09.13.11.Health_Medical_Care - Health and the Role of...

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Health and the Role of Medical Care HCMG 101 Daniel Polsky September 13, 2011
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Today’s Objectives 1)What determines health? 2)What factors have been most important in improving health over the past 200 years? 3) Role of public health vs. Medicine 4) What factors might be most important to improve health over the next 50 years?
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Health Function • Health=H(Endowment, Medical Care, Lifestyle, Socioeconomic Status, Environment) • Which factor is the most important determinant of health (in terms of avoiding premature death)? http://www.polleverywhere.com/multiple_choic e_polls/ODI2OTY2NDU3
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Source: Cutler, Deaton, and Lleras-Muney, 2006. Pre 1900 1900-1950 1950-2000 Life expectancy over time – by age
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Before 1900 High infant mortality. Children most susceptible to infectious diseases Modest improvements in life expectancy among the young Resilience improved by nutrition Economic growth Nutrition What was the contribution of health care to the mortality rate? Source: Cutler, 2004.
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Health care before 1900 • Hospitals – Places of sanctuary – Patients “patiently waiting for death” • Surgeons – Part-time barbers – Judged by speed of completing amputations • Physicians – Masters of “watchful waiting” – Judicious application of herbal remedies • Nurses – Sisters of mercy
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Source: Cutler, Deaton, and Lleras-Muney, 2006. Pre 1900 1900-1950 1950-2000 What changed around 1900?
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Ignaz Semmelweis Discovered Effects of Handwashing Hungarian physician working in Vienna Noted that death rate among mothers delivered by medical students in Vienna much higher than by student midwives Medical students came straight from anatomy room He instituted hand washing with chlorinated water (1847)– death rate fell It would still be another 30-50 years before the reason for this effect was discovered and used to greatly improve health Death rate among women delivered by . .. 0 5 10 15 20 % mortality Medical students Student midwives
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Reducing germs Microbial cultures demonstrating the effectiveness of disinfection: (A) without disinfection procedures (B) after washing hands with soap (C) and after disinfection with alcohol
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Source: Cutler and Meara, 2004. U.S. Infant Mortality Rate Dropped Sharply and Steadily Between 1900 and 1950
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Impact of Early Medical Treatments Antibiotics: Sulfa drugs discovered in 1935 Penicillin Discovered in 1928 by Alexander Fleming Not widely available until 1941 Others: ?
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filtering and chlorinating water supplies building sanitation systems draining swamps pasteurizing milk vaccination campaigns boiling bottles and milk protecting food from insects washing hands ventilating rooms Macro: Big Works Projects Micro: Educating People Source: Cutler, Deaton, and Lleras-Muney, 2006. Water- and food-borne diseases such as typhoid, cholera,
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09.13.11.Health_Medical_Care - Health and the Role of...

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