In one of the most memorable lectures I ever heard in medical school, “A Tale of Two Cities,” a guest lecturer on epidemiology (the study of disease trends) described a study by medical economist Victor Fuchs comparing health statistics from Nevada and Utah. Although the study’s participants from the two states were nearly identical in income level, education, and age, the states had strikingly different rates of disease and mortality.
The healthier residents were from Utah. Fuchs determined that this could be directly linked to positive lifestyle patterns. The participants from Utah had good diets, exercised regularly, and avoided tobacco, excessive caffeine and alcohol, and drugs. Our lecturer concluded by saying that in the United States, the vast majority of chronic disorders—like heart disease, cancer, diabetes, hypertension, and stroke—can be considered lifestyle diseases. The government has estimated that 85–90 percent of these diseases are preventable.
I was awed as well as confused by this lecture: awed because it showed we do possess the power to control disease, and confused because so little control was being exercised.
Lifestyle vs Access to Care
Eventually, I came to see that many people don’t change their lifestyles to improve their health to optimum levels because they have excessive faith in the power of drugs and surgery to save them from their own poor choices. They give up responsibility for their wellness to their doctors. As Donald B. Ardell, MD asserted in High-Level Wellness, “The single greatest cause of unhealth in this nation is that most Americans neglect, and surrender to others, responsibility for their own health.”
John Knowles, the former president of Rockefeller Foundation, suggested that people have been duped, either accidentally or on purpose. He wrote, “People have been led to believe that national health insurance, more doctors, and greater use of high-cost hospital-based technologies will impart health. Unfortunately, none of them will.”
A new study, has found that across much of the Western world, 25 years of expansion of the medical system has actually led to people feeling less healthy over time, a new study has found.
A researcher at The Ohio State University used several large multinational datasets to examine changes in how people rated their health between 1981 and 2007 and compared that to medical expansion in 28 countries that are members of the Organization for Economic Co-operation and Development.
During that time, the medical industry expanded dramatically in many of those countries, which you might expect would lead to people who felt healthier.
But that's not what Hui Zheng, assistant professor of sociology at Ohio State University, found.
Greater Access to Medical Care Doesn’t Improve Subjective Health
"Access to more medicine and medical care doesn't really improve our subjective health. For example, in the United States, the percentage of Americans reporting very good health decreased from 39 percent to 28 percent from 1982 to 2006," Zheng said.
In fact, Zheng conducted what is called a "counterfactual analysis" using the data to see what would have happened if the medical industry hadn't expanded at all in these countries since 1982. In this analysis, other factors that are generally linked to improved health, such as economic development, were left unchanged.
Under this scenario, the analysis predicted that self-rated health would have increased in these 28 countries. For example, the percentage of Americans reporting very good health could have increased by about 10 percent.
"It seems counterintuitive, but that's what the evidence shows. More medicine doesn't lead to citizens feeling better about their health - it actually hurts," Zheng said.
The study appears in the July 2015 issue of the journal Social Science Research.
The OECD is an organization of countries, including the United States and many countries in Europe, that accept the principles of representative democracy and free-market economy. This study included information from OECD Health Data, World Development Indicators, the World Values Survey and the European Values Study.
Zheng measured three kinds of medical expansion. One was medical investment, which includes health care spending per capita and total health employment; medical professionalization and specialization, which includes the number of practicing physicians and specialists; and expanded pharmaceutical industry, which includes pharmaceutical sales per capita.
People around the world rated their health on a five-point scale from 1 (very poor) to 5 (very good).
In the study, Zheng took into account a variety of factors, other than medical expansion, that may be related to health. He included country-wide variables like economic development and life expectancy at birth. He also included individual-level variables, such as whether people were married, their levels of education and their income.
Even after all these factors were taken into account, all three types of medical expansion were associated with poorer subjective health over time.
"All of the improvements we might expect to see in subjective health as economies grow and citizens become richer seem to be offset by medical expansion," he said.
Zheng said there are several reasons why medical expansion may actually lead people to feel less healthy. For one, more diseases are discovered or "created," which increases the risk of being diagnosed with "new" diseases. Three examples, he said, include the rise in diagnoses of Attention Deficit Hyperactivity Disorder (ADHD), depression and autism.
In addition, there is more aggressive screening, which turns up more diseases in people. Overdiagnosis can potentially cause harm to perfectly healthy people, he said.
As more medical care becomes more widely available, people may expect better health, perhaps to an unrealistic degree, Zheng said.
"Consumers begin demanding more medical treatment because of the declines in subjective health and the increasing expectations of good health, and medical expansion continues. It is a cycle," Zheng said.
Declining Confidence in Medical Treatment
In a separate but related study published online in Social Science Research, Zheng found that Americans' confidence in medicine has declined over the last three decades, again at the same time as medical expansion.
"The decline in confidence has occurred at the same rate, regardless of gender, age, income or any other factor," Zheng said.
This decline occurs even after taking into account many of the same factors used in the other study that may affect confidence in medicine. Related to the other study, the decline in confidence in medicine may be partly due to the adverse effect of medical expansion on individual subjective health. People with worse subjective health generally have lower confidence in medicine.
The study, based on data from the General Social Survey from 1972 to 2008, showed that people's declining confidence in medicine could also be linked to declining trust in doctors' ethics.
"We don't know for sure, but one reason consumers may have less trust in the ethics of their doctors is because of the introduction of managed care in the medical market," Zheng said.
"People may feel that doctors work more for these managed care companies than they do for the patients."