Is Poor Quality or Culture Central to the Health Debate?

You've probably seen the infant mortality studies showing the United States ranking 5th among the nations with the highest infant mortality rates. The Netherlands, Russia, Afghanistan, and Angola are worse, in order of progression. You may not know that life expectancy is 8 years longer if you live in Hawaii vs. Washington D.C. Or, you may not be surprised to know the United States ranks #1 in Cancer Care. What's going on? Are we the best, or among the worst? Do you really believe health care is better if you live in Hawaii vs. if you live in Washington D.C.?

What's to blame? Is it our health care system, or is our culture to blame for higher infant mortality and shorter lifespans than other countries? When you have nothing more to do than read blogs, go on the CDC website and look at the slides regarding the obesity epidemic in the United States. Is this a problem for the health care system to solve? Or, look at the infant mortality rates adjusted for level of social poverty and see how the United States immediately holds its own when compared to other countries.

Quality and patient safety has lots of room for improvement. As a health care provider and executive, such improvement is a personal passion and lifelong ambition. I'm amazed the United States has never been able to marshall the required leadership for a central repository of all primary immunization histories on its Citizens. We not only under immunize our children, in all liklihood, we over immunize them because of absent records when they enter school. How much more basic can it get! But at the same time, this problem again exemplifies the need for public health leadership at a state and national level, a government run and funded agency.

So, does the United States really have poor quality health care because of inattentive providers and bad hospitals when compared to alternatives in other countries? Or, do we have a very diverse social economic structure and poor leadership for system based solutions, resulting in fragmentation at the most basic level that can be solved through investment in the public health infrastructure and healthy lifestyle initiatives? Thoughts?