Number of Infant Deaths/1,000 Live Births: 2012 (est.)
Cuba 37.3 5.3 4.83 Czech Republic 20.0 3.3 3.70 Finland 21.0 2.8 3.40 France 27.7 3.8 3.37 Japan 30.7 2.6 2.21 Luxembourg 31.5 2.5 4.39 Norway 18.9 3.2 3.50 Portugal 77.5 3.3 4.60 Spain 43.7 3.8 3.37 Sweden 16.6 2.8 2.74 United States 26.0 6.7 5.98
Source: U.S. Department of Health and Human Services. (2010). National Center for Health Statistics. Health, United States, 2010: With Special feature on Death and Dying. Hyattsville, MD. 2011: Author. Retrieved from www.cdc.gov/nchs/data/hus/hus10.pdf 2011; U.S. Department of Health and Human Services. (2009). National Center for Health Statistics. Health, United States, 2009: With Special Feature on Medical Technology. Hyattsville, MD. 2011: Author. Retrieved from www.cdc.gov/nchs/data/hus/hus09.pdf 2011, p. 104; and Central Intelligence Agency. (2012). The World Factbook. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/ rankorder/2091rank.html, March 9, 2012.
188 ■ Chapter 8
Social organizations and peer review bodies to control the use of technol- ogy did not exist in 1850; today they proliferate, and the federal government is expected to play a dominant role. The belief that health care is a right for all Americans is still a prominent philosophy, yet the fulfillment of that right is still in question. The trends, begun in the 1980s and early 1990s, such as the cutbacks in federal funding for health services and the attempt to turn the clock back on social programs have led to a diminished and denigrated role for the government in people’s health. On the other hand, the events of September 11, 2001, have pointed out the consequences of these cuts and the enormous and compelling need to boost public health and national security efforts.
There is growing and grave concern about the realization of this basic hu- man right of health and health care. Mounting social problems, such as toxic waste, homelessness, and millions of people without health insurance, confound the situation. These factors all affect the delivery of health care. The problems of acquiring and using the health care system are legendary and ongoing.
The year 1960 is the benchmark being used to compare health care costs and significant events. A brief overview of these landmark events follows. These events have contributed to what we see today as the health care “nightmare.” We are in a situation where health care delivery has become less and less personal and more and more technological in many health care settings. The barriers to health care are increasing and, as evidenced earlier, more and more people are unable to obtain health care, in spite of having health insurance. The events de- picted that have occurred in the health care system, whether within the public health or medical sector, have happened within the context of the longer societal framework. The public sector events include those related to the collective re- sponsibility for the health of large populations in many dimensions— prevention, surveillance, disease control, and so forth—and those events, positive and neg- ative, that affect large population cohorts. The medical events are those that include the development of diagnostic and/or therapeutic methods that are problem-specific and affect limited numbers of people. The public health events include government laws and policies that were designed initially to increase the scope of the health care system and later to control medical costs.
This information is further embedded in the key health system issues of the century and the start of this decade, the key health problems, and the selected key health strategies of the time. The key issues are professionalization, infrastructure building, improved access, cost control, market forces, and the reinvention of government. The key health problems are reemerging infectious diseases, chronic diseases, and the modern care changes. Key health strategies include maternal and infant health, antibiotics, screen and treat, and managed care.
At the turn of the 20th century, 1900–1930, efforts were underway to identify medicine as a profession and to eradicate all philosophies of care that were not under the umbrella of the Flexner definition of a profession. Agents such as quinine for malaria and the diphtheria antitoxin for immunization were discovered, and the use of radium to treat cancer began.
Infectious diseases, including pneumonia and influenza, were pan- demic. The main health strategy was maternal and child health, given the large
Health and Illness in Modern Health Care ■ 189
numbers of new immigrants. In 1929, third-party payment for health care be- gan with the creation of Blue Cross and Blue Shield.
Between 1930 and 1960, the health care system issue was infrastructure building. The passage of the Hill-Burton Act in 1946 provided funding for the building of hospitals and other health care resources. The system was on a roll—the development of today’s extraordinarily costly tests and treatments began, and the settings for their use were built. The development of vaccines and antibiotics paved the way to a decrease in the occurrence of communicable disease, and a false sense of freedom from illness began to develop. At the same time, it began to become obvious that, for many, access to health care was be- coming more and more difficult.
In 1965, President Lyndon B. Johnson’s War on Poverty became the focal point of social and health policy and, among other laws, Medicare and Medicaid came into being. The Health Professionals Education Assistance Act was passed, which led to the proliferation of medical nursing and other allied health programs. In 1967, the first heart transplant was performed by Dr. Christiaan Barnard in South Africa, and a whole new focus on science and technology was born. Today, transplants have become nearly ordinary events, and an entitlement philosophy is applied to receiving them.
The 1960s were an explosive time—there were too many assassinations, too many riots—yet strides were made in the struggle for civil rights. The war in Vietnam was a nightly television event until the truce in 1975. The 1970s, 1980s, and 1990s all had their share of strife and progress. Progress in health care was accompanied by the escalation of costs and the limiting of comprehen- sive care. The cases of HIV/AIDS continue to increase, and the threat of an- thrax and other forms of bioterrorism are present in the minds of most people. In addition, the 1960s were a decade of profound change in the delivery of health care, public health, and available methods of treating health problems and funding new resources. Selected highlights include the:
■ Development of the vaccines for polio and rubella (1961 and 1963) ■ Development of the methods for external cardiac pacing (1961) ■ Development of liver transplant method (1963) and first human heart
transplanted (1967) ■ Surgeon General’s Report on Smoking (1964) ■ War on Poverty, Medicare/Medicaid passed (1965)
The 1970s brought even greater strides in medical technology and public health:
■ Professional Standards Review Organization established, Clean Water Act passed, and the Tuskegee experiment1 ended (1972)
■ Comprehensive Health Planning; “Certificate of Need” (1974) ■ HBV—the hepatitis vaccine was developed (1978)