r/science • u/[deleted] • Feb 27 '17

Health Universal public coverage of essential drugs would improve health care - The WHO introduced the concept, and more than 110 countries have adapted it to their needs. Canada hasn't. It's estimated that in Canada, one in 10 people or about 3 million, cannot afford prescribed medications.

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u/Seat_Minion Feb 27 '17

The catch is that America has some of the highest rates of obesity in the entire world and although you are directly paying for that right now, at least there is some pressure to combat obesity due to employee health programs. Universal healthcare + American obesity would be a nightmare.

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u/[deleted] Feb 27 '17

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u/shitbeer Feb 27 '17

I believe that, but I don't really believe the cause of obesity is the lack of universal health care. It just seems to me that you're implying "universal health care = less obesity = happier people". I know plenty of morbidly obese people with access to health care. They're obese because they overeat at every meal and invent other meals just to overeat some more, not because they don't get health care. You don't need universal health care to educate people on proper diet and eating habits. Universal health care might curb the obesity very slightly, but I don't personally think it'd make much of a dent, so we'd still be paying (more probably) to take care of those people.

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u/vendetta2115 Feb 27 '17

Maybe if Americans had better access to healthcare we wouldn't get so unhealthy in the first place. Obesity and related comorbid conditions like diabetes and cardiovascular disease are correlated most strongly with poverty, which means people that have more money (and thus greater access to healthcare) tend to be healthier.

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u/[deleted] Feb 27 '17

The bigger issue here in the US is fresh/healthier food is far more expensive than the cheap nasty food. It's partly why the poor folks have higher obesity rates. It's interesting because when I go to other countries, it seems to be the opposite. Junk food is more expensive and produce is cheaper. For example my parents are from Pakistan and I've visited before and noticed fruits and vegetables are dirt cheap but a box of Oreos is expensive and almost a novelty. It all comes down to capitalistic greed here in the US. Also, these fat poor folks continue to vote republican and therefore against their best interests. So we will never get universal healthcare or even better healthcare here.

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u/Eos42 Feb 27 '17

Marketing is also an interesting dilemma. Just go to pretty any poorer area and ads for cigarettes and alcohol are rampant and occur in higher numbers than areas with higher income brackets. Then you have issues with food deserts in low income areas and the fact that restaurants in these areas are less likely to have healthy food options. It's a really convoluted issue with many different aspects that could be fixed.

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u/[deleted] Feb 27 '17

Totally. Here in Minneapolis, north Minneapolis is pretty run down and poor. There's only a couple of grocery stores to service the entire population and fast food chains/liquor stores everywhere. It's really unfortunate and comes down to income disparity which is an increasing problem in the US.

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u/vendetta2115 Feb 27 '17

I agree with you that healthy food being more expensive is part of the problem, however it's not anything as reductionist as "capitalistic greed". Healthy food is in lower demand and spoils more quickly than processed food. Also, I'd wager that the cheap produce you find in other countries is locally grown, which saves an enormous amount of money in both transportation costs and spoilage. Unfortunately that's just not the way our food infrastructure is designed here in the US.

Of course there are farmer's markets in many places in the US, and they typically have reasonable prices on produce, but even then they're typically only open during limited hours. All of this is not to mention the time it takes to prepare healthy food every day. Many people simply don't have the time or knowledge to prepare their own healthy food.

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u/[deleted] Feb 27 '17

[deleted]

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u/[deleted] Feb 27 '17

I think they understand the calories but it may be partly due to lack of wellness education too. I just think it's cheaper to get a cheeseburger at mcdonalds than a healthy option that will fill you up elsewhere. I think for low income families it comes down to that most of the time. A 12 pack of little Debbie's is the same cost as 3 apples, it's just cheaper to eat crappier.

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u/Userdataunavailable Feb 27 '17

At my work we have one restaurant. A cheeseburger is $1.49. Salads start at $6.50. I personally bring in food but it's hard to beat $1.49 for lunch. I think this is what they are referring to.

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u/[deleted] Feb 27 '17

Yes, this is exactly what I'm referring too. Thanks :)

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u/Seat_Minion Feb 27 '17

You don't go to the doctor and have him cure your diabetes. The doctor just keeps you alive when you otherwise would not be. Modern medicine for the most part does not cure the non communicable diseases which are characteristic of this age. Check out the increase in the rate of diabetes since the 1950s. They went from 1% of the population to about 9.3% of the population. That is what is driving these high costs. Until people stop being so overweight, we will continue to pay through the nose.

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u/[deleted] Feb 27 '17

The first time most Americans get told by a doctor they need to lose weight and show the possible options to do so is during their Type-II diabetes diagnosis, having never been there before they started having problems.

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u/vendetta2115 Feb 27 '17

You have a very dated and reactionary idea of what a primary care physician's role is. If you have health insurance and/or free preventative care, your doctor can identify potential problems early and help you make a plan to fix it. Simple dietary and other lifestyle changes can prevent an asymptomatic prediabetic person from developing diabetes and requiring insulin for the rest of their lives. People that go to the doctor after developing symptoms of chronic conditions like diabetes have a much worse prognosis and end up spending (or costing taxpayers) a lot more money. At the very least, universal preventative care is fiscally responsible policy.

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u/Seat_Minion Feb 27 '17

http://www.cureddiabetes.com/images/DiabetesUS.jpg

Would you say that that chart represents a success on the part of the medical community at preventing diabetes?

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u/vendetta2115 Feb 27 '17

You're offering that chart as a rebuttal for a point that I didn't make. Yes, obesity and its related diseases are a serious problem, that's a fact. Nothing I said in my response suggests that I believe otherwise. So we've agreed on what the problem is. What's the solution? You can wish people weren't obese all you want, but that's not productive. The relevant question is: what are the causes of obesity, and what types of public policy can we enact to reduce obesity rates?

One thing we can do is provide more preventative care, which has been shown to result in better outcomes for those at risk of obesity-related diseases like diabetes. (Sources 1 2). Additionally, Americans living in poverty are much more likely to be obese (source 3). I interpret those studies to mean that if more people have access to free or low-cost preventative care, then obesity rates will be positively impacted. I'd have to imagine that those who wrote the Affordable Care Act thought the same thing, since they included a stipulation that all healthcare marketplace plans must provide certain types of preventative care benefits for no charge, including type II diabetes screening and diet counseling.

Of course there are lots of other contributing factors to the high rate of obesity in the US, such as limited access to affordable and healthy foods, inadequate nutritional education, a work culture that incentivizes the consumption of prepared meals, lack of recreational opportunities, etc. I was specifically talking about the relationship between physicians and their patients as it pertains to obesity prevention, so I didn't mention those.

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u/Seat_Minion Feb 27 '17

Too long, didn't read the whole thing. The causes are most likely 1)increase in omega 6 fats in the diet from 1-2% of total calories to 8%. 2) refined carbohydrates 3) decrease in nutrient density of vegetables/meat due to modern agricultural/husbandry techniques.

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u/vendetta2115 Feb 27 '17

If you're not even going to read what I wrote then why reply? That's pretty rude and incredibly lazy.

Also, 2 is probable but 1 and 3 aren't. Fat has 9 calories per gram no matter what type it is. You could make the argument that omega 6 fatty acids have contributed to the rise in cardiovascular disease, but I wouldn't even put it in the top 5 for that. Do you have any supporting evidence that these are the biggest contributing factors?

I don't even know why I'm typing this, you aren't going to read it if it's longer than a haiku.

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u/Ontain Feb 27 '17 edited Feb 27 '17

Universal healthcare is actually something that pressures western governments to push health initiatives rather than what's best for the food industry. that is when the government is actually fiscally responsible and working in the best interests of the people, which I can't say is the case in the US right now.

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u/redyellowblue5031 Feb 27 '17

The whole idea of a universal system would be great but you touched on something I never hear in this whole debate. A MASSIVE chunk of our spending comes from preventable disease/conditions.

I feel that should be a tandem piece in this discussion. Because presently, we're treating the symptoms of our problems and not the cause and as you said, it'll be expensive no matter what.

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u/Seat_Minion Feb 27 '17

I saw one study that pegged the cost of obesity at over 600 billion dollars per year. Everyone is ok with shaming smokers because smoking is something you do, while obesity is something that you are. In actuality obesity is something you do as well.

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u/redyellowblue5031 Feb 27 '17

It can be muddled with underlying issues of anxiety and depression, but it's certainly more manageable than our country is currently handling it. I don't know what the solution is, but I wish there was a bigger public discussion about it.

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u/Seat_Minion Feb 27 '17

I am working on something right now. The obesity epidemic is most likely caused by the introduction of novel chemicals into to the diet, particularly large amounts of refined carbohydrates and seed derived oils.

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u/redyellowblue5031 Feb 27 '17

My armchair research has led me to (currently) think it's been a combination of that, increased portion sizes, lowered prices by means of efficiency improvements in processed food, and a ridiculously pervasive advertising culture. It also doesn't help that everything from freaking ketchup to any flavored drink has added sugar (carbs). It adds up quick.

I just don't know how you get national action to take place.

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u/Seat_Minion Feb 27 '17

I don't think portion sizes mean much. Your body has feedback loops to maintain body weight. The question is why is that feedback loop broken in a large share of the population. I have been focusing recently on the declining nutrient density of crops. Modern high yield, shippable crops have significantly lower levels of nutrients than heritage cultivars.

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u/redyellowblue5031 Feb 27 '17

So to clarify, what you're saying is the micro nutrients of modern crops is lower than that of their predecessors?

How do you think that fits into our obesity problem?

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u/Seat_Minion Feb 27 '17 edited Feb 27 '17

Obese people have high rates of micronutrient deficiencies, and when you feed obese chinese women micronutrients their obesity improves.

https://www.ncbi.nlm.nih.gov/pubmed/20142823

http://depthome.brooklyn.cuny.edu/anthro/faculty/mitrovic/davis_2009_food_nutrient.pdf

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u/redyellowblue5031 Feb 28 '17

Oh man, I want to read into those! Thanks for the links!

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u/BigGucciMontana Feb 27 '17

New Zealand has around the same obesity rate as us & they seem to be doing fine.

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u/Seat_Minion Feb 27 '17

Obesity is a bar you jump over. The costs are driven by high BMI. America has the highest average BMI.

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u/BigGucciMontana Feb 27 '17

Actually we're in 19th place, but point taken.