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Electronic Letters to:

Kenneth E. Thorpe, David H. Howard, and Katya Galactionova Differences In Disease Prevalence As A Source Of The U.S.-European Health Care Spending Gap Health Affairs, November/December 2007; 26(6): w678-w686. [Abstract] [Full Text] [PDF] [Technical Appendix] [Reprints & Permissions]

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Electronic letters published:

Health Disparities And Spending Differences

Julie A. Broadwin, MPH, PhD   ( 11 October 2007 )

Why American Adults Are Sicker Than Europeans

Boris Odynocki   ( 26 November 2007 )

Health Disparities And Spending Differences 11 October 2007
Julie A. Broadwin, MPH, PhD, Epidemiologist Graduate of San Diego State University's School of Public Health Send letter to journal: Re: Health Disparities And Spending Differences jbroadwin{at}gmail.com Julie A. Broadwin, MPH, PhD	This article is the first time I have seen health disparities discussed as a significant factor in spending differences between the United States and Europe. I was surprised to learn that smokers over age 50 are more prevalent in the US, but not surprised to see our greater rates of obesity. One good way to reduce our rates of chronic disease and thus our health care spending is simply to stop driving so much and to walk more. My understanding is that fewer Europeans own cars and that walking is built in to their daily lives. If we detect and diagnose diseases earlier in their course than Europeans do, that would increase our spending, but one would hope that increase would be offset by improved quality and quantity of life and savings down the road from avoidance of costly complications. I wonder if it's possible to show whether this is the case. I am suspicious of increased survival rates for cancer when earlier detection makes living 5 years with disease more attainable.
Why American Adults Are Sicker Than Europeans 26 November 2007
Boris Odynocki, Researcher Business Consulting, Slidell, LA Send letter to journal: Re: Why American Adults Are Sicker Than Europeans odynock{at}aol.com Boris Odynocki	The Thorpe et al. discovery that Americans appear to be sicker than the Europeans confirmed my own similar, naked eye observations made years ago, after my arrival in the U.S. from Europe. Disappionting, however, is the authors' explanation as to why such disparities exist. And yet, the reasons are quite obvious in light of modern social epidemiology and social psychology (Wilkinson, Marmot, Karasek, and Theorell). To begin with, American society is much more socially divided in terms of income and race than societies of Europe. Income and racial inequalities translate into health disparities. Inability to control one's own work environment (alienation) is associated with poorer health. Working Americans are insecure in the workplace, threatened with the loss of a job "for good, bad, or no reasons at all" at any moment. According to the International Labor Organization, our country ranks in job security well below the European Union but close to countries of South America and Africa. Job insecurity triggers enormous stress that results in illness and early death. American employees are subjected to autocratic management practices on a daily basis that use coercion and control as incentives to higher productivity. The suppression of freedom of speech in the workplace is justified by the requirements of work discipline. Also, lack of universal health insurance, and with it, neglect of preventive medicine and primary health care, leads to higher prevalence of chronic diseases in later life. Another reason, among many, for poorer health of Americans is the design of American urban areas. A great many are not walking sites, unlike in Europe, where most cities and towns have sidewalks. Combined with unhealthy eating habits, this irrational urban planning leads to high rates of obesity and diabetes. Finally, American neglect of children results in their underachievement in later life, lower standards of living, and poor health that is universally associated with poverty or near-poverty.