Is infectious disease the only problem healthcare can solve?
www.africanaccelerationism.com
We spend a lot of time in the developed world thinking about healthcare. But maybe we shouldn’t. Healthcare doesn’t much change outcomes for people in the US…anymore.
Let explain.
Life expectancy has increased dramatically:
But that is nearly all due to solving infectious disease and childbirth (neonatal) deaths. Everything else is flat (or up in the case of cardiovascular disease and cancer)
Solving infectious disease was the development of three things:
pooping in toilets
antibiotics and
vaccines.
Note on why we use Burden of Disease not Deaths explained below.
While all age groups have improved life expectancy, it’s the under 5 group we have seen the biggest improvements in:
Unsurprisingly, most of disease burden is in Sub-Saharan Africa:
Lucky for developing countries like Kenya, most of the disease burden is in a form we know how to treat
The result is a strange situation where increasing healthcare spend from $0 to $1,000 per capita per year reduces disease burden by 80%. But increasing spending from $1,000 to $10,000 has absolutely no effect (in fact burden of disease gets slightly worse above $4,000):
So for a fraction of what we spend in the US on healthcare we can save 80% of the DALYs in the developing world. It’s strange that there isn’t some kind of Tom’s model to make this happen—that hospitals don’t say, for each $1 you spend here we put $0.10 towards saving a life in Mozambique.
Warning! Rant ahead:
I've heard people (mostly left-wing, perhaps because that’s the group I grew up in) say that there isn’t enough space in the world if we save everyone’s life. Which to me seems a rather disgusting point of view—saving your relatively well off neighbor in the US is good but saving 1,000 in a developing country is bad. How do they square this with the idea that all lives are equal? I’d be really curious to understand where such people are coming from. For every person who has said that I assume there are 10 who think it and keep it to themselves. And I suspect that kind of resistance is partially the cause of not making much of an effort for truly universal healthcare. Notice that when we talk of “Universal Healthcare” in the US we are only talking about the US; not the universe, not even the planet. Just one country = universe, apparently.
End rant.
If Non-Communicable Diseases (NCDs) are not significantly affected by more healthcare spending, what can they be affected by?
NCDs are affected almost entirely by things in our control: smoking, obesity, diet, drug use, mental illness:
Solving NCDs is not a healthcare problem: it’s an eating, drinking, exercise problem (exercise is more effective than antidepressants for depression). The US is spending $10,000 per capita per year on healthcare. We can spend $100,000 a year and it won’t solve the problem because NCDs are (largely) not a healthcare problem.
Conclusion
If you want to live a longer, healthier life, the rules are simple:
Get vaccinated for infectious disease
Only put healthy things (food, water, air) into your body
Exercise
Everything else is a rounding error. Maybe there will be some huge breakthrough in heart disease or cancer in the future, but for now, following three simple rules gets most of the benefit. AI Medicine, the war against cancer, personalized medicine is, so far, (expensive) hot air.
My health is 90% in my control.
To me, healthcare is a one trick pony. It solved infectious disease and then we assumed it could solve other things like heart attacks and gun deaths. But it can’t. Let’s use it in the developing world where we know it can be useful and move on to new lifestyle decisions in the developed world.
I’m not an expert so take all of this as the beginning of an inquiry for yourself, not a final judgement.
Note: the best way to compare health over time is to use burden of disease (measured in DALYs averted, Disability Adjusted Life years), not deaths. An 86 year old with limited mobility who dies is different than a 5 year old who is otherwise healthy and would live for 81 more years. The other benefit of DALYs is it adjusts for quality of life. Someone who would have died at 81 due to cancer but instead dies at 83 after two years of brutal chemotherapy brings in the “Disability Adjusted” part of DALY, and we don’t count that as 2 full years of healthy life.
Is infectious disease the only problem healthcare can solve?
Is infectious disease the only problem healthcare can solve?
Is infectious disease the only problem healthcare can solve?
We spend a lot of time in the developed world thinking about healthcare. But maybe we shouldn’t. Healthcare doesn’t much change outcomes for people in the US…anymore.
Let explain.
Life expectancy has increased dramatically:
But that is nearly all due to solving infectious disease and childbirth (neonatal) deaths. Everything else is flat (or up in the case of cardiovascular disease and cancer)
Solving infectious disease was the development of three things:
pooping in toilets
antibiotics and
vaccines.
While all age groups have improved life expectancy, it’s the under 5 group we have seen the biggest improvements in:
Unsurprisingly, most of disease burden is in Sub-Saharan Africa:
Lucky for developing countries like Kenya, most of the disease burden is in a form we know how to treat
The result is a strange situation where increasing healthcare spend from $0 to $1,000 per capita per year reduces disease burden by 80%. But increasing spending from $1,000 to $10,000 has absolutely no effect (in fact burden of disease gets slightly worse above $4,000):
Source of graphs: Burden of disease - Our World in Data
So for a fraction of what we spend in the US on healthcare we can save 80% of the DALYs in the developing world. It’s strange that there isn’t some kind of Tom’s model to make this happen—that hospitals don’t say, for each $1 you spend here we put $0.10 towards saving a life in Mozambique.
Warning! Rant ahead:
End rant.
If Non-Communicable Diseases (NCDs) are not significantly affected by more healthcare spending, what can they be affected by?
NCDs are affected almost entirely by things in our control: smoking, obesity, diet, drug use, mental illness:
Solving NCDs is not a healthcare problem: it’s an eating, drinking, exercise problem (exercise is more effective than antidepressants for depression). The US is spending $10,000 per capita per year on healthcare. We can spend $100,000 a year and it won’t solve the problem because NCDs are (largely) not a healthcare problem.
Conclusion
If you want to live a longer, healthier life, the rules are simple:
Get vaccinated for infectious disease
Only put healthy things (food, water, air) into your body
Exercise
Everything else is a rounding error. Maybe there will be some huge breakthrough in heart disease or cancer in the future, but for now, following three simple rules gets most of the benefit. AI Medicine, the war against cancer, personalized medicine is, so far, (expensive) hot air.
My health is 90% in my control.
To me, healthcare is a one trick pony. It solved infectious disease and then we assumed it could solve other things like heart attacks and gun deaths. But it can’t. Let’s use it in the developing world where we know it can be useful and move on to new lifestyle decisions in the developed world.