Drop in life expectancy in the U.S. a Reflection of the American health system

According to David Blumenthal of the Commonwealth Fund, Americans are dying younger which is a reflection of the failure of the American health system. 

Blumenthal notes that while it is easy to blame the nation’s opioid epidemic, the abysmal new life expectancy data from the Centers for Disease Control and Prevention show the data for what they are — an indictment of the American health care system.

According to the CDC, the average life expectancy at birth in the U.S. fell by 0.1 years, to 78.6, in 2016, following a similar drop in 2015. This is the first time in 50 years that life expectancy has fallen for two years running. In 25 other developed countries, life expectancy in 2015 averaged 81.8 years.

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National Adolescent Drug Trends in 2017: Findings Released

In the annual Monitoring the Future study by the University of Michigan, now in its 43rd year, about 45,000 students in some 380 public and private secondary schools have been surveyed each year in this U.S. national study, designed and conducted by research scientists at the University of Michigan’s Institute for Social Research and funded by the National Institute on Drug Abuse. Students in grades 8, 10 and 12 are surveyed.

 

Highlights:

This increase in marijuana drove trends in any illicit drug use in the past year. Marijuana use among adolescents edged upward in 2017, the first significant increase in seven years. Overall, past-year use of marijuana significantly increased by 1.3% to 24% in 2017 for 8th, 10th, and 12th graders combined.

The 2017 survey also reports first-ever national, standard estimates of nicotine vaping, marijuana vaping, flavoring-only vaping, and any vaping. Previously, no national study has published estimates for vaping of specific substances for the standard time periods of past 30 days, past year, and lifetime.

Cigarette smoking by teens continued to decline in 2017. For the three grades combined, all measures (lifetime, 30-day, daily, and half-pack/day) are at historic lows since first measured in all three grades in 1991. Since the peak levels reached in the mid-1990s, lifetime prevalence has fallen by 71%, 30-day prevalence by 81%, daily prevalence by 86%, and current half-pack-a-day prevalence by 91%.

Smokeless tobacco also showed a continuing decline this year with 30-day prevalence reaching a low point for the three grades individually and combined.

In general, alcohol use by adolescents has been in a long-term decline that actually first began in the 1980s and was interrupted for a few years during the relapse phase in the substance use epidemic in the 1990s.

In 2017, however, lifetime prevalence, annual prevalence, 30-day prevalence, and daily prevalence all showed little or no change with no significant changes for any grade or for the three grades combined. This is the first time this has happened in many years and may herald the end of the long-term decline in adolescent alcohol use.

Use of inhalants significantly increased among 8th grade students in 2017. Inhalant use includes sniffing glue, gases, or sprays, and is an unusual type of substance use because it is more common among younger than older adolescents.

The opioid epidemic among adults has received much attention in recent months, and MTF offers the opportunity to see what is happening with opioid use among adolescents. Heroin use by adolescents has always been low, and did not significantly change in the 8th, 10th, or 12th grades in 2017, with annual use levels at 0.4% or lower in all three grades.

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New Commonwealth Fund scorecard notes states made little progress before ACA

According to a recent Commonwealth Fund report on State Health System Performance, in the five years preceding implementation of the Affordable Care Act’s major coverage provisions, the majority of states declined or failed to improve on two-thirds of the measures that could be tracked over time.

Commonwealth Fund researchers ranked the health systems of every state and the District of Columbia on a variety of health care measures. Of the 34 measures that could be tracked between 2007 and 2011–12, all states saw meaningful improvement on at least seven. But more than half of states lost ground on at least nine measures. 

The Commonwealth Fund scorecard covers areas such as Access and Affordability, Prevention and Treatment, Potentially Avoidable Hospital Use and Cost, and Health Lives (public health measures). 

Three US regions rank high on Commonwealth Fund scorecard

Case studies of three U.S. regions that ranked relatively high on the Commonwealth Fund’s Scorecard on Local Health System Performance, 2012, despite greater poverty compared with peers, revealed several common themes. In these communities, multistakeholder collaboration, mutually reinforcing efforts by health care providers and health plans to improve the quality and efficiency of care, a shared commitment to improve accessibility of care for underserved populations, and state policy and national and local funding programs all played a role in expanding access to care and providing resources for innovation.

High-intensity primary care may help lower costs and improve quality

“High-intensity” primary care, a model of care similar to the Patient-Centered Medical Home specifically for patients with chronic and multiple conditions, shows promise in lowering costs and improving quality, according to a press release by the National Institute for Healthcare Reform.
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Commonwealth Fund calls for government to develop a vision for improving population health

A Commonwealth Fund report calls for the federal government to develop a comprehensive, disciplined implementation plan that takes full advantage of the new opportunities provided by the Affordable Care Act, the American Recovery and Reinvestment Act, and the Health Information Technology for Economic and Clinical Health (HITECH) Act.
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Performance on Children’s Health varies across states

The State Scorecard on Child Health System Performance, 2011, finds that where children live and their parent’s incomes significantly affect their access to affordable care, receipt of preventive care and treatment, and opportunities to survive past infancy and thrive, according to the Commonwealth Fund.
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