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Monday, 4 March 2013

Shorter Lives, Poorer Health - US Health under an international microscope

As we have debated some of the challenges of practising public health in Canada, a pre-release document from the US undertaken by the National Research Council and Institutes of Medicine provides solace for those that feel vilified north of the border.  Prepublication access site 

The US has 2565 local public health departments that operate in highly disparate situations and circumstances.   While this and other sites are debating public health funding in Canada, estimates from the US lack precision with 3-9% of its health budget (and most health services are not within publicly funded health budgets).   Canada has about 100 distinct geographic public health entities which receive about 3% of the Canadian publicly expended health resources. Regionalization compounds the ability to count distinct entities where provinces like Alberta might count as one or nine depending on definition.

A notable conclusion of this expert group is that there is insufficient data to compare public health services between countries, whereas the information on health care systems is more robust.  Further evidence that what gets measured, gets the attention.  

The international comparisons in the document are well worth the scan.  A nice summary of the reaction by Dr. Ted Schreker at Health as if everyone matters 

While the document in part defends portions of the health system, its irrefutable conclusion that whatever the US is doing, is not resulting in good health status compared to peer countries that invest considerably less per capita in health services.  Its conclusions and recommendations come up very short with a focus on services and personal choice, and a dearth of recommendations on population level interventions for which there is acknowledgement of significant differences in approach in other countries, but for which they claim minimal evidence. 

Mandatory reading for anyone in public health as it provides for great international comparisons and some good Canadian information embedded throughout the document.  Be forwarded, the text runs to 300 pages.  

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