Medical care in the United States is often compared unfavorably to that of other developed countries. It’s commonly stated that life expectancy in the US is much lower than in other countries and that this is due, at least in part, to poor medical care in the US. Life expectancy, of course, is affected by many things other things  than medical care. Murder and accidents reduce life expectancy but are not much of a reflection on the condition of the medical care where they happen. Nevertheless, unfiltered life expectancy is continuously used to argue against the effectiveness of American medical care as well the unfairness of its distribution.

Such an argument abuts the excellence of America’s medical research and it’s medical education. When the world wants to learn medicine it typically comes here. So what may be going on? Unfortunately Americans are more likely to murder other Americans as well as to accidently kill themselves compared to other residents of developed countries. More than 5 years ago Mark Perry published data which account for violent death. When these are removed life expectancy in the US is the best in the world. This difference may not be the result of superior medical care in the US, but it does show that poor life expectancy is not a good argument against American medical care.

The take away message is stay out of harm’s way and you can get well past your biblical three score and 10 years. I’m sure, however, that the argument from life expectancy will still continue to emanate from those who wish to see American medical care altered even more than it has been over the recent and not so recent past. If your are of the school that holds everything to be a medical problem, then our unfiltered life expectancy is a medical problem, because virtually every problem in life impacts on health in one way or another and therefore is a medical problem.

The Social Determinants of Health presents this view. It, in essence, argues that physicians (who I thought had enough to do taking care of diabetes and hypertension) need to be more socially aware about the effects of poverty and poor education on health. Of course these are important problems, but in my view a physician has no more expertise about them than does any other concerned citizen. The author of the piece obviously feels otherwise. Consider the questions he wants physicians, presumably in their professional capacity to ask themselves.

We need to contemplate the following questions:

  • How can we give every child the best start in life?
  • How can we help everyone to have the best health and life?
  • How can we provide educational opportunities for everyone?
  • How can we strive for an adequate standard of living that supports health and sustainable communities?
  • How can we prevent disease and disabilities?

As you can see the questions involve much more than the typical preserve of the medical practitioner. In essence they medicalize every aspect of modern life with possible exception of national defense. The author seems to think that if we shift our focus from the disease specific model medicine has always followed to a stance that addresses the five questions above that the ruinous increase in medical costs will somehow be controlled. Just ask yourself who the we in each of the questions above is likely to be and you will understand the entire piece as well as the solution it seeks. Life is hard, poverty bad, progress slow – but if you truly want it we must accept its sometimes glacial pace. Becoming more socially aware, whatever that turns out to mean, is not likely to reduce medical costs. Indeed in the long run it usually turns out to mean greater not lesser expenditure. Being poor is definitely bad for your health, but that doesn’t make poverty a medical disorder.

Read the piece with a jaundiced eye and come to your own conclusion. It takes a position consistent with that of those who lead American medicine. Its by Dr Richard L. Byyny who is the executive director of Alpha Omega Alpha, the medical school equivalent of Phi Beta Kappa. I was an AOA councilor for 25 years and know its leadership very well. They are not typical of the rank and file of America’s physicians. They are the elite of the profession and like to think big and look down from the commanding heights.