1. Global Health and Wealth Masters of Interpretation Fujian Normal University Dr. Janet Sio 邵婉瑜 May 8, 2013

2. Sayings and Quotes about Health and Well-being “It is health that is real wealth” “Early to bed and early to rise makes a man healthy, wealthy, and wise.” “You are what you eat.” What is the connection between Health and Wealth?

3. Goals Explore connections between the health and wealth of nations via a statistics tool called Gapminder Investigate the impact of economics on global health care systems Learn about universal health care and the global state of health care delivery

4. Populations of richer nations are healthier than populations of poorer nations

5. Historically, as people became richer, they also became healthier (Deaton, A. Health and Wealth of Nations 2007)

6. Within countries, richer people are healthier than poorer people (Deaton, A. Health and Wealth of Nations 2007)

7. Gapminder.org Stockholm Sweden a modern “museum” on the internet promoting sustainable global development and achievement of the United Nations Millennium Development Goals

8. Questions Health = Wealth? OR Wealth = Health? Why is there such a strong relationship between the two? Why should we care about it?

9. Health = Wealth? Questions:

10. Wealth = Health? OR

11. What place does this sound like? Larger rooms, with modern technologies More natural light and spectacular views of the city A state-of-the-art therapy area on each floor for easy access An in-ground therapy pool Bright, open dining rooms and common areas for visiting and recreational activities A cafeteria Auditorium retail shops Library internet café rooftop garden labyrinth terrace

12. Therapeutic Indoor Pool Pet Therapy Music Therapy

13. Why do we care about this? Global inequality is larger when measuring income and health vs income alone Poor of the world are poorer, sicker and die earlier Reinforces the obligation to do something Income can be ONE determinant of health. However, governance of health care delivery can also be an influential determinant of health. See: USA vs Australia Ghana vs South Africa

14. “Macro” vs “micro” level impact of income on life expectancy

15. Why do poor people die so young? Most of the deaths are from diseases we know how to cure or prevent (except HIV/AIDS and cancer) So it is not new science we need, but better methods of delivering existing knowledge What prevents this? Low incomes OR poor organization/governance?

16. Top Ten Deadly Diseases of the Developing World Disease% of deaths 1Lower respiratory infections11.3 2Diarrhea8.2 3HIV/AIDS7.8 4Heart disease6.1 5Malaria5.2 6Stroke4.9 7Tuberculosis4.3 8Prematurity3.2 9Birth trauma2.9 10Neonatal infections2.6 Information provided by the World Health Organization, 2008

17. Ten Leading Causes of Death in the US (2011) vs China (2010) Rank Cause - USCause - China 1Heart DiseaseStroke 2Lung cancerHeart disease 3StrokeChronic Lower Respiratory Disease 4 Road injury 5Road InjuryLung cancer 6Self HarmLiver cancer 7DiabetesStomach cancer 8Liver disease (cirrhosis)Self harm 9Alzheimer’s diseaseLower respiratory infections 10Colon cancerEsophageal cancer Sources: Global Burden of Disease Study, USA and China Profiles, 2010 www.healthmetricsandevaluation.org/

18. New Drugs 2012, FDA Approved 45 new medications approved 14 for cancer and cancer related illness 4 for cardiac or weight loss 4 new vaccines (for illnesses like the flu) 1 st new tuberculosis medication in 40 years 1 drug for HIV “Show me the money” Jellen, J (Ed). Pharmacist’s Letter, 2012

19. Global Healthcare Issues… Universal Health Care 1 BILLION people lack access to health care…. All residents of a geographic/political entity have equal access to needed health services - prevention, promotion, treatment and rehabilitation - without the risk of financial hardship associated with accessing services --WHO Health Report 2010--

20. Global Health Care Systems Definitions Universal healthcare/”socialized medicine” = basic health insurance provided to all Public sector = government supported/provided Private sector = for-profit businesses Single Payer = payment for healthcare costs comes from 1 source (usually the government) Out-of-pocket = payment must come directly from the patient

21. Universal Health Care Australia Austria Belgium Bahrain Brunei Canada Cyprus Cuba Denmark Finland France Germany Greece (Hong Kong) Iceland Ireland Israel Argentina Brazil Chile China Colombia Costa Rica Ethiopia Georgia Ghana Guatemala India Indonesia Jamaica Kenya Kyrgyz Republic Mexico Nigeria Peru Philippines Thailand Tunisia Turkey Vietnam (USA) Sources: WHO Health Report 2008 The World Bank Group, Feb 14, 2013 Press Release Italy Japan Kuwait Luxembourg Netherlands New Zealand Norway Portugal Singapore Slovenia South Korea Spain Sweden Switzerland United Kingdom United Arab Emirates In Progress

22. Universal Health Care: Support Health care is a right/entitlement. Ensuring the health of all citizens benefits a nation economically. Health care increasingly unaffordable for businesses and individuals. Reduces wastefulness and inefficiencies in the delivery of health care.

23. Universal Health Care: Support Reduces the severity of epidemics by reducing the number of disease carriers Aligns incentives for investment in long term health care productivity, preventive care, and better management of chronic conditions A centralized national database makes diagnosis and treatment easier for doctors. Medical professionals can concentrate on treating patients rather than on administrative duties Profit motive adversely affects the cost and quality of health care.

24. Universal Health Care: Opposition Increased waiting times Poorer quality of care, as opposed to private healthcare Unequal access and health disparities still exist Government agencies are less efficient due to bureaucracy Must be funded with higher taxes/spending cuts in other areas.

25. The US Health Care System The US spends more on health care per capita (per person) than any other country; The US spends more on health care as a percentage of GDP (Gross Domestic Product) than any other country in the world (> 15%; in contrast, Britain and Canada both spend about 10%) US life expectancy (78.5 years) is below that of most developed nations (Canada is 80.8, China is 73.3 years) The US is one of the few industrialized countries that does not guarantee access to health care

28. The US Health Care System Healthcare facilities (hospitals, clinics) – mostly private sector businesses, some government Health insurance – many people have some combination or mixture of private and public insurance Health insurance is provided by employers (the company you work for), the government, or yourself (private insurance)

30. Government programs directly cover about 30% of the population: Low-income children and the Veterans Administration (for military and their families) don’t see the bill. The government provides funds for their bill through general taxes US Health Insurance

31. 59% of Americans receive health insurance through their employer (private and public sector), which buys group insurance from a private insurance company which pays bills Employees and employers usually contribute to health insurance payments through their salaries, and often have family coverage (

32. US Health Insurance The largest government insurance programs are: (1)Medicare covers people over 65 years old and the disabled; (2) Medicaid covers low-income people Everyone pays for an insurance plan run by the government through taxes. Doctors and hospitals paid through a set fee schedule.

33. US Health Insurance About 50 million Americans (~16%) are uninsured

34. US Health Insurance Few Americans (<10%) buy individual health insurance Applying for individual health insurance is difficult if you already have an existing disease (like diabetes) Even with insurance, when people require medical care, they may have to pay up-front a part of the cost (deductible )