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Mr Epidemiology

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Mr Epidemiology

The only way to save Obamacare is to expand it

The Affordable Care Act was a landmark piece of legislation for the United States. While most other G-20 countries already have some form of universal healthcare (either through a single payer system, or mandatory insurance coverage), the US was one of the few countries that did not have one. Arguably, however, it didn’t go far enough, and therein lies its biggest problem.

One of the key provisions in Obamacare was that insurers could not deny coverage based on pre-existing conditions. This was a hugely important for those with serious or chronic illnesses, who would normally be denied coverage. For example, diabetes can cost someone approximately $7900 a year in direct medical expenses, which is a hefty sum if you don’t have insurance coverage. Obamacare mandating that these individuals, and others with similar conditions, have to be able to purchase coverage, is an excellent step forward. However, the business of insurance relies on those who enrol but do not require services subsidising those who enrol and do. In terms of healthcare, this would be low risk people paying and not using services, ensuring high-risk individuals are able to access services. As you can imagine, there is very little incentive for low risk individuals to enrol; a phenomena known as “adverse selection.”

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Basic Income: From an idea to reality

Our current way of dealing with poverty is inefficient at best, with mountains of forms, paperwork, weighed down by bureaucracy and procedures. At worst, it’s stigmatising and judgemental, keeping people in poverty rather than giving them opportunities to break free and elevate themselves out of poverty. One possible solution is providing individuals with a Basic Income (click link for my previous post on the subject).

A selling point for Basic Income is that it can save the government money. By streamlining select government services into one agency, it can reduce inefficiency. In fact, this is something that people on both sides of the political spectrum can agree on – both those who want small government and those who want the government to support our most vulnerable citizens. One example is in Ontario, where a recently published report titled “Finding a Better Way: A Basic Income Pilot Project for Ontario” by Hugh Segal reported that a basic income guarantee would replace Ontario Works and the Ontario Disability Support Program, giving everyone an income of $1320 a month, with an extra $500 for those with a disability. This would effectively replace those two programs with one larger, more comprehensive program that doesn’t require the same intensive oversight and monitoring.

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Which diseases do we get to “fight”?

About two weeks ago, the Hospital for Sick Children, also known as SickKids, launched their new ad campaign. For those who aren’t from Canada, SickKids is based in Toronto, Ontario, is the second largest children’s hospital in the world, and does some truly amazing and inspiring work. I highly recommend watching the ad, as the messaging and production quality is absolutely amazing. The imagery and symbolism is strong, and shows these children as fighters who will vanquish their foes. It shares more in common in terms of tone and imagery with NBA and NFL commercials than typical hospital advertisements.

I have mixed feelings on this ad campaign. On the one hand, it is meant to provide a strong, motivational message to children undergoing treatment, and to help raise funds for the SickKids Foundation. In this, it is wildly successful, with an ad that has been viewed almost half a million times (as of this writing), and one that has sparked lots of discussion. However, while the ad is motivational and empowering, it is not without fault.

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How can one person completely change the results of a survey?

In public health, we rely heavily on samples, as measuring everyone you are interested is often impractical. However, this requires a lot of thought and development in order to avoid unintentionally biasing your sample, as was the case for the USC Dornslife/LA Times Daybreak poll.

Last week, a story came out about how one 19-year old black man in Illinois was single-handedly changing the standings of the US Presidential election. This was based on the results from the USC Dornsife/Los Angeles Times Daybreak, a survey of voter attitudes on “a wide range of political, policy, social and cultural issues.” In this survey, Donald Trump has generally held the lead, until last week, when Hillary Clinton came out in front. Interestingly, this is markedly different than most other national polls, that have shown Clinton is generally ahead, or a much closer contest than that poll would have you believe. So what happened?

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City of Philadelphia successfully passes a soda tax

Last week, Philadelphia became the first major city to pass a “soda tax.” While other cities have tried and ultimately failed to pass similar pieces of legislation, Philadelphia was successful. So what made Philadelphia different?

Picture from Flickr user Scribe215
Picture from Flickr user Scribe215

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Is plain cigarette packaging just smoke and mirrors?

The Marlboro Man is one of the most iconic advertising images from the 20th century. The cowboy, depicted in some rustic setting, was single-handedly responsible for turning Marlboro’s annual sales from $5 billion a year to over $20 billion a year in the two years after the campaign was introduced. Since the success of that campaign, anti-smoking activists have tried several different ways to limit cigarette advertising. The latest salvo comes in the form of last week’s WHO statement on plain packaging, where they recommended plain packing as part of “comprehensive approach to tobacco control that includes large graphic health warnings and comprehensive bans on tobacco advertising, promotion and sponsorship.” Plain packing standardizes how cigarettes are sold, keeping the picture health warnings, but making the brand names, pack size, colour scheme all identical to limit their appeal.

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Perhaps there is a drug that can prolong your life. It’s called money

A wise man once said that “mo’ money, mo’ problems” (Wallace, 1997). However, despite increases in supposed problems, one of the major benefits is increased life expectancy.

New research published in JAMA last week examined how big a difference earning more money makes in life expectancy, as well as how this changes by geographic location across the United States. Researchers collected tax records from 1.4 billion individuals from 1999 to 2014 aged 40 to 76. Of these, around 4 million men died, compared to 2.7 million women (mortality rates of 596.3 and 375.1 per 100 000 respectively). They examined these data to look at what predicted life expectancy at age 40, after adjusting for race and ethnicity.

What makes New York different to other US cities? | Photo credit Kah-Wai Lin
What makes New York different to other US cities? | Photo credit Kah-Wai Lin (click for more)

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Tackling obesity needs all of us, not some of us

One of the most important issues facing public health today is obesity. Worldwide, approximately 30% of adults are obese,  and costs around $2 trillion annually. A health concern with complex determinants and many intertwined causes, there’s no single magic bullet solution to the rising prevalence of obesity. A new report by the McKinsey Global Institute studied 74 interventions to see what was effective. They studied 74 interventions that target obesity, which range from subsidizing school meals, adding calorie and nutrition labels, as well as restrictions on advertising high-calorie food and drinks.

The report covers areas one would expect, such as energy balance and changing dietary and physical activity behaviours. While these issues are important and do require study, the authors also looked at the environment and how that impacts obesity. There’s a lot of literature that shows that your environment plays a large role in obesity, and simply telling someone to “eat less and move more” is an ineffective strategy at best, and one that further stigmatizes at worst. It’s something we’ve discussed in relation to poverty, and illustrated with the retailer IKEA.

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Basic Income: A radical idea for eliminating poverty

The Watson Arts Centre in Dauphin, Manitoba (photo from Wikipedia)
The Watson Arts Centre in Dauphin, Manitoba (photo from Wikipedia)

I imagine most of my readers have never heard of Dauphin, Manitoba. A small, farming community in Canada, Dauphin is a town that was part of an experiment back in the 1970s. The “mincome” project was launched in 1974, and offered everyone a minimum income. Unfortunately, the project was shut down in 1979 with a change in the government, and so the effects weren’t long term enough. The purpose of the mincome project was to see what would happen if a “top up” was offered to everyone. Dr. Evelyn Forget has been studying records from those years, and following up on people to see how it impacted their life. Would people stop working? Would there be higher rates of employment? How would people respond?

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