“The stagnation in life expectancy isn’t due to some natural limit of human lifespans. In 2019, life expectancy was 84.4 in Japan, 83 in France, and 81 in the United Kingdom and Germany. The US, with its life expectancy of 78.8 years, was already lagging before the pandemic.”
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“The relatively poor health of the US is rooted in “fundamental causes,” according to epidemiologists Bruce Link and Jo Phelan. These are the social conditions like economic inequality and racial segregation that worsen some illnesses and reduce access to health care. In the US, solutions could also include policies that replace jobs in towns and cities that have been hollowed out by globalization and deindustrialization. The dignity of meaningful work can improve health.
Of course, we should not ignore the gains that can be made within medicine. I don’t mean high-profile technological advances that will make headlines or boost the bottom line of new biotech startups. I mean routine and preventive care that can detect disease early, help get patients into treatment, and provide a trusted source of medical advice.
Rather than wringing our hands about the Covid-19 life-expectancy dip, the US should be passing laws and expanding programs that draw medical workers into primary and preventive care, not least by paying them more. This is especially true in rural areas with aging populations and a shortage of doctors. Training more Black doctors, especially in obstetrics and gynecology, may lead to dramatic improvements in the shamefully bad maternal health outcomes among Black women in the US.
By focusing on one historical measure of years lost to the pandemic, we run the risk of dwelling on what we can’t change and ignoring what we can improve. If you want the next generation to live longer and healthier lives, one of the best things you can do is push for economic and health care policies that reduce economic and racial inequality, and help ensure that every person has access to the kind of world-class, routine health care that saves lives. Let’s give the demographers of 2110 something to celebrate.”
“relatively little attention has been paid to what the Taliban victory will mean for one of the nation’s biggest accomplishments: the sharp decline in child and maternal mortality over the past two decades.
A study in The Lancet Global Health found that between 2003 and 2015, child mortality in Afghanistan fell by 29 percent. While maternal mortality is difficult to estimate, one data set found that deaths in childbirth fell from 1,140 per 100,000 in 2005 to 638 per 100,000 in 2017, or nearly in half.
This progress was not necessarily all generated by the US-led occupation, with aid from international organizations and Afghan-led initiatives contributing heavily; and these estimates rely on household surveys that are difficult to conduct well, especially in poor, war-torn countries with large nomadic populations, meaning they are likely off to some degree.”
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“The best-case scenario would be a continued emphasis on the health of women and children, expansion of the developing public health sector — including nutrition, water, sanitation, and housing — and attention to the emerging problem with chronic or noncommunicable diseases.
The health workforce needs continuing support. Things can go bad if restriction of women, both as a health focus and in the workforce, occurs and ideology starts getting in the way of health programming. The health of Afghanistan cannot move forward without continuing external support, and this is likely to be required for some years to come, regardless of who is the government. A plunge back into war and instability is the very worst case imaginable for the health of the country”
“There is an underappreciated contributor to the United States’ comparatively poor health: We underinvest in social services that help people live healthier lives and therefore overspend on medical care relative to other developed countries.
The long-term trends in US health care, as I wrote about earlier this week, tell a clear story: Medical outcomes have gotten better, with measures of life expectancy and disease burden improving over the last 25 years, but they haven’t improved as much as they have in other wealthy nations that spend less money on health care than the US.”
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“If you combine social services spending with health spending, the US and its peers spend about the same amount of money (a little more than 30 percent of their respective GDPs). But spending in those other countries is weighted more toward social support — food and housing subsidies, income assistance, etc. — whereas America spends more on medical care.”
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“Eighteen percent of people in the US live in poverty, compared with 10 percent in other wealthy countries. And we know that people with lower incomes face many structural challenges — lack of access to healthy food, clean water, and fresh air, for starters — that lead to worse health outcomes. When they get sick, they have a harder time both finding a doctor and affording their medical care. In general, they also live with more stress and anxiety than people who make more money, which also has deleterious effects on their health.”
“It’s been 10 days since Joel Valdez was shot outside of a Houston grocery store, and he still hasn’t been able to undergo surgery, due to his hospital being overcrowded with COVID-19 patients.”
“The proposed Advanced Research Projects Agency would deliver breakthrough treatments for cancer, Alzheimer’s, diabetes and other diseases and reshape the government’s medical research efforts, by adding a nimble new agency modeled on the Pentagon’s Defense Advanced Research Projects Agency, or DARPA, which laid the groundwork for the internet.
But the way Biden would make “ARPA-H” and its $6.5 billion budget part of the sprawling National Institutes of Health is raising concern within the research community and in Congress about whether it will bring a new approach to old problems or become a duplicative bureaucracy with a lofty mandate.
“Most of us did not support putting this in NIH, for the simple reason that if NIH were capable of doing this, it would have done it,” said one person outside the government familiar with the planning who’s worried NIH’s staid culture and leadership will bog down the effort.
A half dozen individuals both inside and outside the administration who were involved in discussions about the plan told POLITICO there are alternative approaches being discussed, like putting ARPA-H well outside of Washington, to escape some of the Beltway’s inertia and turf battles. More autonomy could, in theory, speed up the way scientific discoveries are turned into drugs and diagnostic tests.
But the prevailing view is that making the new agency part of NIH’s infrastructure will give it a foundation to spring off — and foster communication to head off unnecessary duplication. As Congress prepares for hearings on the first budget proposal, administration officials are expressing confidence ARPA-H can carve out a distinct identity, wherever it is.”
“Washington state first approved its public option in 2019 and made it available to consumers for enrollment in 2020. The state now has a year of experience getting the Cascade Care program up and running, and it’s already starting to tinker with the policy design. It’s also offering lessons for Colorado and Nevada (the other state to pass a public option this year, one week before Colorado).
As these states have drawn up their plans, one thing has become clear: The potential value of a public option is in keeping health care costs in check by keeping rates lower than those of private insurance plans. But it still remains to be seen whether a public option can expand health coverage to more people.”
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“None of the states offer a “public” option like the one Congress contemplated in 2009, where the government sets up and administers its own health insurance plan.
“None of them are true public options in that sense,” says Katie Keith, who writes about insurance reform for Health Affairs and consulted with states as they developed public option legislation.
Instead, she compares them with public-private partnerships. States are contracting with private companies to create new insurance options to be overseen, if not run, by the government. States would face practical challenges to doing a “true” public option — namely, building up the financial reserves they’d need to pay out claims — so they’re taking another approach wherein private insurance companies will run the public option under rules set by the government.”
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“The plans will be sold on the ACA marketplaces, alongside ACA-compliant private insurance. Only people who are eligible for ACA coverage through the individual and small-group market can sign up”
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“How much to pay health care providers is the most important issue for any health insurance plan — those prices dictate the premiums charged to customers — and these states are taking divergent approaches in their calculations.”
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“One challenge in trying to set lower provider rates is that doctors and hospitals might simply choose not to accept the public option plan. That was Washington’s experience in its first year: Some hospitals refused to contract with the public plan, and since an adequate provider network isn’t possible without a hospital, the plan has only been available in 19 of the state’s 39 counties.
Washington is trying to correct that issue through recently signed legislation that will, among other things, require hospitals in large systems to participate in at least one public option plan. Nevada and Colorado, having seen Washington’s network-adequacy issues, are setting up their own provider participation requirements from the start.”
“But it’s one thing to come up with a vaccine, and entirely something else to manufacture it on a mass scale. That’s where the world has stumbled and where concerted planning now can make sure we’re prepared for the future. If we’re to have a better chance to fight the next pandemic — and there will be a next one — the US needs to build on these vaccine tech innovations and make investments to establish permanent facilities producing mRNA and adenovirus vaccines.”
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“that slack won’t arrive naturally.
Weber, the former assistant secretary of defense for biodefense, has pushed for what he dubs a “10 + 10 Over 10” plan to prevent biological threats in the future. It is essentially a big government investment that could enable the kind of infrastructure necessary to have gotten to full vaccine availability in the US in, say, one or two months, not five.
The plan calls for $10 billion in additional annual funding for the Department of Defense, and another $10 billion per year for the Department of Health and Human Services, devoted to anticipating pandemic and other biological risks, for at least 10 years.
With that funding, government could finance the infrastructure for year-round vaccine manufacture.”
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“The key is that these facilities need to be active during non-pandemic times, otherwise their expertise and readiness could deteriorate.”
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“Pharmaceutical companies are not going to go this big on their own, and there’s no guarantee that the government will fund them sufficiently without pressure. In 2020 — during the pandemic — the Trump administration cut the DOD’s chemical and biodefense programs by 10 percent, with much of the cuts going to the vaccine component of the budget. To set this vision in motion, the US needs to not just reverse cuts like that but spend much more, in line with Weber’s $20 billion per year proposal.”
“Studies on marijuana use during pregnancy are inconsistent and inconclusive. But cannabis is not known to be teratogenic—that is, to cause birth defects—in humans. The bulk of scientific evidence suggests that risks posed to developing fetuses are relatively minor and babies exposed to marijuana in utero still fall within normal ranges of outcomes.
A 2020 review looked at longitudinal studies on “the impact of prenatal cannabis exposure on multiple domains of cognitive functioning in individuals aged 0 to 22 years” and found that “evidence does not suggest that prenatal cannabis exposure alone is associated with clinically significant cognitive functioning impairments.” Researchers did note some differences—”those exposed performed differently on a minority of cognitive outcomes (worse on < 3.5 percent and better in < 1 percent)" — although "cognitive performance scores of cannabis-exposed groups overwhelmingly fell within the normal range."
A 2016 review of studies on potential ties between in utero marijuana exposure and adverse birth outcomes—things like low birth weight and preterm delivery to miscarriage and stillbirth—found "maternal marijuana use during pregnancy is not an independent risk factor for adverse neonatal outcomes after adjusting for confounding factors." Instead, any increases in adverse outcomes appeared "attributable to concomitant tobacco use and other confounding factors.""
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""The best new evidence on this comes from a 2019 study out of Canada," Oster writes. Matching women who used cannabis with demographically similar women who didn't, researchers did "find evidence of worse birth outcomes among the cannabis users," including "an increased risk of prematurity and NICU transfer. The increases are moderate but statistically significant: preterm birth occurred in 10% of cannabis users and 7% of non-users." An August 2020 study from the same authors found marijuana use correlated with slightly higher incidences of intellectual disability and learning disorders, as well as higher chances of having autism spectrum disorder. "The percent increase is large—about 50%—and significant," Oster points out, though the researchers do note that the overall incidence rate is still small.
Though the researchers tried to demographically match participants between groups, it can still be hard to totally compensate for the ways marijuana users may differ from non-users."
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"The biggest problem is that it's hard to isolate specific factors like marijuana consumption. The population of women who not only use marijuana during pregnancy but are also willing to admit to researchers that they do may differ from those who don't."
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"A review of evidence published in February 2020 "points to the possibility of lower birth weight, diminished IQ and more behavior problems among children whose mothers used cannabis during pregnancy, but notes it is very difficult to separate the marijuana use from other demographics or other variables,""
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" With the limited evidence available, it may make sense for most pregnant women to avoid marijuana to minimize possible risks to their offspring. But the best choice for one woman and her baby won't be the best choice universally. For women who have extreme morning sickness that makes getting adequate nutrients through food and vitamins difficult, and for whom marijuana mitigates nausea, using cannabis might make sense. Likewise, women with certain mental health conditions helped by marijuana may deem it safer than their usual prescription drugs."