An Apple a Day.....

I have got to learn to write more clearly. Whenever I speak to people by e-mail about something on my mind, they often write back as if the are in the grips of adult dyslexia. For example, here is Prof. David Warner, Wilbur J. Cohen Fellow in Health and Social Policy, Lyndon B Johnson School of Public Affairs, who seems a nice enough fellow, but for his confusion, I would think he is answering me with a bit of obfuscation in mind. You decide:

>> Professor Warner:
>>
>> After state agency consolidation a number of vital services to protect public health were under-funded or eradicated altogether. For example, rural indigent clinic funding, reduced, Medicaid funding eliminated for dental, glasses, hearing aids, assistive devices, less provider reimbursement, and mental health services for adults; MHMR closures/curtailment, greater restrictions on hospital district indigent care, lack of autism programs, declining chip roles. This cuppled with increased Medicaid drug costs, shrinking Medicaid provider participation, and prenatal care would predict, I think, would drive over-all mortality rates in Texas up instead of down. Yet, HHS public health tables listing mortality rates list decreases in deaths from incidence of disease accross the board. From my perspective, the only thing new, in terms of health services in rural Texas are more dialysis and hospice services. http://www.dshs.state.tx.us/chs/cfs/default.shtm
>>
>> This result seems counterintutive to me. Less services = less disease? How is this accounted for, do you think?
>>
>> Sincerely,
>>
>> Peter Higgins

>
> this is 95-2003--the Medicaid cutbacks and CHIP cutbacks didn't begin until late 2003. Also there has been generally full employment and in general death rates have declined nationally as well. Also an increased number of Hispanics who generally have longer lives and better mortality experience may also have an effect even though they have less access to care. The fact is that these services don't really have much to do with mortality.

> Professor Warner:
>
> I was thrilled and felt very privileged to receive your facinating reply. You got me thinking outside my box, so to speak.
>
> Incidentally, I have seen the HHS 2003-06 mortality tables, but when searching recently I couldn't find them again. However, I clearly recall that the downward trend continued, which probably isn't too surprising to you.
>
> To differentiate between US Dept of Labor unemployment (claims-based) statistics vs. "real" unemployment; or, the other non-medical factors contributing to mortality in minority population (accidents and assaults) wouldn't change much. You are no doubt right as to the fact that, "these services don't really have much to do with mortality."
>
> Risking that I am further imposing on you, should I assume reduced social/medical services from school lunches to geriatric physical therapy make us less healthy? My hope is to find out where any impact on public health would be found in terms of objective measurement.
>
> You are a gentleman and a scholar.
>
> Warmest regards,
>
> Peter


there is a big literature on how a more egalitarian society may have fewer stresses and better health. I think there is certainly an impact on children's health now and in the future from healthy lunches and breakfasts and physical therapy for the geriatric population has a positive impact--whether it can be substituted for by various exercise and other regimens is antoher story.....