Monday, November 10, 2008

Generous Welfare State Policies Improve Public Health?

An international study reported in Lancet (See below) links such policies with lower infant mortality and old-age excess mortality. Public health statistics are not my forte but the infant mortality claim is an old chestnut. The rate depends on what you count. The USA counts very premature births. Other countries do not. The full original article is here. I could find no discussion in it of the critical question of the criteria used in assessing rate of infant mortality -- which shows a complete ignorance of the existing literature on the question. Most unscholarly! I also note that they found important similarities between Britain and the USA -- despite the very different health systems in those countries -- which suggests genetic and cultural factors as being involved rather than the health system. But that too is glided over in the article. The article is garbage.

It should be noted that British medical journals operate under very heavy Leftist influence so their intellectual and scholarly standards are in consequence often woeful (See many examples dissected in FOOD & HEALTH SKEPTIC). Their standards are what you would expect of people who believe that "There is no such thing as right and wrong". And when politics gets involved their standards are even more woeful. They should therefore normally be ignored when they comment on politically relevant issues. Lancet even tried to intervene in the Iraq war, using VERY suspect data!

Advanced nations with more generous welfare programs for families and pensioners tend to have lower infant mortality rates and old-age excess mortality rates, according to an article published in the Nov. 8 issue of The Lancet.

Olle Lundberg, Ph.D., of Stockholm University/Karolinska Institute in Stockholm, Sweden, and colleagues studied the association between health outcomes and variations in family and pension policies in Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

The researchers found that lower infant mortality rates were associated with increased generosity in family policies that support dual-earner families but not in policies that support more traditional families with gainfully employed fathers and stay-at-home mothers. They also found that lower old-age excess mortality rates were associated with increased generosity in basic security types of pensions but not with generosity of earnings-related income security pensions. They calculated that each 1 percent increase in dual-earner support would lower the infant mortality rate by 0.04 deaths per 1,000 births and that each 1 percent increase in basic security type of pensions would decrease old-age excess mortality by 0.02 for both men and women.

"The ways in which social policies are designed, as well as their generosity, are important for health because of the increase in resources that social policies entail," the authors conclude. "Hence, social policies are of major importance for how we can tackle the social determinants of health."

Source. Another comment here.

Australia: Self-aggrandizing hospital bureacrats waste public money

Staff at Sydney's Royal Prince Alfred Hospital are outraged that $100,000 was spent buying highly specialised neonatal equipment, which is sitting idle during a new round of cost-cuts. The Health Department was unable to stop RPA administrators recently spending public donations to set up a fetal laser surgery unit, despite medical staff saying it was unnecessary and potentially risky for mothers and babies. No fetal laser surgery has been performed at RPA since the equipment was bought, and sources say obstetricians are unwilling to refer patients to an inexperienced unit. The nearby Royal Hospital for Women has successfully provided intrauterine laser surgery for NSW and New Zealand patients since 2003. Only about 15 procedures take place each year.

RPA staff say there is a lack of clinical governance at the hospital and the decision raises questions about the waste of scarce health dollars. The hospital is already under siege after the resignation of executive director Di Gill on Friday and the ongoing public furore at the closure of the 20-bed women's ward. It will no longer be a women-only ward. "There are a lot of upset people in gynaecology at RPA because they wasted money on lasers which don't need to be bought, yet they're closing the women's ward," said a clinician who did not want to be named. "Some doctors are egotistical and it's about them, not what's best for the patient, and you have to wonder about the governance of the hospital."

A spokeswoman for NSW Health confirmed it had urged clinicians at RPA to work with existing services at RHW. Victoria and Queensland each have a centralised fetal laser service to treat rare conditions such as twin-to-twin transfusion syndrome and amniotic band syndrome. "As the service at RPA is new, the Department has asked the Area Health Service to ensure clinicians work together across both sites to ensure high standards of patient care," the spokeswoman said.

The RPA expects to treat up to 20 cases a year of twin-to-twin transfusion syndrome, a life-threatening condition in which there's an uneven blood flow between identical twins.

John Smoleniec from fetomaternal medicine at Liverpool Hospital, said spreading cases among multiple hospitals will lead to a dangerous dilution in procedural experience and eliminate the capacity to monitor success and complication rates.


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