COST OF AIR POLLUTION

Air pollution has emerged as the fourth-leading risk factor for deaths worldwide. While pollution-related deaths mainly strike young children and the elderly, these deaths also result in lost labor income for working-age men and women. The loss of life is tragic. The cost to the economy is substantial. The infographic above is mainly based on findings from The Cost of Air Pollution: Strengthening the economic case for action, a joint study of the World Bank and the Institute for Health Metrics and Evaluation (IHME). There’s literally nothing you can do that’s better for the environment than to not produce another resource-sucking, waste-making human being.

Healthcare is claiming an ever-increasing share of national wealth. In recent years, healthcare expenditure in Organization for European Cooperation and Development (OECD) countries has been rising at a rate one to two percentage points faster than GDP. If this trend were to continue, healthcare would represent more than 25 percent of France’s GDP—and more than 35 percent of the US’s—by 2050. Clearly, action is needed to bring costs under control.

Moreover, medical errors and other safety lapses persist even in the strongest health systems and are often caused by inconsistencies in care and lack of adherence to good practices. Outcomes vary enormously across healthcare systems and among the care providers within them. For instance, maternal mortality is four per 100,000 births in Italy, but more than three times higher in the US, at 14. Postoperative pulmonary embolisms and thrombosis affect 865 of every 100,000 patients leaving a hospital in France, but just 107 in Belgium, a difference of 706 percent. Regular albumin screening to prevent complications is provided annually for 88 percent of diabetics in the Netherlands, but for fewer than 30 percent of those in France.

Medical errors are the third-most-common cause of death in the US after cancer and heart disease, accounting for more than 250,000 deaths every year. Addressing these issues and the variations in care practices and quality that cause them is another priority for all countries.

As payment and care delivery models shift from episodic, fee-for-service care toward population health and value-based reimbursement, health care leaders are focused more than ever on patient engagement as a key to driving down costs and improving outcomes. And yet, as so many of us know who have attempted to manage our own care or tend to sick family members, the health care system rarely feels like it’s been set up to help us succeed.

What’s needed is a fundamental redesign of the patient’s role — from that of a passive recipient of care to an active participant charged with defined responsibilities, equipped to dispatch them, and accountable for the results. In other words, we need to view the patient’s role as a job and then design that job in such a way as to drive the best health outcomes possible.

The most profound reforms of a public health service may come from initiatives that operate in the shadows with little financial resources because they attract less attention from vested interests. Reform projects that operate away from scrutiny can develop resourcing space that allows for rapid change with little negotiations and minimal coordination cost.

Public health reform initiatives which attract little attention can achieve bigger results because they are relatively shielded from too much interference. Change can come despite, and perhaps even because of, a lack of resources. Usually, organizational change entails a shift in resource control, and this prompts resistance by people who feel this can undermine their resource-derived authority.

Patient advocates and others who have studied the U.S. health care system have catalogued the degree of unpaid, and unsupported, work patients take on in service of their own care. The average, low-risk patient must follow up on referrals to specialists, fill and manage medications, and comply with physical therapy and other regimes. With legacy, pre-internet software systems still the norm in most hospital environments, patients also become unpaid couriers, shuttling critical health data from one provider to the next.

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