Another Study Finds U.S. Healthcare System Among Worst

I know reports like these are a dime a dozen, especially in post-recession America, but it bears reaffirmation, if only because a fair number of Americans still seem to think that our system is vastly superior to any existing or hypothetical alternative — even though the social and economic costs are vast and growing.

Let us start with this chart, courtesy of i09, which comes from a new report by the Commonwealth Fund, a private U.S-based foundation that promotes a more efficient healthcare. It compares the results of an extensive survey of patients and physicians across ten developed countries, looking at several relevant metrics.

Notice that by all measures, the United States is either middle-of-the-road or dead last , despite spending the most per person by far — $8,508 compared runner up Norway at $5,669 (incidentally the latter also does not perform all that well). Canada, while comparatively more efficient at nearly half the cost, does not perform all that impressively either.

By contrast, the highest ranked country on average, the United Kingdom, spends just $3,405 per person on health care. Taken as a whole, it appears that per capita spending has little bearing on the overall quality and effectiveness of the healthcare system (something that has been noted in similar international studies). Another chart from the report confirms this:

Despite such astronomical spending, in both proportional and absolute terms, the report sums up the America’s performance thusly: “[the country] fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity.”

The culprit for such inefficiency? The very fact that many Americans lack access to reliable health care (including those who are technically insured).

Not surprisingly—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost. Patients in the U.S. have rapid access to specialized health care services; however, they are less likely to report rapid access to primary care than people in leading countries in the study. In other countries, like Canada, patients have little to no financial burden, but experience wait times for such specialized services. There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; however, the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.

However, as i09 notes, the study’s conclusion points to more than just broadening access:

The authors believe that the problems inherent in the U.S. healthcare system are so pervasive that it will take more than better access and equity to solve them. According to Karen Davis, lead author of the study, overall improvement “is a matter of accountability, having information on your performance relative to your peers and being held accountable to achieving a kind of care that patients should expect to get.”

But it’s not an intractable problem. The U.K.’s excellent result can be attributed to a number of reforms, including the hiring of more specialists, allocating bonuses to family physicians who meet quality targets, and adopting health system information that allows physicians to easily share information about their patients. Moreover, every citizen (apparently) has a doctor.

If there is any silver-lining, it is that the U.S. is moving in the right direction, if ever so slowly. In addition to the flawed but still impactful Affordable Care Act:

The U.S. has significantly accelerated the adoption of health information technology following the enactment of the American Recovery and Reinvestment Act, and is beginning to close the gap with other countries that have led on adoption of health information technology. Significant incentives now encourage U.S. providers to utilize integrated medical records and information systems that are accessible to providers and patients. Those efforts will likely help clinicians deliver more effective and efficient care.

Indeed, all of this attention towards the inefficiency of our healthcare system is leading to changes in both the political and private spheres. However, it will take a lot more than this piecemeal and hodgepodge approach to rectify what is very clearly a failing system. The solutions, while often difficult to implement, are clear, and both the necessary capital and public will is available. When will that be enough to spur necessary change?

Inequality in a Global Context

When it comes to wealth and income inequality — a subject I have discussed at length here –  the news is rarely positive. As the following graph makes succinctly clear, the issue has worsened dramatic over the last few decades.

Income includes household wages and government transfers. Source: Census / Colin Gordon. Credit: Quoctrung Bui / NPR

While the most recent data in these sorts of graphs are around seven years old, newer evidence suggests the problem is still prevalent, if not worsening — at least in the United States.

According to an interesting new paper on global income distribution conducted by economists Branko Milanovic and Christoph Lakner, the global pictures regarding income inequality is far more nuanced, if not positive. As NPR reports, the study found that globalization — the same mechanism that plays a large, though hardly solitary, role in rising inequality — has had the opposite effect, broadly speaking.

Essentially, they look at inequality at a global scale, accounting for the world’s population as a whole rather than breaking it down country-to-country (as is usually the case).  S what happens if you look at the change in income over the past few decades for everyone on Earth? Here’s what the graph of the data shows:

Income is defined as per-capita income. Source: Milanovic and Lakner (2014). Credit: Quoctrung Bui/NPR

So what does this mean? Basically, people in the middle of the global income distribution — mostly concentrated in China and India, as as well as a few other developing Asian countries — have had the biggest gains in come by percentage. In fact, the average American, like most others in the developed world, would fall at the far right of this graph, at the top of the global income distribution.

So in a global context, the typical developed-world individual is capturing the lion’s share of income growth. Assuming this is truly the case (I await for more research and scrutiny to be certain one way or the other) that does not make inequality any less worrisome, now and especially in the long-term. Worldwide, we are still finding far too much wealth concentrated at the top amid austere policies, insufficient investment in the public good, and the persistent absolute poverty of hundreds of millions of people.

An increasingly transient global elite is still capturing the lion’s share of investment — as made depressingly clear by the revelation that 85 individuals hold more wealth than 3.5 billion people. Too many countries are mired in the same old problems despite the ever-growing generation of wealth that never seems to be reflected in higher wages, incomes, or public investments. Even if some people in this arrangement have it worse than others, the fact that many have it worse than they should given the capital potential is a problem, for most individual countries and the world at large.

Those are just my brief thoughts. What are your opinions?

Happy Birthday Red Cross

On this day in 1864, twelve European nations signed the seminal First Geneva Convention, which established “the basis…for the protection of the victims of armed conflicts” and with it what is now called the International Committee of the Red Cross (ICRC), conceived and founded by Swiss businessman and social activist Henry Dunant and Swiss jurist Gustave Moynie. 

The organization served as both the catalyst and enforcer of the convention’s articles, which were history’s first legally-binding rules guaranteeing neutrality and protection for wounded soldiers, field medical personnel, and specific humanitarian institutions in an armed conflict.

The first of several such conventions, this watershed moment for both international law and humanitarianism launched the wider Red Cross Movement (now known as the International Red Cross and Red Crescent Movement), which is comprised of several distinct humanitarian organizations geared towards protecting human life and health, ensuring respect for all human beings, and preventing and alleviating human suffering.

The ICRC is one of several institutions in this broad movement, along with the International Federation of Red Cross and Red Crescent Societies (IFRC), and 189 National Red Cross and Red Crescent Societies. Together these groups number around 97 million volunteers, members, and staff across the world, making it by far the largest movement of its kind in history. The Red Cross and Red Crescent remains the most enduring and universally recognized symbol of humanitarianism and compassion. 

The World’s Friendliest Cities

According to the annual Readers’ Choice Survey conducted by luxury travel and lifestyle magazine Condé Nast Traveler, the following are the world’s friendliest cities:

11 (tie). Salzburg, Austria

11 (tie). Budapest, Hungary

9 (tie). Seville, Spain

9 (tie). Savannah, Georgia, U.S.

8. Cape Town, South Africa

7. Siem Reap, Cambodia

5 (tie). Sydney, Australia

5 (tie). Dublin, Ireland

4. Charleston, South Carolina, U.S.

3. Victoria, BC, Canada

1 (tie). Melbourne, Australia

1 (tie). Auckland, New Zealand

You can read the consensus review for each selection in the first hyperlink of this post (although the site was acting a bit wonky for me, hence why I could not reproduce the details here). Respondents allegedly based their choices on a range of factors, although CN notes that the survey is ultimately subjective. It appears most of the top cities tended to share a valuable combination of hospitality, beauty, great amenities, and overall character (unique, historically rich, etc).

Additionally, the majority of friendly cities are medium-sized, temperate in climate, and fairly wealthy (which is reflected by good infrastructure, low crime, lots of public attractions and spaces, etc). This is especially true of Australia and New Zealand, whose cities were dual winners for being warm and welcoming places (they also tend to rank high in indexes of livability, although interestingly, there is little correlation between quality of life and friendliness to outsiders, perhaps because the priorities and focuses of residents and visitors differ).

Siem Reap, hardly as well known as the other contenders, also stands out for being a relatively poor place in a poor country; however, it is apparently a well-established and popular resort-town that recently ranked as the world’s fourth-best city for tourists, so it is clearly a hidden gem of sorts. Budapest did a good job of giving lie to the stereotype of dour and unfriendly eastern Europeans, while Savannah and Charleston seem to confirm the endurance and appeal of southern hospitality.

Anyway, aside from the most pleasant places to visit,  respondents also selected the least friendliest ones:

10. Nassau, Bahamas

9. Monte Carlo, Monaco

8. Milan, Italy

7. Frankfurt, Germany

6. Beijing, China

5. Marseilles, France

4. Paris, France

3. Moscow, Russia

2. Cannes, France

1. Johannesburg, South Africa

An interesting mix of cities across the world, although France stands out with a plurality of three spots, including two among the top five. As with the previous list, this is all based on an aggregate of factors beside the hospitality of residents: for example, Beijing was given bad marks for its “terrible pollution” and “dirty streets and hideous traffic”, while Johannesburg made the list (despite being “one of the most beautiful” cities in the world) for its crime and staggering inequality.

Overall, however, it seems that most of the cities that ranked as unfriendly did have an attitude problem:  Marseilles was described as “threatening”, Monaco as “overcrowded and ostentatious”,  Frankfurt as “rude”, and Paris as “cold and aloof” (which in fairness can be said of many cities its size).

You can read the original summaries and judge the fairness of these assessments yourself, although those of you who are familiar with these locations in any way are more than welcomed to share your two cents. My own traveling experience is sadly limited, and none of the places I have been too (such as Orlando, Florida or Prague, Czech Republic) made either cut.

I do feel there are three big caveats to take into account when going over this list: one mentioned earlier is subjectivity — what is rude or cold behavior to some people may seem perfectly normal or even polite to others, depending both on one’s own personality and the sociocultural norms in which they were raised.

This leads to the next issue: the backgrounds of these respondents plays a role in how they interact with, and are perceived by, the cities they visit. Given the target demographic of this high-end, American-based magazine, I imagine most respondents represent a rather limited socioeconomic and cultural group that may have differing experiences in certain areas than people of other groups (would speakers of French or another Romance language feel the same coldness from Paris as those who do not know the language? Would someone who is used to living in big, polluted cities find Beijing so objectionable?)

Finally, a lot of these assessments are based on ultimately limited sample sizes. I do not just mean the number of respondents — although that, too, applies — but how much they experienced, how long they were there, and how often they have gone. Perhaps I missed this factor in looking through the criteria of those participating in the survey, but who is to say they got a good picture of the city they are visiting? Where you go within the city, when you visit, and even how you travel through it all influence one’s experience and overall impression.

As a resident of Miami, I can tell you that sticking to Miami Beach is very different from visiting the duller suburban areas or experiencing the grinding poverty of peripheral areas).

Still, this is nonetheless an interesting pair of lists to look at or consider, although I would much prefer to see these cities and judge them each for myself!

Source: CNN

World Humanitarian Day

It will come to know no surprise to regular readers that I have an avid interest in humanitarian issues, ranging from global inequality and poverty to human rights abuses and war. I have long had a keen interest in the United Nations as a mechanism for bettering the human species and facilitating the more positive aspects of globalization — illuminating and addressing these global problems in multilateral ways while promoting an ecumenical and unified global identity.

While I have no delusions about the U.N.’s vast flaws and shortcomings, I find it to be conceptually sound and an ideal start to a hopefully more effective international framework. One thing is for certain: whatever the institutional problems of this and other international organization, the everyday work done by its members is usually sound, well-intentioned, and altruistic — which is precisely what World Humanitarian Day is dedicated to highlighting.

This day pays tribute to the often unseen aid workers who carry out life-saving activities around the world, often in dangerous and difficult circumstances. It also celebrates the spirit of humanitarian work worldwide, work that brings communities together and alleviates the common human suffering that we should be concerned about.

It is observed annually on August 19, the anniversary of the 2003 bombing of the U.N. headquarters in Baghdad that killed 22 people, including U.N. envoy Sergio Vieira de Mello. There will be a wreath-laying ceremony at the U.N. Headquarters in New York City to honor de Mello and other aid workers killed in the line of duty.

Unfortunately, such a commemoration is especially relevant today, as  aid workers are suffering at record numbers as of 2014:

The research shows that in 2013, 155 aid workers were killed, 171 were seriously wounded and 134 were kidnapped. Overall this represents a 66 per cent increase in the number of victims from the previous year. With 81 aid workers killed in 2013, Afghanistan is still the country with the highest number of attacks.

Preliminary figures show that as of 15 August 2014, 79 aid workers have been killed this year alone. The months of July and August saw a rise in the level of attacks and incidents involving aid workers including in Gaza and South Sudan.

Only these past few weeks, aid workers were killed in the midst of conflicts in South Sudan and Gaza, just two of many places that rely on their vital services. Such loss of life is a tragedy in itself, especially for the global community as a whole. As the world faces increasingly more difficult and existential threats, there needs to be a more concerted effort to address these matters and protect those who willingly risk their lives to dispense such solutions.

Parenting Habits From Around The World

Globalization has allowed us to discover and learn more about all sorts of previously unknown ideas and concepts, and parenting is certainly no exception. Cultures across the planet have wildly different approaches to raising or education children, some of which may shock Americans — although the feeling is often mutual.

NPR has gathered an interesting collection of general parenting trends from around the world, some of which may catch on here, while others would be unthinkable. It is interesting to consider how and why certain societies adopt the parenting norms that they do. How each generation is raised has a tremendous impact on overall values and attitudes, and those parenting methods are in turn influenced by all sorts of other external factors (climate, geographic, prevailing economic conditions, etc).

Ponder this while taking a look at the following.

1. In Norway, kids nap outside even in subzero temperatures

In Norway, childhood is very institutionalized. When a kid turns one year old, he or she starts going to Barnehage (Norwegian for “children’s garden”), which is basically state-subsidized day care.

Parents pay a few hundred dollars a month and their kids are taken care of from 8 a.m. to 5 p.m. Toddlers spend a ton of time outside at Barnehage, even in extremely cold temperatures. It’s not uncommon to see kids bundled up outside during a Scandinavian winter, taking a nap in their strollers.

Even with the obvious benefits provided by the government in Norway, some parents complain about the lack of creativity in people’s approaches to parenting.

One American mother adjusting to raising kids in Norway wrote:

“There’s a sense that there’s just one right way to do things. And everyone does it that way. In America there are different parenting styles — co-sleeping, attachment parenting, etc. Here there is just one way, more or less: all kids go to bed at 7, all attend the same style of preschool, all wear boots, all eat the same lunch … that’s the Norwegian way.”

2. Vietnamese moms train their babies to pee on command

Here’s a good one. In Vietnam, parents train their babies to pee on command. Kind of like Pavlov with his salivating dogs. Except this is moms with peeing babies. The Chinese do it too, apparently. Parents start by noticing when their baby starts peeing and making a little whistle sound. Soon enough, the baby starts to associate the whistle with peeing and voila!

Think this sounds a little odd? Or a little like someone is conflating a kid with a pet schnauzer? Well, researchers say Vietnamese babies are usually out of diapers by 9 months. What do you think now?

3. Traditionally, Kisii people in Kenya avoid looking their babies in the eye

Kisii, or Gussii, moms in Kenya carry their babies everywhere, but they don’t indulge a baby’s cooing. Rather, when their babies start babbling, moms avert their eyes.

It’s likely to sound harsh to a Western sensibility, but within the context of Kisii culture, it makes more sense. Eye contact is an act bestowed with a lot of power. It’s like saying, “You’re in charge,” which isn’t the message parents want to send their kids. Researchers say Kisii kids are less attention-seeking as a result.

4. Danish parents leave their kids on the curb while they go shopping

In Denmark, writes Mei-Ling Hopgood in How Eskimos Keep Their Babies Warm, “children are frequently left outside to get frisk luft, or fresh air — something parents think is essential for health and hearty development — while caregivers dine and shop.”

As you might imagine, this idea sends shivers down the spines of many parents in the United States. In New York, a couple (one of whom was Danish) was arrested for leaving their child outside a BBQ restaurant while they went inside to eat.

“I was just in Denmark and that’s exactly what they do,” Mariom Adler, a New Yorker out walking with her 2-year-old son, told the New York Times. “We would see babies all over unattended. We were stunned, frankly. But Denmark also struck us as exceptionally civilized.”

5. In the Polynesian Islands, children take care of children

We’re not talking any old big brother baby-sitting little sister here. We’re talking organized kid collective.

Hopgood writes in her book that adults take the lead in caring for babies in Polynesia, but as soon as a child can walk, he or she is turned over to the care of other children.

“Preschool-aged children learned to calm babies,” she wrote, “and toddlers became self-reliant because they were taught that that was the only way they could hang out with the big kids.”

Jane and James Ritchie, a husband-and-wife anthropology team, observed a similar phenomenon over decades in New Zealand and the Polynesian Islands. But they don’t think it would fly in the United States.

“Indeed in Western societies, the degree of child caretaking that seems to apply in most of Polynesia would probably be regarded as child neglect and viewed with some horror,” they wrote in Growing Up in Polynesia.

6. Japanese parents let their kids go out by themselves

Parents in Japan allow their kids a lot of independence after a certain age. It isn’t uncommon for 7-year-olds and even 4-year-olds to ride the subway by themselves.

Christine Gross-Loh, author of Parenting Without Borders, lives in Japan for part of each year, and when she’s there she lets her kids run errands without her, taking the subway and wandering around town as they may. But she wouldn’t dare do the same back in the United States.

“If I let them out on their own like that in the U.S., I wouldn’t just get strange looks,” she told TED. “Somebody would call Child Protective Services.”

7. Spanish kids stay up late!

Spanish families are focused on the social and interpersonal aspects of child development, according to Sara Harkness, a professor in the Department of Human Development and Family Studies at the University of Connecticut.

The idea of a child going to bed at 6:30 p.m. is totally alien to Spanish parents, Harkness told TED.

“They were horrified at the concept,” she said. “Their kids were going to bed at 10 p.m.” so they could participate in family life in the evenings. The same is true in Argentina, according to Hopgood.

8. Aka pygmy fathers win the award

For the Aka people in central Africa, the male and female roles are virtually interchangeable. While the women hunt, the men mind the children. And vice versa.

Therein lies the rub, according to professor Barry Hewlett, an American anthropologist. “There’s a level of flexibility that’s virtually unknown in our society,” Hewlett told The Guardian. “Aka fathers will slip into roles usually occupied by mothers without a second thought and without, more importantly, any loss of status — there’s no stigma involved in the different jobs.”

This flexibility, apparently, extends to men suckling their children. Ever wonder why men have nipples? That’s why.

9. French kids eat everything

Set mealtimes; no snacking whatsoever; the expectation that if you try something enough times, you’ll like it. These are among the “food rules” in France that are taken as given. The result is French kids who eat what adults eat, from foie gras to stinky cheese. Tell that to my nephew.

Of course, it goes without saying that most of these are just generalizations: not every Argentinian parent lets their kids stay up very late, nor do all French parents have such a liberal attitude towards what their children eat. Individual and subcultural nuances doubtless exist.

But perhaps like many other globalizing trends, we may start to see the development of trans-cultural approaches and standards. Just as cuisines, art styles, and consumer trends have emerged across the planet, so too will certain parenting ideas.

Then again, as I noted earlier, child rearing is a fundamental characteristic of a given society, and thus not something that can be transcribed nor altered so easily. Granted, the pace of globalization continues to accelerate, challenging all sorts of established cultural norms and concepts. Only time will tell, but in the meantime it is interesting to learn about — and learn from — how our fellow humans practice this vital social institution.

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How the world’s armies picture their enemies

Eupraxsophy:

It is fascinating what one can glean from something as seemingly trivial as a target or effigy used for shooting practice. At the risk of looking too deeply at certain irrelevant elements, many of the most routine and minor practices in a given society can reveal a lot about it history, culture, economics, politics, and the like (especially if one takes into account other dynamics, influenced, etc).

Originally posted on Quartz:

You can often tell a country’s enemies by the targets its soldiers use for shooting practice. That’s what Herlinde Koelbl found while visiting the military shooting ranges of nearly 30 nations over the course of the past six years. Her photographs are collected in a recent book, Targets, and an exhibition at Berlin’s Deutsches Historiches Museum, up through October 5.

At every stop in her travels, Koelbl wondered, she writes in the book’s introduction, “Who is the bad man? What does he look like—the enemy that they are later expected to kill? Is he an abstract figure? Does it have a gender and if so, which? Are there cultural differences? Has the image of the enemy changed?” For the US, the target of choice was once a Soviet figure—”Ivan”—with a red star on his green helmet. Now, reflecting a change that’s taken place in much of the world, Ivan has largely been supplanted by Middle…

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Command and Control: Nuclear Weapons, the Damascus Accident, and the Illusion of Safety

If you look at the Pentagon’s official list of how many nuclear weapons accidents, serious accidents, we have — what they call “broken arrows” — the list contains 32 accidents. But I was able to obtain a document through the Freedom of Information Act that said just between the years 1950 and 1968, there were more than 1,000 accidents involving nuclear weapons. And many of the serious accidents I found don’t even appear on the Pentagon’s list. So I’m sure there were many more that I was unable to uncover that occurred.

The problem today is that we have very aging weapons systems — both in the United States and Russia. It’s very old technology. Our principle nuclear bomber, the B-52, hasn’t been built since John F. Kennedy was president. Our principle land-based missile, the Minuteman III, was put into the ground originally in 1970. [It] was supposed to be retired in the early 1980s, and the infrastructure is aging — the wiring, the computers in our Minuteman launch complexes use 9-inch floppy discs. There’s all kinds of potential for problems there — and in Russia, the same thing.

—  Eric Schlosser, in an interview with NPR about his new book on nuclear weapons.

Timelapse Video of North Korea’s Capital

Given the exceptionally insular and totalitarian nature of North Korea’s regime, everyday photos and accounts of the country are hard to come by (though contrary to popular belief, outside visits and reports aren’t nonexistent). So I was surprised to see this rather beautiful timelapse video of Pyongyang, North Korea’s capital and premier city, courtesy of Mother Jones. It gives a far more vibrant and organic picture of the city than we’re accustomed to seeing.

The MoJo article points out that the video’s cheery vibe reflects the fact that it is an advertisement for Koryo Tours, a Beijing-based company that has run tours into North Korea and that subsidized the filmmakers’ travel expenses. Moreover, the plight of North Koreans is far more dire than one may imagine from the otherwise sleek-looking capital:

[The] capital is home to the ruling elite, and used by the regime as a showcase city; people here are hardly representative. For example, 16 million of North Korea’s 24 million people suffer from critical food insecurity, relying only on state-rationed food, according to the U.N.; one out of every three children is too short for his or her age. Hunger, poverty, lack of electricity, brutal repression and political reprisals… you name it: A UN special inquiry recently described North Korea’s human rights violations as without “parallel in the contemporary world.”

The lack of traffic in such a large and otherwise modern-looking city is just a mild reminder that most North Koreans are in dire circumstances, regardless of their rulers’ efforts to plaster it all over.

Seeing this, I cannot help but reflect on the potential of a united Korea, and whether I will ever live to see it happen.

Video — World Demographics

The following video chat from The Economist tackles a topic that’s been of great concern to the American public for some time: global population growth. In just a little over one minute, it shows that overpopulation isn’t as big an issue as popularly believed.

So overall, the world population is stabilizing, with many countries — including many in the developing world — experiencing negligible or even negative population growth. Most of the population increase stems from longer lifespans and the “demographic momentum” of younger generations coming into child-rearing age (at which point they will have increasingly fewer children, if any at all).

The following map confirms that most of the biggest population gains will be concentrated almost entirely in Sub-Saharan Africa:

Population growth by percentage increase. Source: Wikimedia / CIA World Factbook.

Of course, this doesn’t mean population growth won’t bring its problems, given that most of the growth is concentrated in nations that lack the resources, infrastructure, and institutions to optimally accommodate their ever-larger number of citizens.

However, as much of the rest of the world experiences a stagnating or declining labor force — not to mention the subsequent financial and economic burdens — nations with more youthful populations may gain a considerable advantage on the global market for human resources.

If poorer nations manage to tap into the potential talent of their young and vibrant people, investing in education and infrastructure to facilitate and promote opportunities, they may well reach unprecedented levels of prosperity and influence — provided they are not turned into giant factories for foreign companies first.