Social Medicine and Public Health
What follows was triggered by a debate with arcana_mundi.
We were discussing, inter alia, the relatively poor showing of the US on many population health indicators despite the US spending more on health than the rest of the OECD and whether the US healthcare financing and delivery model was responsible for that. She argued that there are many factors affecting population health indicators besides the US healthcare model including lifestyle issues, incidence of poverty etc and, of course, she is correct.
The train of thought that I have been playing with in my head goes something like this. Maybe there is a correlation between lifestyle factors and the extent to which healthcare is taxpayer funded. Public health interventions are almost invariably tapayer funded (this was true even in impeccably laissez faire Victorian England) because nobody else is going to pay for them. Well designed public health interventions can be very successful but the opposition to them is usually vocal and concentrated, the benefits hard to measure in the short term and beneficiaries may not be aware or unduly concerned about the outcomes. The big exception is where public health investments ease the strain on a publicly funded healthcare system since there the immediate payor and the apparent financial beneficiary are one and the same.
To take perhaps the most obvious example, smoking cessation policies can save a fortune in down the road healthcare costs but are invariably opposed by the cigarette companies and the tobacco farmers (and usually by the ministry of finance who find short term tobacco revenues more attractive than long term savings. Wasn't there a Yes, Prime Minister episode on that very theme?). It took a very long time for Ontario to adopt fairly aggression smoking cessation strategies precisely because of the strength of that lobby in the province and one wonders if it would ever have happened if the costs imposed by smoking on the healthcare system were not being met from the public purse.
If it is the case that polities with substantially publicly funded healthcare systems are more likely to engage in public health interventions, one might reasonably expect that to result in healthier lifestyles in those polities. Of course, there are other reasons why the government of a polity with a private healthcare system might choose to make public health interventions and, of course, they do. My suspicion is that they do less. It would though be interesting to compare comparative spending on public health interventions across, say, the OECD, and see if there are correlations either to the degree that healthcare is socialised(1) or to population health statistics.
I don't have access to J-STOR until I get back to the Cancer Pits but I might try and have a look then.
(1) It is a question of degree. Contrary to popular belief and a lot of political rhetoric, all of the OECD countries have mixed healthcare systems with a mix of taxpayer and non-taxpayer funding and delivery split, in different proportions, between government, not for profit and commercial providers.