President Donald Trump, for once, could not ignore, deride or distract attention from the undeniable statistics in his interview last week with Axios journalist Jonathan Swan. As Trump stumbled over Covid figures Swan made it plain that whichever way you look at it the US is performing abominably.
The old adage “You get what you pay for” certainly does not apply to the US health system.
When Swan pointed out that the US had a quarter of the world’s deaths with just 4.3 per cent of the world’s population, Trump tried to say that, with Covid deaths, the US was doing well compared to other countries. Trump was comparing deaths as a percentage of cases not deaths per head of population.
But even on that score the US comes up badly. As a rich country you would expect the US to more successfully treat infected people than the world average and so a lower percentage of Covid patients would die. But no. The US death rate of 32 per 1000 cases is only slightly better than the world average of 37 and much worse than Australia’s 16 and New Zealand’s 14.
The US has the eighth-worst death rate per head of 150 countries which can be measured. Belgium is worst, followed by the UK. Australia is 92 nd and New Zealand 124 th. Incidentally, Brazil (9 th) is doing better than the US, but not by much.
It damns Trump’s lack of leadership. His failures to take the disease seriously, his mixed messages and abdication to the financially strapped states resulted in millions of unnecessary infections and hundreds of thousands of deaths.
Compounding this are some underlying weaknesses in the US health system which Trump has made worse. Many people in the US have no health insurance and so are reluctant to go near a doctor or hospital unless desperate. Many people have no sickness benefits so are more likely to go to work and infect others.
Too little is done on prevention so many people have underlying morbidity caused by poor diet and little exercise reducing their chance of surviving infection.
Covid aside many aspects of the US add to poor health outcomes: high imprisonment rates; low rates of helmet- and seatbelt- wearing. Over-servicing, through drug companies’ incentives (in effect, bribes) to doctors, unnecessary procedures, and prescription drug prices that discourage people taking proper medicine all worsen the position.
Bizarrely, the US spends far more on health ($US10,224 per person) than any country. Australia spends less than half that ($4543).
On a list of 20 or so comparable countries, the US spends more than double the average per person on health. It spends 18 percent of is GDP on health compared with an average of 9 per cent.
Yet its outcomes on nearly all measures (such a Covid) are worse than average: infant mortality; number of hospital and ICU beds available; longevity; cancer-survivorship rates and so on.
With better leadership, a rich nation like the US could again lead the world on health.
Greater public and less private funding for health helps, but with one major caveat. It has to be properly funded. The austerity cuts to the National Health System in Britain are now resulting in poorer health outcomes, again exemplified by Covid.
Britain has the second-highest death rate per head of population at 617 per million in the world. Worse, as an indictment upon decades of NHS cuts, your chances of surviving Covid in Britain are among the worst in the developed world – at 132 deaths per 1000 cases. Australia has just 16 and New Zealand 14. The US’s rate of 32 deaths per 1000 is twice as bad as ours.
In short, if you are going to get Covid, you are eight times more likely to die in Britain than Australia or New Zealand and twice as likely to die in the US than here.
British health statistics are getting worse in other areas, too.
It seems that both the financially starved mainly public British system and the hideously expensive mainly private US system are leaving a lot of people behind.
The gathering of Covid statistics and the scorecard mentality in developed countries, overshadows more deadly world health matters.
In the developed world we have largely overcome infectious diseases (until now). Very few people die of them. Instead we kill ourselves through poor diet, lack of exercise, smoking and excessive drinking leading to heart disease and cancers.
So when an infectious disease starts killing people we get alarmed. But from the perspective of the developing world and poorer nations, Covid, with just 745,000 deaths worldwide and just 37 deaths per 1000 cases is small beer.
The Big Three pathogens – HIV, tuberculosis, and malaria – cause hundreds of millions of infections annually and collectively kill more than five million people a year, mostly in sub-Saharan Africa and Asia. The economic waste and human suffering is immense, but there is no scramble to get a vaccine or deliver treatments in the way that an eye on huge expected profits for selling a vaccine in rich developed countries is sending drug companies into a frenzy.
The travesty is that all of the three “perpetual” epidemics are preventable and largely treatable.
Bacterial, viral, and parasitic diseases cause only about 163 000 deaths a year in the developed world compared to 9.2 million deaths (mostly among children) in the developing world. Nearly all would be treatable or preventable with comparatively small amounts of money.
Incidentally, Jonathan Swan is the son of journalist and physician Norman Swan who has done so much towards public understanding of Covid and health in general in Australia.
Crispin Hull
This article first appeared in The Canberra Times and other Australian media on 15 August 2020.