Health Care During the United States’ Existence

Every now and then someone attempts a piece of research that is a very big picture, long-term read on events.  Those can be useful, especially when it is easy to get bogged down with the large issues that our health system currently is handling.  A paper from the National Bureau of Economic Research examines changes in population health in the United States since its early times–around 1750.  Today’s transitions seem minor compared to some earlier ones and the experience of the United States may be relevant to emerging economies.  (NBER Paper)   The paper is rambling and poorly structured at times, but that may be unavoidable on such a large topic.  Over a multi-hundred year period, health has improved dramatically, based on measures such as longevity and height, as has the amount of money spent on health.  Much of the early gains were due to public health measures such as clean water availability and efficient sewage and garbage removal.  These developments benefited all socioeconomic groups, but particularly the poor.  At the same time, economic and cultural forces led to other health issues, such as excessive smoking and pollution-fed diseases.  Over recent decades, scientific innovation, including antibiotics and other pharmaceuticals, surgical techniques and medical devices, have been key to improving health over longer lives.  As wealth increased even in the 18th century, nutrition improved and was a key to better health, but our very wealthy nation now has many citizens who overfeed themselves, leading to health declines.  The link between health and economic growth must be there, but teasing out its subtleties is not easy.  Perhaps there is an intense feedback association between the two, in which more economic growth allows for better nutrition and better access to health care services and products and better health allows individuals to be more productive and to remain focused on work matters.  And the changing nature of the economy may have implications for the interaction with health as well–does that relationship change as a country moves to a more intellectually-driven economy?  And what is the role of education–more educated people generally are healthier, but is that just association or causation?  The paper raises a host of fascinating topics, which are relevant to all countries and economies as they work toward maximizing their people’s health and wealth.