Brian Middleton: Welcome back Jacksonville, happy Saturday to you all. We’re so glad you’re joining us today for the conversation with Dr.
Ali Kasraeian. I’m Brian Middleton filling in for Danielle Lee. We have another great show for you today, can’t wait to jump into it. Before we to get into it, let me remind all the listeners if you have a question at any point in today’s show, you can always call into our phone lines 904-340-1045, that’s 904-340-1045, and our producer, Scott will make sure to get you on.
With that being said Doctor, who is joining us in the studio? Secondly, what are we talking about today?
Ali Kasraeian: Today, joining us in the studio is Dr. Kelli Wells a fellow gator. She is the Deputy Secretary for Health and the Director of the Duval County Department of Health. I’m very excited to talk about a very interesting topic today. Basically, a study came out this week that found that each child born in the United States has about a 70% greater chance of not making it to adulthood than a child born in other wealthy democratic countries, so our peer countries. This study that was published last week in a journal called Health Affairs compared us to 19 other similar wealthy countries, countries like Canada, Australia, France, the United Kingdom, and they found that although all of the countries studied, 20 countries studied had declines in childhood death over the past three, four decades, since the 1960s, the United States has ranked last since the 1990s. The US falls especially far from its peer countries when it comes to infant mortality and deaths in teenagers.
In a nation as wealthy and as sophisticated as the United States I found this to be intriguing, and so who better than Dr. Wells to help us navigate this intriguing and very interesting question? The other interesting thing, this recent data comes on the cusp of recent data that shows that the United States’ overall death rate has fallen for the second year in a row, and this trend has not happened since the 1960s. Infant mortality and overall death rate are two very, very important statistics for overall health of a nation. Who better than our director of our Department of Health to discuss the two very interesting, studies and bits of research, and epidemiologic studies statistics?
Welcome to our show.
Dr. Kelli Wells: Glad to be back. Thank you so much for having me.
Ali Kasraeian: What do you think about all the interesting statistics?
Dr. Kelli Wells: I think, the most striking thing, for me, is the obvious differences between the United States and the other countries that were cited in the study in terms of size. You’re talking about countries with populations significantly under what the US population is, so that’s first. I think that we certainly have a larger number of folks in our country that live below the poverty line, and that are faced with significant challenges to accessing the things that make you healthy than other members of the population.
Secondly, I think … and I’m not an expert on how health care is financed in these other countries, but I know that in our country we do a lot of funding toward tertiary care, we don’t do a lot of prevention. We do a great deal of taking care of you when you get sick. As a matter of fact, our system has been constructed such that that type of care is incentivized. As we are making the transition to more value-based care I think we need to recognize that the impact that often that we are spending a lot of money for really not the best outcomes.
Ali Kasraeian: I always say that the United States does a great job of taking care of you when you are sick. We do not do a great job of keeping you healthy, that’s the concept of preventative care. 68% our nation is overweight and obese, approximately 35% of our nation is actually obese when you look at BMIs, and things of that nature. As a surgeon, it’s very challenging when the majority of the patients we operate on are very, very large, and that is very challenging compared to, like I always mention, I did my training at the University of Florida with my surgical and neurology residency, and then I did my fellowship in Paris, it was just such a pleasure to operate on thin, healthy people because there’s such a vast difference.
In looking at that and seeing studies such as this, we’ve done shows before in terms of disparities of healthcare, you mentioned population. The United States has a population between, depending on the year, I think the most recent statistics show somewhere between 327 million to 329 million people. We make up approximately 4.28% of the world’s population. Some of the other countries in this study: Canada, 36 million, France, 67 million, Australia, 23 million, the UK, 65 million, so one could make an argument that the percentage of our people in poverty could be relatively similar to the population of some of these nations. The discrepancies and the disparities in our population are very, very large so we’re dealing with a large population that’s very diverse, and so when the comparisons are made, and the fact that we spend more per patient, or per person how do those disparities come into play when these comparisons are made, and everyone talks about the United States’ healthcare being so bad, yet if someone gets sick across the world and they have funds they fly over here to get care?
Dr. Kelli Wells: I think you make a very, very important point that a great deal of what is healthcare happens in the prehospital setting. We talked a bit before about the importance of ensuring that everyone has the same opportunity to have access not just to medical care, which is where the focus tends to be, let’s get folks insured, and everybody needs a doctor, but that doesn’t solve the problem. In Duval County we are ranked 48th out of our 67 Florida counties in terms of health outcomes, but we don’t have a lack of physicians in our community, so I would submit that increasing the access to the medical community doesn’t solve the problem for everyone, and in some cases won’t touch the problem.
It is access to the other things, so it is a lifestyle that allows you to be healthy. It means that you’ve got access to healthy foods at a price point that you can afford, that you are not being close to anything in your environment because your financial situation limits your choice in terms of housing and location of your housing, that you are exposed to information that allows you to make healthy choices and to incorporate things into your life.
I have often given this example, growing up one of the things that I frequently asked of my mom was I want to make the little pizza that comes in the box, I want the macaroni and cheese with the powdered cheese in there. My mother’s a nurse, I grew up in a house where we ate fresh every day, and she cooked every day because of a commitment to providing a certain quality of food. Similarly, in households around our nation we have parents of children for whom a healthy lifestyle involving physical activity is never modeled, never discussed, never addressed. For many families who live in financial or social crisis it becomes a challenge to incorporate those things into their lives.
I would say that there are a lot of things that I think we do very, very well. I think now we need to back up and begin to look at the things that influence those choices, and access to some of the things that I’ve mentioned, and begin to look at restructuring that. The other thing I’ll say is that because it’s a diverse population there is not one faceted solution to this, and if I’ve learned anything as a health officer, and now as deputy secretary and that our communities across our state are very, very different in terms of need, in terms of demographics, in terms of readiness for community change. Most of the interventions that are going to be of greatest benefit to have to happen at the local level based on what the needs are of a particular community.
Ali Kasraeian: I think this will not be a quick fix and I think it needs the hands of all the different community leaders, and the individuals within those communities to step up because I don’t think complacency can be an answer here. The authors of this paper actually cited persistently high poverty rates, poor educational outcomes, and that doesn’t mean that people are poor in terms of not wanting to get education. It’s just it’s difficult to learn about health and if you don’t know about health it’s difficult to teach your children-