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DOES MORE HEALTH CARE LEAD TO BETTER HEALTH?
November 21, 2017
Dr. Thomas McKeown was an influential British physician who wrote a book in 1976 entitled “ The role of medicine, dream, mirage or nemesis? He raised the issue whether healthcare itself is the major determinant of population well-being? Does communal health rely on more doctors, more drugs, more hospitals, or more surgery, or are these expensive maneuvers mere observers of the major Health outcomes?
His argument was based on the fact that between 1850 and 1970 there were tremendous decreases in mortality and increases in life expectancy, but these dramatic changes occurred before the introduction of the medical model which I term is the “disease model”.
His views ( the McKeown Hypothesis) gave rise to the theory of the social determinants of health which is now been powerfully supported by the World Health Organization. This perspective emphasizes that a person’s social and economic position in society, early life experiences, exposure to stress, educational attainment, employment status, societal exclusions all exert powerful influences on health throughout life. Does poor health result from medical dereliction, or by issues of poverty, nutrition, education, education and control?
It is well recognized that in indigenous populations such as the Australian aborigines, the Pima Indians, and the Pacific Islanders all have precocious prevalence of diabetes.
I recall a visit that I made to Alice Springs, Australia years ago. The leaders of the local health centers lamented “we are going broke”. I said “that’s not possible.” They countered that they are overwhelmed by kidney failure requiring dialysis associated with the soaring incidence of type II diabetes in the Aborigines. This is a $40,000 dollars per case per year, and their budget is not equipped to counter this. As a result of this Dr. Karen O’ Dea of Melbourne selected 10 full-blooded diabetic aborigines who agreed to be tested before and after living for seven weeks as hunter gatherers in the traditional country in Northern Australia. Their resumption of the traditional lifestyle yielded marked improvement in their metabolic parameters and avoided the need for dialysis, indicating lifestyle’s greatest impact.
Her results lend strong support to McKeown’s observation that healthcare per se has a relatively minor impact on the major health issues of today.
Prevention rather than treatment is paramount. We need to learn this profound truth pretty soon!