Improving Population Health

In the Literature 2012 Year-End Roundup

By David A. Kindig, MD, PhD

Best wishes for a wonderful holiday season from Improving Population Health. We regularly scan eleven journals for new studies of particular population health relevance (the list of journals is at the end of this post). For this year-end roundup, we’re highlighting a couple of recent articles and also listing those we’ve called attention to earlier in the year.

McCullough JC, Zimmerman FJ, Fielding JE, Teutsch SM. (2012). A Health Dividend for America: The Opportunity Cost of Excess Medical Expenditures. American Journal of Preventive Medicine, 43(6), 650-654.

This must-read article highlights the recent IOM estimates that $750-$765 billion spent on health care in the U.S. is in excess of what should be spent to achieve our observed health outcomes. Of this amount, the IOM estimates that $421 billion accrues to the private sector which the authors say is “functionally a tax that limits the international competitiveness of the US and reduces the economic welfare of the population.”

This paper focuses on the public sector which pays the remaining $337 billion and questions the “public opportunity costs of the unnecessary healthcare spending,” which they call a Health Dividend and characterize as “a sizeable stream of resources that would come at no net cost to people’s health and that could be invested in achieving two important objectives: stabilizing the nation’s fiscal health and improving well being.”  The authors identify specific investments contributing to Fiscal Stability, Social Investments, and Infrastructure Investments that such a dividend could support. The authors conclude with a clear vision: “whatever one’s values and preferences, eliminating excess medical care costs provides a monumental opportunity to reallocate those resources to strengthen U.S. international competitiveness, enhance well-being, and build a healthier nation. The result of redirecting some $750 billion per year could be transformative for Americans, and the potential uses for these funds are panoramic in both scope and possibility.”

Willie Sutton and Population Health

By Sanne Magnan, MD, PhD

Many governments and private households are struggling with budget deficits.  For example in Minnesota over the next 20 to 25 years, rising health care costs are projected to leave little additional money for spending on other state programs such as education, affordable housing, job development, etc. that arguably contribute more to population health than health care (1). Rising health care costs means there is less money for these other factors, which contributes to less healthy populations leading to higher health care costs which leads to less money to spend on the other factors.  We will be creating a vicious, downward spiral.

There is a way out. It reminds me of the famous legendary quote of the bank robber Willie Sutton when he was asked, “Why do you rob banks? He replied, “Because that’s where the money is.“ Why should we, in population health, care about total cost of care (TCOC) or per capita costs of health care? Because that’s where the money is.

“Do the Math” for Population Health?

By David A. Kindig, MD, PhD

In recent weeks, I have been paying close attention to policy dialogues sparked by Hurricane Sandy. So when I heard Bill McKibben was bringing his Do The Math tour to Madison, I had to be there. The event made quite an impression on me, both in terms of packaging the argument for divestment in fossil fuel stocks, but even more particularly how McKibben has moved dramatically out of his academic comfort zone – understandably driven by his palpable fear that without action our planet will become uninhabitable within a few generations if not sooner.

McKibben is an environmental activist, who at age 27 wrote the The End of Nature. During his presentation he reflected that at the time, he thought a book was all that was needed to spark change. He now recognizes that while academic contributions are important, they’re not necessarily sufficient for social change.

McKibben has devoted himself to this work. He’s not a rock star type (even though the tour has all the elements, including a huge bus, high quality graphics, music, and videos from famous people like Desmond Tutu); this does not seem to be his comfort zone. He seems a bit uncomfortable in the limelight, and dresses very casually. He says he would rather be typing than touring the country.

The morning after attending the presentation, I awoke at 4 AM thinking about key elements of McKibben’s work and contemplating their relevance to broad population health challenges. Here’s what he’s done:

In the Literature: Alcohol Policy and Mass Media Campaigns

By David A. Kindig, MD, PhD

We regularly scan eleven journals for new studies of particular population health relevance (the list of journals is at the end of this post). A couple of recent papers caught our eye:

The Raising of Minimum Alcohol Prices in Saskatchewan, Canada: Impacts on Consumption and Implications for Public Health. Tim Stockwell et al. American Journal of Public Health. 102 (12), e103-e110.

This article describes the impact of raising minimum alcohol prices by 10% in Saskatchewan, Canada. Saskatchewan provides a unique case study in that the provincial government has established a monopoly to control alcohol distribution. The intervention led to an 8.43% reduction in alcohol consumption, with the greatest declines from beer, spirits, and wine respectively. Notably, a significant portion of this effect was observed via retail sales, as opposed to bars and restaurant consumption. Equally interesting, the study found a differential affect by alcoholic beverage potency. High alcohol content beer and wine were associated with the largest decreases in consumption, with high alcohol beer dropping 22% compared to only 8% for low alcohol beer. The surprisingly targeted effects of the alcohol pricing legislation investigated here merits further research, including probing for broader policy application.