Cutting Deaths from Heart Attacks
In the last eight years , from 2002 to 2010, Britain has halved its heart attack death rate. According to recent data published in the British Medical Journal, over half the decrease occurred in the number of attacks, with the rest of the improvement due to increased survival following heart attack. Rates improved across the board, though in younger populations overall incidence of heart attacks did not go down. Obesity and diabetes have been increasing among British youth.
Did you read about this in any American media? No? After all, this is only a greater than 50% reduction in the most common cause of death.
What Are Comparable Changes in the US?
Very hard to gauge—which tells you a lot. Even the CDC has a great deal of difficulty collecting partial national statistics. One comparable: a decrease in Medicare patients heart attack death rate of 16.6% to 16.2% comparing 2005-2008 to 2006-2009. Study participants regarded this .4% decline as "huge."
Translation: we don't carry out similar statistical surveys of the whole population very often, the data are hard to get and often bad—and our numbers don't look anywhere as good as Britain's.
Why Did Britain Do So Well?
It pays to look at the CDC's risk factors for heart disease. They are
• High cholesterol
• High blood pressure
• Cigarette smoking
• Overweight and obesity
• Poor diet
• Physical inactivity
• Alcohol use
How many of these are impacted by lifestyle? Most. How have they been tackled in Britain?
First, look at public health: there are large British government supported education programs to get people to eat more vegetables and fruits; to exercise more; more money placed on mass transit, and much money spent on parks and walking spaces; congestion charges on cars in areas like central London, pushing people onto mass transit.
British studies have noted a halving of the difference in survival between the highest and lowest socioeconomic groups simply by how much greenspace exists around where they live. When people have parks and easy to use walkways they use them; they also appear to develop more cohesive communities with better social support. And live years longer.
Cigarettes taxes in Britain are onerous. Public education and media attacks on smoking are ubiquitous. Alcohol use has been rising, especially binge drinking, and has drawn numerous White Papers and attempts to cut drinking among the young.
Now let's look at health care: The large majority of Britain's doctors are GPs. Many are directly incentivized to treat high blood pressure and high blood lipids - they get paid more if their patients show reductions in both.
Though "high tech" cardiac care is less prevalent in Britain, hospital and primary care are regionalized and rationalized. Communities are very aware that most heart attack deaths occur in the first hour. When people are thought to have a possible heart attack they go directly to the regional emergency center set up to treat them. Compare that with coordination of care in the US.
National health services are routinely attacked by American politicians as "socialist" and lacking the "liberty" and "superb technology" of the American health care system. The US ranks 50th in overall longevity in the world - according to the CIA. Our health care costs about twice as much per person as Britain's.
Until we recognize that health is much more significant than health care—and affected much more by how we eat, move, rest and socialize than the size and technology of our hospitals—we will be condemned to waste money hand over fist. We also should allow facts, reason, and analysis into our political health debate. Health care is, as Warren Buffet has said, a huge "tapeworm" on American business. Other countries get the job done far better—and a lot cheaper.