Two issues stand out in current research on human health and healthcare in the United States.
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With regard to the former, there is increasing evidence that our health is affected by factors that affected both our parents health, primarily that our mothers, and our own – by the environmental conditions present during the in utero period and during post-natal development, well into our teenage years. Click here for a summary on some of the mechanisms of nutritional programming.
Some factors of relevance are inadequate nutrition, exposure to toxic environments – i.e., hazardous/persistent chemicals (e.g., endocrine disruptors, pesticides, flame retardants/PBDE’s), micro-particulates (i.e., mold, dust, insect feces, etc.), biological toxins – and psycho-social factors such as stress, poverty, lack of education, etc.
Many of these factors are known collectively as the Social (Societal) Determinants of Health. The subject is an active area of research, both at the World Health Organization (WHO) and at the Centers for Disease Control and Prevention (CDC). My recent blog post on this issue, and the equity dimension of sustainability, can be found here.
Outcomes from these environmental exposures affect our health via developmental pathways that are, in a collective sense, epigenetic mechanisms. i.e., environmental factors that result in variable activation of our genome (i.e., genes, chromosomes, etc.), throughout our lives. Health impacts from these exposures often show up later in life. The developmental programming of disease can be found in a recent review.
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The second issue is even more troubling– the persistent waste and technical incompetence in the United States healthcare system. The financial impacts of these unsustainable practices on US healthcare, from the perspectives of public health and of business competitiveness, cannot be ignored any longer.
The Journal of the American Medical Association published an article in April 2012 indicating that waste in US healthcare 2011 expenditures (est. $2.5 trillion) amounted to approximately $1 trillion or ~40% of the total. Titled “Eliminating Waste in US Health Care,” the authors note 6 categories of waste—overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse.
Approximately 25% of this waste (est. 2011 average, $250 billion) was attributable to overtreatment- the use of therapies and services that provide no benefit to the health of the patient. Where is the science supporting this type of medical practice? Similar concerns are raised by clinician Gilbert Welch in his 2011 book– OVERDIAGNOSED : Making People Sick in the Pursuit of Health.
During this recessionary period, when the need for fiscal austerity is recognized by all branches of government, the subject did not appear on the political agenda during the 2012 election year. Is a trillion dollars of savings per year too small for us to notice?
It appears that healthcare policy in the United States is where environmental policy was about twenty years ago. Specifically, a lack of understanding and focus on public education and on the prevention of disease.
As environmental scientists and engineers will agree, it is much better, and usually cheaper, to avoid putting something into a pipe than trying to fix outcomes at the end of the pipe.
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WE, the public, need to become more active and engaged in this discussion to implement Sustainable Healthcare in the United States.