by Michael A. LeNoir, MD
When evaluating a health system’s performance, it is measured by the outcomes it achieves for its citizens. Unfortunately, the United States stands out for all the wrong reasons among Western nations. The data speaks volumes: the U.S. has the lowest life expectancy of developed nations, trailing an alarming four years behind the average. It ranks last in preventable and treatable mortality, highlighting the tragic loss of lives from conditions like hypertension, diabetes, and heart disease. COVID death rates were significantly higher, along with deaths from self-harm and gun violence. In terms of access to care, the U.S. ranks last in providing equal health care for people of color.
There are a number of obvious problems, but the cost-related issues due to a high number of uninsured residents is a major cause. Despite historic lows in uninsured Americans, this figure still exceeds those in other high-income countries with universal coverage.
Even with insurance, navigating health care can feel chaotic—high deductibles and copayments make it challenging to find a primary care doctor. The disparities in access and health outcomes between lower and higher-income individuals, regardless of race, are more pronounced in the U.S. than in any other nation. A Black male in Oakland who lives in the flatlands is four fewer years to live than those who live in more affluent areas.
These systemic issues demand our urgent attention and action. It’s vital to advocate for health equity and work towards a more accessible and efficient health care system for all.
The Failing U.S. Health System
Authors: David Blumenthal, M.D., M.P.P., Evan Gumas, B.A., and Arnav Shah, M.P.P.Author Info & Affiliations
Published October 9, 2024
N Engl J Med 2024;391:1566-1568
https://www.nejm.org/doi/full/10.1056/NEJMp2410855
DOI: 10.1056/NEJMp2410855
The study uses 70 measures of health system performance across five domains: access to care, care process, administrative efficiency, equity of care, and population health outcomes. Data is from 2020 or later and includes publicly available sources like the OECD, Our World in Data, and the World Health Organization, along with Commonwealth Fund surveys of doctors and residents in the participating countries.
Why Is This Important: The United States ranks last overall on these performance measures. And the importance of making changes is discussed.
Neighborhood Deprivation and Breast Cancer Mortality Among Black and White Women
Lauren E. Barber, PhD1; Maret L. Maliniak, PhD1; Leah Moubadder, MPH1; et al
Dayna A. Johnson, PhD1; Jasmine M. Miller-Kleinhenz, PhD2; Jeffrey M. Switchenko, PhD3; Kevin C. Ward, PhD1; Lauren E. McCullough, PhD1June 12, 2024
JAMA Netw Open.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819908
2024;7(6):e2416499.
doi:10.1001/jamanetworkopen.2024.16499
Neighborhood deprivation has been associated with increased breast cancer mortality among White women, but findings are inconsistent among Black women, who experience different neighborhood contexts. Accounting for interactions among neighborhood deprivation, race, and other neighborhood characteristics may enhance understanding of the association.
Why This Is Important: The findings from this analysis suggest that the links between neighborhood characteristics and breast cancer mortality are especially important for non-Hispanic White women, regardless of whether they live in rural areas, move around a lot, or what the racial makeup of their neighborhoods is. On the other hand, these connections don’t seem to matter much for non-Hispanic Black women, even though they face greater neighborhood deprivation. There could be several reasons for this lack of association among non-Hispanic Black women. It might mean that as we move up the economy, they encounter different stresses but stress nonetheless.
Validation of a Mobile App for Remote Autism Screening in Toddlers
Authors: Pradeep Raj Krishnappa Babu,et al
Published September 26, 2024
N Engl J Med 2024;1(10)
https://www.nejm.org/doi/full/10.1056/NEJMp2410855
DOI: 10.1056/AIcs2400510
Early detection of autism is important for timely access to diagnostic evaluation and early intervention services, which improve children’s outcomes. Despite clinicians’ ability to reliably diagnose autism in toddlers, diagnosis is often delayed. SenseToKnow is a mobile autism screening app delivered on a smartphone or tablet that provides an objective and quantitative assessment of early behavioral signs of autism based on computer vision (CV) and machine learning.
Why is this Important: This issue is even more significant for Black families. Research indicates that Black children often miss out on early screenings and diagnoses for developmental disorders compared to their white peers. It’s crucial because the sooner these diagnoses are made, the better the outcomes for the children. So, any app that helps would be welcome.