022. But let’s set aside that steep post-2020 downtick in life expectancy resulting from nearly 1.2 million Americans dying of COVID-19 infections.
A 2020 study in Health Affairs chiefly attributed the 3.3-year increase in U.S. life expectancy between 1990 and 2015 to public health, better pharmaceuticals, and improvements in medical care. By public health, the authors meant such things as campaigns to reduce smoking, increase cancer screenings and seat belt usage, improve auto and traffic safety, and increase awareness of the danger of stomach sleep for infants. With respect to pharmaceuticals, they cited the significant reduction in cardiovascular diseases that resulted from the introduction of effective drugs to lower cholesterol and blood pressure.
So a big part of what propelled increases in U.S. life expectancy is the fact that the percentage of Americans who smoke has fallen from 43 percent in the 1970s to 16 percent now. Smoking is associated with higher risks of cardiovascular diseases and cancers, rates of which have been dropping for decades. In addition, the rising percentage of Americans who are college graduates correlated with increasing life expectancy.
However, since the 2004 peak, countervailing increases in the death rates from drug overdoses, firearms, traffic accidents, and diseases associated with obesity contributed to the flattening of U.S. life expectancy trends.
A 2021 comprehensive analysis of the recent stagnation and decline in U.S. life expectancy in the Annual Review of Public Health (ARPH) largely concurs, finding that “the proximate causes of the decline are increases in opioid overdose deaths, suicide, homicide, and Alzheimer’s disease.” Interestingly, the U.S. trend in Alzheimer’s disease prevalence has been downward since 2011. In addition, the ARPH review noted that “a slowdown in the long-term decline in mortality from cardiovascular diseases has also prevented life expectancy from improving further.” So enabling and persuading more properly diagnosed Americans to take blood pressure and cholesterol-lowering medications would likely boost overall life expectancy.”
“The CDC estimates 375,000 Americans died due to Covid-19 infection in 2020, and about 460,000 in 2021 — an almost incomprehensible loss of human potential.
In 2022, there were fewer Covid-19 deaths, but still a lot: 244,000.”
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“In 1980, US life expectancy was among the highest in the developed world; now, it’s one of the lowest. There are many possible reasons for this: Compared with other countries, the US’s health care system is one of the most difficult to afford and navigate, and invests less in preventive care than in high-tech treatment. The nation wildly underfunds public health, has a high prevalence of processed foods, and promotes overwork and underrest. And access to guns and opioids has made high rates of death due to both a uniquely American problem.
The prevalence of many chronic health conditions — along with smoking cigarettes, another important contributor to premature death and Covid-19 mortality — can be changed by policy choices.
“Improving the public health system, rebalancing the health care system more toward prevention, thinking about the social drivers of health more intensely, addressing major social challenges that sometimes are right in front of our eyes and associated with a lot of death,” said Sharfstein, “all of those things are going to be necessary” to improve Americans’ overall health.”
“The Centers for Disease Control and Prevention is calling for “urgent action” to address a tenfold rise over the last decade in cases of congenital syphilis — when the life-threatening infection is passed to an infant during birth. The agency found that the vast majority of the cases, nearly 90 percent, could have been prevented with better access to testing and treatment, a warning sign that vulnerable people are falling through the cracks of the American medical system.”
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“Syphilis is treatable with antibiotics, but if left untreated in pregnant people, the STD can cause stillbirth, miscarriage and infant death. Infants who don’t receive treatment could also develop blindness, deafness, developmental delays or skeletal abnormalities. In 2022, the infection caused 231 stillbirths and 51 infant deaths.
“It’s particularly difficult to get your head around the increases when we know that this is preventable,” Bachmann said. “If a pregnant person is screened and treated in a timely manner, we really should not have any syphilis in babies.””
“in 2022, the death rate for American infants increased for the first time in 20 years.”
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“rates of congenital syphilis — that is, syphilis infections acquired in the womb — have risen tenfold over the past decade.
Although a lot of different risk factors drive each of these trends, there’s an important one they have in common: bad — and worsening — health care access for mothers and babies.
In the US, the obstacles mothers face in accessing health care are too often insurmountable — and as this latest data shows, the consequences to American children are dire. Things might only get worse, some experts fear, as financial, political, and social pressures drive providers further from many of the places where they’re needed most.
“We only are hearing about more [obstetricians] leaving and more maternity wards closing,” said Tracey Wilkinson, a pediatrician who specializes in reproductive health issues at Indiana University’s medical school. “I am terrified about what the data is going to look like next year.””
“Almost four in 10 Americans — 38 percent — said that in 2022 they had put off medical care because of the cost, per Gallup. That is the highest number ever recorded since the polling firm started asking the question in 2001. Another survey, from KFF over the summer, found 28 percent had difficulty affording prescription drugs.
The truth is that insurance alone isn’t always enough to help people afford health care. The Commonwealth Fund concluded that 43 percent of Americans had been “inadequately insured” in 2022. That meant either they had been uninsured, had a gap in coverage during the year, or the insurance they had would not be adequate if they had an expensive medical emergency or diagnosis — for example, if their plan’s out-of-pocket costs could exceed 10 percent of their household income.
More than 40 percent of people said they had skipped care due to its cost, or they had trouble paying off medical bills, medical debt, or both.
It does not have to be this way. There is not one specific prescription for fixing health care. Countries have found various ways to make health insurance more affordable, standardized, and universal”
“Ashtabula’s problems stand out compared with two nearby counties – Erie, Pa., and Chautauqua, N.Y. All three communities, which ring picturesque Lake Erie and are a short drive from each other, have struggled economically in recent decades as industrial jobs withered – conditions that contribute toward rising midlife mortality, research shows. None is a success story when it comes to health. But Ashtabula residents are much more likely to die young, especially from smoking, diabetes-related complications or motor vehicle accidents, than people living in its sister counties in Pennsylvania and New York, states that have adopted more stringent public health measures.
That pattern held true during the coronavirus pandemic, when Ashtabula residents died of covid at far higher rates than people in Chautauqua and Erie.
The differences around Lake Erie reflect a steady national shift in how public health decisions are being made and who’s making them.
State lawmakers gained autonomy over how to spend federal safety net dollars following Republican President Ronald Reagan’s push to empower the states in the 1980s. Those investments began to diverge sharply along red and blue lines, with conservative lawmakers often balking at public health initiatives they said cost too much or overstepped. Today, people in the South and Midwest, regions largely controlled by Republican state legislators, have increasingly higher chances of dying prematurely compared with those in the more Democratic Northeast and West, according to The Post’s analysis of death rates.
The differences in state policies directly correlate to those years lost, said Jennifer Karas Montez, director of the Center for Aging and Policy Studies at Syracuse University and author of several papers that describe the connection between politics and life expectancy.
Ohio sticks out – for all the wrong reasons. Roughly 1 in 5 Ohioans will die before they turn 65, according to Montez’s analysis using the state’s 2019 death rates. The state, whose legislature has been increasingly dominated by Republicans, has plummeted nationally when it comes to life expectancy rates, moving from middle of the pack to the bottom fifth of states during the last 50 years, The Post found. Ohioans have a similar life expectancy to residents of Slovakia and Ecuador, relatively poor countries.
Like other hard-hit Midwestern counties, Ashtabula has seen a rise in what are known as “deaths of despair” – drug overdoses, alcoholism and suicides – prompting federal and state attention in recent years. But here, as well as in most counties across the United States, those types of deaths are far outnumbered by deaths caused by cardiovascular disease, diabetes, smoking-related cancers and other health issues for residents between 35 and 64 years old, The Post found. Between 2015 and 2019, nearly five times as many Ashtabula residents in their prime died of chronic medical conditions as died of overdoses, suicide and all other external causes combined, according to The Post analysis of the Centers for Disease Control and Prevention’s death records.
Public health officials say Ohio could save lives by adopting measures such as a higher tobacco tax or stricter seat-belt rules, initiatives supported by Gov. Mike DeWine, a Republican generally friendly to their cause.”
“the White House points to a 2022 report to Congress from the Health and Human Services, Labor and Treasury departments, which found that not one of the 156 insurance plans and issuers studied were following rules requiring them to measure their compliance with the 2008 law.
The problem is actually quite simple, advocates of the Biden rules say.
“The insurers are cracking down on mental health reimbursement in order to save money,” said Sen. Chris Murphy (D-Conn.).”
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“Estimates vary, but the latest data from HHS indicates that more than half of adults with mental illness don’t get treatment. Treatment levels may be even lower for substance use conditions like opioid use disorder”
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“The new proposed regulations, from HHS and the Treasury and Labor departments, are open for public comment until Oct. 2.
If finalized, they would mandate that insurers analyze their coverage to ensure equivalent access to mental health care based on outcomes.
The companies would have to look at how they respond to requests from doctors to authorize treatments for mental illness, compared with physical ones, as well as audit their provider networks and examine how much they reimburse providers out of network.
“This is something that you would have expected the issuers and plans to be doing as part of their own internal analysis to ensure compliance,” said JoAnn Volk, co-director of the Center on Health Insurance Reforms at Georgetown University.”
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“Insurers say they agree that access to mental health care should be equivalent to that of physical health care.
But AHIP, the lobbying group for insurers, says the situation is more complicated than Biden makes out, and that workforce shortages are what’s behind barriers to care.
“Access to mental health has been, and continues to be, challenging primarily because of a shortage and lack of clinicians, which is why for years, health insurance providers have implemented programs and strategies to expand networks and increase access,” AHIP spokesperson Kristine Grow said in a statement.
The group said those include boosting telehealth coverage and integrating physical and mental health care. And it points to rising mental health care usage since the 2008 law as evidence that the law is working.”
“On abortion, on health care for transgender people, even on mental health care, the candidates were comfortable flexing governmental authority to dictate the terms of medical treatment.
But when it comes to using that same authority to protect people during a global pandemic or providing health coverage to people with low incomes, they don’t want the government getting involved.”