Welcome back, Jacksonville. Happy Saturday to you all. We’re so glad you’re joining us today for the conversation with Doctor 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. But before we get into it, let me remind all of 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.
So, with that being said, Doctor, who is joining us in studio, and secondly, what are we talking about today?
Kasraeian: Today joining us in studio is Doctor Kelli Wells [inaudible]. She is the Deputy Secretary for health and the Director of the Duval County Department of Health. And I’m very excited to talk about a very interesting topic today. Basically it sorta came out this week that found in a child born in the United States has about a 70% greater chance of not making it to adulthood that 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, and 19 other similar wealthy countries. Countries like Canada, Australia, France, the United Kingdom, and they found that although all of the countries studied, the 20 countries studied had declines in childhood deaths over the past three, four decades since the 1960s, the United States has ranked last since the 1990s. And the U.S. falls especially far from its peer countries when it comes to infant mortality, and deaths in teenagers.
So in a nation as wealthy, and as sophisticated as the United States, I found this to be intriguing. And so, who better than Doctor Wells to help us navigate this intriguing and very interesting question. And the other interesting thing that 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 has not happened, this trend has not happened since the 1960s. So infant mortality and overall death rate are two very very important statistics for overall health of a nation.
So who better than our Director of our Department of Health to discuss these two very interesting studies, and bits of research in epidemiologic statistics. So, welcome to our show.
Dr. Kelli Wells: So glad to be back, thank you so much for having me.
Kasraeian: So what do you think about all these interesting statistics?
Dr. Kelli Wells: Well I think the most striking thing for me is the obvious differences between the United States, and other countries that were cited in the study in terms of size. You’re talking about countries with populations significantly under what the U.S. population is. So that’s first. I think that we certainly had 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 healthcare is financed in these other countries, but I know that in our country, we do a lot of funding toward tertiary care. So we don’t do a lot of prevention, we do a great deal of taking care of you when you get sick. And as a matter of fact, our system has been constructed to such that that type of care is incentivized. So as we are making the transition to more value based care, I think we need to recognize that the impact of that is often that we are spending a lot of money for really not the best outcomes.
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. And that’s the concept of preventative care. I mean, 68% of our nation is overweight and obese, approximately 35% of our nation is actually obese when you look at BMI and some 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 it’s just such a vast difference. And so in looking at that, and seeing studies such as this, and we’ve done shows before in terms of the disparities with healthcare, you mentioned population. So the United States has a population between … depending on the year, I think the most recent statistics shows 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.
So we have 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 these 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 kind of talks about the United States healthcare being so bad, yet if someone gets sick across the world, and they have the 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 pre-hospital setting. And we had 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. So it means that you’ve got access to healthy foods at a price point that you can afford, that you are not being exposed 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 is I wanna make the little pizza that comes in the box, I want the macaroni and cheese with the powdered cheese in there.
And I grew up in a household … My mother’s a nurse. I grew up in a household 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. And for many families who live in financial or social crisis, it becomes a challenge to incorporate those things into their lives.
So 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 a one faceted solution to this, and if I’ve learned anything as a health officer, and now as deputy secretary, it has been 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.
And most of the interventions that are gonna be of greatest benefit have to happen at the local level based on what the needs are of a particular community.
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-