Advocates for Evidence-Based Health Policy Speakers
Public Health For The Win
As people, we like to know to whom our accolades are going when we have a good experience. Had a good meal? Compliments to the chef. Enjoy the movie? Bravo to the actors, but who’s the director? It’s also helpful for an establishment to give an outstanding employee a more influential role or more customer interaction for better outcomes and higher customer satisfaction. It follows, then, that we want to know where praise is due for the advances in health care over the past few decades. Life expectancy in the United States increased by 3.3 years between 1990 and 2015, but to where do we give credit?
A new paper found that credit for increased life expectancy is largely due to public health efforts (44%), followed by pharmaceuticals (35%), and to a lesser degree non-pharmaceutical medical care (13%). It should be noted, however, that there was heterogeneity of results between conditions and in pace of improvements. Much of the improvement from public health efforts was found to be due to the increased adoption of known risk reduction practices, and the authors go as far as to say that “public health is the dominant determinant of longevity in general.”
The study results were not without problems. Multifaceted influences to longevity change were attributed to “most proximal cause,” so factors with contributions from multiple areas were allocated to just one. This ignores the interaction between different areas of health care, the intersection of public and private health, and it oversimplifies our system’s complexities.
Although the results were complicated by methodology, the importance of public health measures and implementation of known risk reduction practices remains critical. Policy makers should explore (1) translating success from previous health policy wins to current issues, (2) creating a system for quicker and easier adoption of science-backed health practices, (3) targeting causes of death that contribute highly to mortality but that few improvements have been noted, and (4) allocating additional funds for the research and implementation of public health measures.
This Health Policy Journal Club review is written by Charles Walker as part of our collaboration with the Health Policy Journal Club at Baylor College of Medicine where he is a medical student.
Abstract
Life expectancy in the US increased 3.3 years between 1990 and 2015, but the drivers of this increase are not well understood. We used vital statistics data and cause-deletion analysis to identify the conditions most responsible for changing life expectancy and quantified how public health, pharmaceuticals, other (nonpharmaceutical) medical care, and other/unknown factors contributed to the improvement. We found that twelve conditions most responsible for changing life expectancy explained 2.9 years of net improvement (85 percent of the total). Ischemic heart disease was the largest positive contributor to life expectancy, and accidental poisoning or drug overdose was the largest negative contributor. Forty-four percent of improved life expectancy was attributable to public health, 35 percent was attributable to pharmaceuticals, 13 percent was attributable to other medical care, and -7 percent was attributable to other/unknown factors. Our findings emphasize the crucial role of public health advances, as well as pharmaceutical innovation, in explaining improving life expectancy.
PMID: 32897792