Are students teaching the nation a lesson on health reform? (Gazette)

Dead is dead. It really makes little difference if a high school students dies of a drug overdose or is killed by a former or current student with a bullet or driving an automobile under the influence of alcohol or drugs.

Why is there profuse praise for students protesting that they will not tolerate safety inaction regarding being shot dead, while they leave unaddressed their chance of dying from risks orders of magnitude higher?

The media is full of articles regarding how these students will teach the nation a lesson, bring communities together in a “movement” and change policy to assure their safety. No doubt considerable resources have been spent to support students in these nationwide demonstrations, while other greater threats beg for such attention. Will these students teach the nation a lesson, or do they simply reflect the way the nation lately prefers to address most health threats?

The March 14 issue of JAMA (e-edition) contains four articles by established policy wonks on the huge, unsustainable costs of the U.S. health care system compared to other industrialized nations. There was little disagreement that we pay too much for expensive medical care, often for diseases and injuries that, to varying degrees, are preventable. The price we pay for drugs and devices, health professionals and administration are simply too high, most agree.

As to solutions, there is the usual split between those who favor government versus market solutions. Some praise the enormous advancements in medical research that lets us cure and/or contain diseases like HIV, hepatitis C and certain cancers, noting the U.S. leads industrialized nations in cancer survival. They are fearful of too much central control of the private sector regarding worldwide research, new drugs and biologics, or defining the “value” of care, especially in the elderly.

Others promote central government administrative oversight, new models of care, unified reimbursement and information technology as solutions.

This same issue of JAMA contains an article titled, “U.S. Trends in Mortality From Substance Use Disorders and Intentional Injuries, 1980-2014.” The findings were: “in this study of 2,848,768 deaths in the United States from 1980 to 2014, mortality rates varied widely among counties and increased by 618.3 percent for drug use disorders but decreased by 8.1 percent for alcohol use disorders, 6.0 percent for self-harm, and 44.9 percent for interpersonal violence. Mortality rates due to drug use disorders increased in every county, while mortality rates due to alcohol use disorders, self-harm, and interpersonal violence increased in some counties and decreased in others”

That is a lot dead. The trend is clear, with a 618 percent increase of deaths from drug use. The fact that the rates differ, sometimes significantly, among communities is also of note.

The simple fact is that if high school students want to feel safe, they need to look at what is killing them in their individual communities and take action. Although reducing interpersonal violence is a worthwhile safety goal, its contribution is miniscule in regard to improving overall student safety.

There is another lesson. It relates to improving health status, care and cost saving. The action is at the community level, where the demography, social determinants of health, culture, health risks, disease/injury mix/intensity vary considerably, as do the effective and efficient use of available health resources.

The fragmentation, duplication, waste and unmet health and social needs in many communities is staggering. Many of these factors can only be addressed locally, but the authority, willingness to assume responsibility, organization and resources are lacking. There is little discussion of this factor in the four articles on the cost of the U.S. health care system.

It’s great if high school students are interested in improving health and safety in their communities. However, I suggest that, when they exit the bus, train or plane returning from their demonstrations “teaching the nation a lesson,” they engage in study of what kills people — especially students — in their communities, what is or is not being done to lessen the toll and what they can do to increase the odds of staying alive.

Perhaps then they can teach a lesson to the health policy wonks who appear deadlocked on solutions. Perhaps the solutions to both lies close to home.

Jim Felsen, of Great Cacapon, is a retired public health physician.aa

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