To reflect its complexity, the Calvert-Henderson Health Indicator (initially discussed in Part 2) focuses on three basic questions: "Who gets a chance at life?", "How long will that life last?" and "How healthy will that life be?" Infant Mortality Rate is a measure of the first question, Life Expectancy is a measure of the second question and Self-Reported Health is one way of measuring the third question. All of these help to reveal inequalities in health both within the US and between the US and other countries.

These issues are important because, while the United States provides more health care services at higher costs per capita than any other country in the world, we rank below most of the wealthy nations and even some of the poorer nations in basic health statistics like infant mortality and life expectancy. In addition, the benefits of health care are spread unevenly across the population in the United States with large disparities depending on race, income and education levels. Infant mortality rates vary according to the mothers' race, ethnicity and education level.

Although there was progress in all the groups in reducing infant mortality rates between 1983 to 2004, the infant mortality rate for infants of African American women in 2004 was more than double the rate among infants of white women and still well above the average of all women in 1983. The largest relative decline in Infant Mortality rates has been among the American Indian and Alaskan Native group, followed closely by the Hispanic and Asian/Pacific Islander groups (2004 rates declined 42% to 45% relative to their 1983 rates). The smallest decline was among infants of African American mothers (31% decline from 1983 rates). Thus, the comparative disadvantage of infant mortality for African Americans has actually worsened, from a ratio of 1.76 times the average rate in 1983 to nearly double the average rate in 2004 - inequality has actually worsened!

Mortality rates for infants go down as the level of education of the mother rises although even here there is a wide disparity between races as seen in this next graph.

The focus of national health efforts needs to be both on the improvement of overall health and well-being and the reduction - indeed the elimination - of disparities in health. These disparities are rooted both in the broader determinants of health and the differential access that people have to those determinants. Biological factors play a large role as well. For this reason, the Calvert-Henderson Health Indicator also includes a measure of the quality of life people experience (such as self-reported health) as well as more conventional measures of mortality and/or morbidity. This measure incites the analysis and understanding of socio-economic, geographic, gender and ethno-cultural disparities that are determinants of the health indicator.

As the graph above shows, people living below the poverty line are more than three times as likely to report their health as fair or poor compared to people with incomes at least double the poverty line. The range in the survey is a five point scale including excellent, very good, good, fair and poor, so fair and poor are below the midpoint of the scale. Poor was defined as below the poverty line, near poor had incomes between 100 and 200 percent of the poverty line and nonpoor had incomes more than twice the poverty line. In addition, there is a disparity in self-reported health in terms of race or ethnicity, as shown in the graph below.

The indicator offers a model of the current U.S. healthcare system to help clarify a systemic set of issues. Health is being redefined beyond the medical intervention model. Today, Americans are focusing on prevention, stress-reduction, and lifestyle choices. Tobacco and alcohol use, and even the availability of guns, are issues entering the public health debate. More Americans now consult "complementary" and "alternative" health providers than visit conventional medical doctors and facilities. This is a paradigm shift, which is restructuring the entire medical-industrial complex and its technocratic, bureaucratic approach that represents some 14 percent of GDP. New statistics are needed as the U.S. integrates these two very different approaches to health. The Calvert-Henderson Health Indicator is a first step towards an expanded concept of health to include acute intervention, remediation, disease prevention (and root cause diagnosis), education and ultimately, behavior patterns to promote long-term health.

This approach seems like it can stir up so many conversations that matter. Conversations that can shape both our national policies and our profession. Perhaps even to create new tools. Wouldn't it be great if we had a conference or track on sustainable wealth? Better, wouldn't it be wonderful if we had these conversations within our communities and moved to action?

Our Goals are about creating wealth. If we don't measure it right, we won't manage it right," warned World Bank Vice President for Sustainable Development Ian Johnson. Without these indicators, leaders risk "knowing the cost of everything and the value of nothing," Johnson said, quoting English writer Oscar Wilde.

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Mike Ryan CFP®

February 07, 2009

66.82.162.21

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Wonderful series Martin. I wish this issue had a higher priority. I am afraid that the economic crisis is sucking all resources to its defense. Thats understandable but is there any excuse for our dismal standing regarding health? Especially when it is so related to economic status. To paraphrase Marie Antoinette, "The people have no health care. Let them use the emergency room"

One anecdote on the topic. I have a home in northern Wisconsin. There are five Ojibwa reservations within a forty five minute drive. Native Americans compose a significant and vibrant part of the community. It has been inspiring to see how this group has taken responsibility for the health and well being of its members. I suspect that a significant part of the overall improvement in the health of this group has to do with increased awareness about nutrition and drug use. While there has been some support from the federal or state governments the tribes have taken control of there own well being. There is strength in education and community support.

Thanks for your important contribution to increasing our understanding of this critical issue.

martin siesta

February 08, 2009

205.188.117.16

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Mike:

It is interesting observation onn the Ojibwa first nation's people. I am seeing the same thing with some of the communities where people have less money. One of the leaders who has been involved for more than 30 years observed: "Organizations is where people turn to when community doesen't work". Perhaps one of the most important skills that we can acquire and carry is that of comunity organizier. If we can help build a cimmunity where the answers can come from within and where we can network to create collective change there is hope

Mike Ryan CFP®

February 08, 2009

66.82.9.14

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That is so true. There is no substitute for community. It is unfortunate that we are so ideologically constricted in this country that many of the people who so desperately need social and economic services deride community (and community organizers) and support political ideas that bring great wealth to a small segment of the people but which also have severe pathological side effects. We are in the midst of a major economic side effect of ineffective and inefficient government. Our pitifully segregated health system is an other example of the un-intended consequences of ignoring common goals and needs.

Perhaps we can learn from successful community action. We are a government of the people by the people and for the people. Sounds like a community to me. Communities, and the individuals that comprise them,should indeed be responsible for their own future and well being. When they are supported by sound national, regional and local government policies community becomes even more vibrant and self sustaining.

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