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6650. tmesis - 8/2/2006 4:03:45 AM http://news.bbc.co.uk/1/hi/health/4965034.stm
Americans 'more ill than English'
Obese woman
Higher rates of obesity in the US could not explain the differences
White middle-aged Americans are less healthy than their English counterparts, research suggests.
Americans aged 55 to 64 are up to twice as likely to suffer from diabetes, lung cancer and high blood pressure as English people of the same age.
The healthiest Americans had similar disease rates to the least healthy English, the Journal of the American Medical Association study found.
The US-UK research found greater links between health and wealth in the US.
We should look for explanation to the circumstances in which people live and work
Sir Michael Marmot
The joint team from University College London, the University of London and health research organisation Rand Corporation, chose two groups of comparable white people from large, long-term health surveys in the US and in England.
In total, the study examined data on around 8,000 people in the two countries.
Each group was divided into three socio-economic groups based on their education and income.
They then compared self-reports of chronic diseases such as diabetes, high blood pressure, heart disease, heart attacks, stroke and lung disease.
The American group reported significantly higher levels of disease than the English.
Rates of diabetes were twice as high among the US group as the English.
One of the study's authors, James Smith of Rand, said: "You don't expect the health of middle-aged people in these two countries to be too different, but we found that the English are a lot healthier than the Americans."
'Medical care'
Those on the lowest incomes in both countries reported most cases of all diseases, except for cancer, and those on the highest incomes the least.
But these health inequalities were more pronounced in the US than they were in England.
The researchers suggested the lack of social programmes in the US, which in the UK help protect those who are sick from loss of income and poverty, could partly help explain why there was a greater link between Americans' wealth and disease.
But the study also found that differences in disease rates between the two nations were not fully explained by lifestyle factors either.
Rates of smoking are similar in the US and England but alcohol consumption is higher in the UK.
'Bad lifestyle'
Obesity is more common in the US and Americans tend to get less exercise, but even when the obesity factor was taken out, the differences persisted.
One of the researchers Professor Sir Michael Marmot, of the department of epidemiology and public health at University College London, said people would automatically presume the differences were caused by the variance in healthcare systems.
US healthcare is funded through an insurance system while England's NHS is funded by taxation and is free at the point of use.
But he pointed out that Americans spent almost double per head on health care than the English do, even though the system was organised in a different way.
He said: "There is more uneven distribution in the US and something like 15% of Americans have no health insurance and (there are) a bigger number who are under-insured."
But this could not fully explain the differences because the richest Americans with access to highest levels of healthcare still had rates of poor health comparable to the worst off in England.
Infant mortality
"We cannot blame either bad lifestyle or inadequate medical care as the main culprits in these socio-economic differences in health.
"We should look for explanation to the circumstances in which people live and work.
"We have to take a much broader look at social determinants of health in both countries.
"We need to do further research to fill in the jigsaw pieces of the puzzle," he added.
A Department of Health spokeswoman acknowledged health inequalities in England of the kind revealed in the research and said the government was anxious to tackle them.
It aims to reduce health inequalities in life expectancy and infant mortality by 10% and improve health generally.
"Health trainers, targeted initially at the most deprived communities, are one of the many initiatives which will help narrow this gap by supporting people to make healthier choices in their daily lives," she added. 6651. tmesis - 8/2/2006 4:04:58 AM The original JAMA article:
http://jama.ama-assn.org/cgi/content/full/295/17/2037 6652. arkymalarky - 8/2/2006 5:21:36 AM Good info, Tmesis. Thanks for posting it!
I've ranted about lunchroom food in public schools and 1) the dependence of poor children from pre-k through high school on it for much of each year and 2) the differences between lunch offerings in rich public schools vs poor ones.
Of course there are lots of factors (British eat less food because so much of it's awful over there?), but I think if we're going to start with kids, which is where the govt and Bill Clinton are focusing, the health benefits of lunchroom food have to be addressed. 6653. arkymalarky - 8/3/2006 4:37:17 PM Interesting on childbirth, from Trillium in the Cafe:
http://www.infoforhealth.org/inforeports/fistula/index.shtml
For a lot of people, it's still "150 years ago" where childbearing is concerned. Apparently obstructed labor happens in about 5 out of 100 cases. It's a problem that is especially difficult for teen/pubescent mothers, who may be small because of age, and in addition because of malnutrition.
Obstetric fistula is gross, so sorry about that aspect of my post. The problem of delivery in those cases is similar to what's described in partial birth abortion movies, except it takes much longer; the baby's head is too large to pass, baby dies, and the mother may have to suffer up to a week later until decomposition is sufficient for it to pass. In the meantime a great deal of damage occurs to the guts of the mother.
I too am glad that advanced medical help is available in our particular area of the globe. I used to be very pro-midwife-natural childbirth; and I still like having that option, but more people could acknowledge -- wow is the existence of clean surgical facilities and experienced surgeons a GOOD THING. A blessing, as many people would describe it.
6654. arkymalarky - 8/3/2006 4:39:07 PM Another thing wrt Tmesis' post earlier, is American portions are out of control and they eat out A LOT. Even if they don't gain weight, the quality of the food they consume is often pretty bad, partly because they're always on the go--not just eating out, but grabbing food between work or on the way from one place to another. 6655. Trillium - 8/4/2006 5:23:16 PM Thank you for posting the #6653, Arky!
I don't expect obstetric fistula to get much discussion, but it seems like something that should be part of broader public knowledge.
We seem to have amnesia about the risks of unattended childbirth, something that used to be widely known but not spoken of in polite company. Obviously, the many people in the past who had watched their mothers, aunts or sisters die in childbirth that lasted a week or more were affected by the experience and knowledge, even if they didn't speak of it (except in polite euphemisms that avoided the foul details, like everything else related to death).
The problem is that we in the "first world" have forgotten the risks of childbirth almost entirely; while we benefit from technology. Yet damage/death during childbirth remains a huge problem elsewhere, and STILL isn't spoken of openly even though it is a problem with massive implications for a whole society. I've been discussing Africa on another board, and this problem has to affect the progress of Africa in a huge way.
I recently watched a snippet of a 1950s sex-ed filmstrip for teenage girls, where a lovely young blonde 16-year-old announced that she was not afraid of childbirth because the doctors can do so many things now to make it safe to have babies! I don't have the name of the filmstrip, but it was interesting. There was an actual campaign apparently to make people feel that childbirth was safe because of science. And it is, relatively if you have the benefits of the technology available; but many people don't.
Our national policies towards contraception in other countries are affected by conditions in our own country, and we think as if it is the same everywhere else. Yet that isn't the case. 6656. Trillium - 8/4/2006 5:27:37 PM About food portions -- I like to eat. But if I don't get the opportunity to walk or bicycle every day, I'll put on weight.
The problem of weight would be helped a great deal if our traffic patterns were set up to encourage pedestrians. In many places walking doesn't even appear to be legal, it is so discouraged -- no sidewalks, no trees shading the sidewalks, or the sidewalks begin and end abruptly without reaching any sort of logical destination (like a school, shopping or entertainment area). In older neighborhoods sidewalks are part of the overall plan; in post WWII areas, the plan appears to be that everyone must get climb into an automobile for every excursion, for every purpose.
That could be modified, and a lot of people whose bodies work like mine would benefit enormously. I've been living for several months in a pedestrian-friendly area where I seldom drive, and the physical effects are quite noticeable not only to me but to my family and acquaintances as well. It's a good thing. 6657. PelleNilsson - 8/4/2006 6:38:35 PM 150 years ago the highest risk for child-bearers was not complications during delivery but streptococcus infections following it. 6658. arkymalarky - 8/5/2006 2:43:49 AM Doesn't the US have one of the highest infant mortality rate among developed nations? 6659. arkymalarky - 8/5/2006 2:47:38 AM AR now requires every student to have 30 minutes of physical activity at school. This is causing scheduling nightmares, but if it can be worked out to where we all "just do it" as part of the school day, rather than as yet another requirement that makes it hard for poor and rural schools to meet standards, I'd enjoy it. There are a lot of ways they could make it fun for everybody.
Or they could make it as miserable as my jr. high p.e. class. 6660. Trillium - 8/5/2006 8:24:23 PM Pelle, streptococcus is deadly, but if the woman survives, she won't be shunned. The terrible thing about obstetric fistula is not only that the baby usually dies, but that the injured mother will become like a leper, shunned by the rest of the community as "dirty" because of incontinence; some also have "foot drop", neurological damage from the labor, and have trouble walking. In those cases the consequences of childbirth are crippling, like polio. Childbirth damage doesn't happen to every woman, obviously, but it happens to enough people in the population to have a huge social impact. Or so I read, and it makes sense to me.
Arky, from what I've read, the high infant mortality rate here in the U.S. also has to do with teen mothers, many of whom may be trying to hide their pregnancy because the social circumstances are unfavorable. Others don't eat well, or use toxic substances while pregnant.
Arky, does your state have a program to make all schools pedestrian-accessible, or is it only up to local communities? A new sidewalk was finally built to one of the local high schools. We've had all sorts of "exercise path" projects, but there wasn't any kind of focused effort to make sure that students can walk to school safely, without walking in the road or in ditches. 6661. arkymalarky - 8/5/2006 8:47:32 PM It's a local thing, and the state would have to fund a mandate like that in order for larger districts, especially, to comply, due to the number of campuses they'd have to accommodate. I doubt it would ever pass at the state level because they've imposed so many unfunded and funded mandates already and we're having difficulty handling them all. Our rural town has a nice paved walking trail already that would make it fairly easy to ensure total pedestrian access to the school, but most communities don't have that, or at least not as handily close to all the campuses as what we do. 6662. arkymalarky - 8/5/2006 8:50:20 PM WRT teen pregnancy in the US, it occurs most often in high poverty areas where the health practices of the population are already marginal. 6663. PelleNilsson - 8/5/2006 8:53:45 PM Trllium, my simple point is that more women died from infections than from any other cause associated with pregnancy.
I've never heard or read about women becoming " like a leper, shunned by the rest of the community as "dirty" because of incontinence". That must be an American, Puritan thing. 6664. Trillium - 8/5/2006 10:25:57 PM Pelle, I copied the following off of a website that claims connection to UN Family Planning Fund. Do you think that they would make this up? The problem is linked strongly to early marriage (as in age 10-15), rural areas without access to hospitals, and of course war zones where medical help becomes unavailable.
http://www.endfistula.org
If you think it's bogus, I'd be interested to know why.
"The Challenge of Living with Fistula
I have to put on heavy clothes. There are painful blisters and itching. I have to continue doing work and it causes increased dribbling of urine. Nobody wants to stay with me because of the smell.
—A woman from Bangladesh, as quoted in an EngenderHealth study
Without treatment, fistula often leads to social, physical, emotional and economic decline. Although some women with fistula display amazing courage and resilience, many others succumb to illness and despair.
The misery of fistula is relentless. In spite of one's best efforts to stay clean, the smell of leaking urine or faeces is hard to eliminate and difficult to ignore. The dampness causes rashes and infections. The cleaning up is constant, and pain or discomfort may be a continuous as well. The grief of losing a child and becoming disabled exacerbates the pain. The courage many women show in the face of these challenges is extraordinary." 6665. wonkers2 - 8/9/2006 6:45:53 PM How about a discussion on fecal incontinence? 6666. wonkers2 - 8/9/2006 6:48:12 PM While we're at it. Some army VD pics on gonnorhea would be great, too. 6667. Trillium - 8/10/2006 11:45:25 PM No Wonkers, while we're at it, we should discuss AIDs
(or are we in a time warp to the early 1980s and it's still a taboo topic?)
When a large part of the population is sick/disabled, it takes a toll. It's difficult to be prosperous under those conditions.
http://www.endfistula.org
Either the problem described on the website above is bogus, or a huge problem is being ignored; Pelle, IIRC, has lived in places where this problem is apparently significant, and he says he's never heard of it.
If it's a big enough problem and enough people have never heard of it, could some foreign aid/economic development plans be falling short of their mark?6668. Trillium - 8/10/2006 11:47:44 PM My link didn't work. Try again?
UN family planning link 6669. Ulgine Barrows - 8/30/2006 6:50:45 AM So how did you get exercise today?
I really whacked my kneecap out of kilter in the spring. I hit it by mistake on the inside with a huge iron plant hanger.
And in the next few months, the outside is swelling up and gives me pain when I bend down.
I think I shifted some kind of floating knee plate.
Damn, why cannot I bounce back like I'm 21?
I think I might ask a chiro about it, rather than a surgeon.
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