Pediatric Annals

Editorial Free

We Are Last!

Stanford T. Shulman, MD

Pediatric Annals Editor-in-Chief Stanford T. Shulman, MD, is the Virginia H. Rogers Professor of Pediatric Infectious Diseases at Northwestern University Feinberg School of Medicine and Chief of the Division of Infectious Disease at the Ann & Robert H. Lurie Children’s Hospital of Chicago.

An avid stamp collector, Dr. Shulman chooses relevant stamps from his personal collection to accompany his column each month.

Address correspondence to Stanford T. Shulman, MD, via e-mail: pedann@Healio.com.

A message from Pediatric Annals’ Editor-in-Chief.

This issue of Pediatric Annals includes a number of updates related to conditions involving allergy and immunology, ably organized by Amal Assa’ad, MD.

A recent analysis of the quality and efficiency of health care systems in 11 advanced countries including the US was performed by the Commonwealth Fund, a nonprofit organization specializing in health care issues. This analysis was summarized in a recent editorial in the International New York Times.1 Three international surveys (in 2011, 2012, and 2013) assessing how physicians and patients view medical practices, together with data from the World Health Organization and the Organization for Economic Cooperation and Development, were analyzed in the report issued June 16, 2014.

Unfortunately, as in previous surveys, the US ranked last on indicators such as infant mortality, healthy life expectancy at age 60 years, and deaths potentially avoidable through medical care. We also ranked last on measures that involve the cost of care, efficiency of care (eg, too many duplicate tests, avoidable emergency department visits, administrative hassles), and system fairness (eg, low-income individuals often going without care). All this despite the fact that we have the most costly health care system in the world!

The US ranks far worse than Britain and Switzerland, which scored the highest in quality and efficiency of care. Our results reflect both the high cost of US medical care, as well as the absence of universal health insurance, which is currently being addressed by the Affordable Care Act (ACA). The ACA already has increased the number of Americans with health coverage by approximately 9.5 million adults, with the rate of uninsured young adults dropping from 28% to 18% since the ACA was launched.2 In the 34 states that are participating in the Affordable Care Act to varying degrees, the number of uninsured Americans should continue to fall considerably in the near future.

In the US, last in the ranking of this Commonwealth Fund analysis, $8,508 per capita was spent on health care, whereas in Britain, the leader in the rankings, only $3,405 per capita was expended on health care in 2011. It is very difficult to escape the conclusion that we have to do better; hopefully, the Affordable Care Act will help us do so.

Having recently returned from a visit to Western Europe (specifically France), I can report on something that we do better in the US. The per capita cigarette consumption today in France seems higher than ever (my anecdotal assessment), despite the presence of bans on smoking in restaurants, bars, and other public places. Another recent article3 recounted the Irish experience with the world’s first ban on workplace smoking, instituted more than 10 years ago on March 29, 2004. Despite very serious doubts by many regarding the Irish public’s likely compliance, it was shown that within 1 month, there was 97% compliance in all workplaces, including most notably the 7,800 Irish pubs that had been notoriously smoke-filled for centuries. The Irish experience motivated dozens of countries to copy the Irish legislation because the predictions of decreased tourism failed to materialize and because of the impressive health benefits that have been seen. The TobaccoFree Research Institute Ireland recently released data from 2013 showing 26% reduction in heart disease and 32% drop in strokes throughout Ireland over the 10 years since the workplace smoking ban, saving as many as 3,700 lives, some of which can be at least partially attributed to the workplace ban.3

One of two 2013 stamps from India related to pediatrics; this one a child’s painting in honor of Children’s Day.

One of two 2013 stamps from India related to pediatrics; this one a child’s painting in honor of Children’s Day.

One of two 2013 stamps from India related to pediatrics; this one honoring the Indian Academy of Pediatrics, which was established in 1962.Images courtesy of Stanford T. Shulman, MD.

One of two 2013 stamps from India related to pediatrics; this one honoring the Indian Academy of Pediatrics, which was established in 1962.Images courtesy of Stanford T. Shulman, MD.

2013 Japanese stamps celebrate the Second Hideyo Noguchi Africa Prize. Noguchi was bacteriologist who discovered that Treponema pallidum is the etiologic agent of syphilis.

2013 Japanese stamps celebrate the Second Hideyo Noguchi Africa Prize. Noguchi was bacteriologist who discovered that Treponema pallidum is the etiologic agent of syphilis.

This Month’s Stamps

The stamps illustrating this column include two 2013 stamps from India related to pediatrics. The more colorful one is a child’s painting in honor of Children’s Day, while the pink stamp shows a baby with a stethoscope and honors the Indian Academy of Pediatrics. This organization was established in 1962 by the merger of the Association of Pediatricians of India, founded in 1950 by Dr. George Coelho (“Father of Indian Pediatrics”) in Mumbai, with the Indian Pediatric Society, founded in 1948 by Dr. K.C. Chaudhuri in Calcutta. The official publication of the Indian Academy of Pediatrics is Indian Pediatrics, published in New Delhi. Coelho was in charge of the B.J. Wadia Hospital for Children, the first children’s hospital in India, established in 1929. By 2007, the Indian Academy of Pediatrics had more than 16,500 members. In the 1940s, there were only 12 to 15 pediatricians in all of India!

The 2013 Japanese stamps celebrate the Second Hideyo Noguchi Africa Prize. Noguchi (1876–1928) was born in Fukushima, Japan, the site of the March 2011 earthquake disaster. He was a famous bacteriologist who in 1912–13, while working at the Rockefeller Institute for Medical Research in New York, discovered that Treponema pallidum is the etiologic agent of syphilis. He subsequently received many nominations for the Nobel Prize. He also studied Oroya fever, polio, trachoma, and yellow fever. He died of yellow fever in Ghana in 1928 while studying this illness. The Japanese government established the Hideyo Noguchi Prize in 2008 in his memory “to honor an individual or organization with outstanding achievement in medical research and medical services to combat infections and other diseases in Africa.” The 2013 recipients of this second award were Dr. Peter Piot, Director of Global Health at the London School of Hygiene and Tropical Medicine, and Dr. Alex Godwin Coutinho, Director of the Infectious Diseases Institute, Makerere University, Uganda, the latter for HIV prevention and treatment.

References

  1. International New York Times. How Health Care Systems Stack Up. June18, 2014. http://www.nytimes.com/2014/06/17/opinion/how-health-care-systems-stack-up.html?_r=0. Accessed July 23, 2014.
  2. The Commonwealth Survey Fund. Gaining Ground: Americans’ Health Insurance Coverage and Access to Care After the Affordable Care Act’s First Open Enrollment Period. http://www.commonwealthfund.org/publications/issue-briefs/2014/jul/health-coverage-access-aca. Accessed July 23, 2014.
  3. Selcraig B. In Ireland, 10 years of fresh air. New York Times. June10, 2014. http://www.nytimes.com/2014/06/15/travel/in-ireland-10-years-of-fresh-air.html?_r=0. Accessed July 11, 2014.

10.3928/00904481-20140723-01

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