• Reflex: September 27, 2011

    Black/White racial disparities in health: A cross-country comparison of Canada and the United States, appeared in Archives of Internal Medicine. This study compared estimates of health indicators among native-born black Canadians as compared to native-born white Canadians, and then did the same in the US for comparison. “Native-born black Canadians generally reported comparable or better health outcomes than their white counterparts in contrast to the findings in the United States, where African Americans fared worse than white Americans on many health indicators.” Aaron’s comment: I’m still trying to come to grips with this one. Think about this the next time you try and dismiss some cross-country comparison because you think we have more diversity than other countries.

    Some pediatricians are refusing to see kids who are not vaccinated, reports Michelle Andrews (KHN). “When repeated efforts to educate parents fail, some pediatricians are now taking action: They’re refusing to treat children unless their parents agree to have them vaccinated.” Some pediatricians worry “about other patients in the waiting room, some of them too young to be immunized or with health problems that compromise their immune systems. Unvaccinated children put those kids at risk.” Austin’s comment: I don’t fully understand the issues on this one. There are kids in the waiting room who are not vaccinated that pediatricians will see, like those with compromised immune systems. Don’t those children put others at risk too? Could the not-yet-immunized kids wait elsewhere, wear a mask, be seen at special designated times and places? Are there liability issues? Is refusing to treat children the best we can do for them even if their parents don’t agree to vaccination? (Paging Aaron.)

    The cost of Cancer care is becoming unaffordable in developing nations, writes Meredith Melnick. She is writing about a group of papers in Lancet on the costs of cancer care and the need to decide how to prioritize treatments. Don’s comment: There is no purely technical way to make such decisions that would inevitably prioritize some treatments over others. Moving forward to develop practical policies to determine when we use cancer therapies will require both broad cultural discussion about values along side the technical production of information in an understandable format that can be used prospectively by providers and patients to guide decisions. It will be very hard. Focusing on three questions would help: does it extend life? Does it improve quality of life? How much does it cost?These questions are a first step; there will never be a last step as we will always struggle with how to spend limited resources.

    • Do you have any data on native-born Black Canadians?

      I would bet that they are much more advanced socioeconomically, have higher IQ’s, and have a larger proportion of high-achieving African immigrants within their numbers than native born African Americans.

      All of these things would alter any attempt to compare how the “system” deals with these superficially similar groups and to suggest otherwise is exactly why many tend to take the idea of crossnational comparisons skeptically.

      In addition, if this comparison is valid, then the statistic that Swedes in the upper Midwest have similar health outcomes to Swedes in Sweden, Japanese Americans to Japanese, etc. should also be mentioned. I think most critics object to the selective and possibly ideologically motivated comparisons you are making…

    • “Native-born black Canadians generally reported comparable or better health outcomes than their white counterparts in contrast to the findings in the United States, where African Americans fared worse than white Americans on many health indicators.

      IHMO though there could be something, more likely life style and crime that healthcare, I think that it is mostly noise. Canada has been receiving the best and the brightest Africans and Caribbean blacks for quite a while now


      Also note the link below says that native Americans have better health indicators in the USA than in Canada.

      A similar pattern is evident in the United States, where between 1940 and 1980 there were substantial improvements in the health of Native Americans as measured by life expectancy: female Native merican life expectancy improved dramatically by 23 years over this period to around 75 years; male Native American life expectancy improved by 16 years to around 67 years.

      At this point the life expectancy gap with the ‘white’ population was down to only 3 to 4 years.

      However, it appears there has been little major improvement in Native American life expectancy since around 1980, while the life expectancy of the non-Native population continued to improve. By the mid 1980s, the gap had widened to almost 5 years (both sexes) and by the period 1996-98 it was almost 6 years.

      Canada shows a slightly different pattern: the data since the mid-1970s show a fairly steep improvement in First Nations life expectancy between 1975 and 1990 (from around 59 years for men and 66 years for women, to around 67 years for men and 74 years for women). This period saw the life expectancy gap between First Nations peoples and Canadians as a whole narrow from 10 to 11 years in 1980 to 7 to 8 years in 1990.

      Since then the rate of increase in First Nation life expectancy has been improving at a slower rate, In 2000, life expectancy at birth for ‘Registered Indians’ was estimated at around 69 years for men and a little under 77 years for women. This slowing of improvements meant that the 1990s saw no appreciable improvement in the gap in life expectancy between First Nation and Canadian men in general (7.4 years in 2000), while for women it narrowed slightly (down to 5.2 years in 2000).

      • Interesting stuff about the First Nations. I would point out two things:

        First, although the rates of improvement are better in the US, the actual outcomes are still better in Canada. They are just not getting better as rapidly.

        Second, the Indian Health Service, along with the VA, is one of the rare US examples of true “socialized” health care. There are many valid criticisms of the IHS, especially including lack of adequate financial support to the point of violating treaty rights, but the IHS gives Native Americans a degree of access to health care that is not shared by other low income groups, especially African Americans. From personal experience working with referrals from IHS units, I can say that many IHS providers are dedicated and competent and doing the very best they can under frequently adverse conditions due to poor support by congress. The improvements in outcomes may reflect that.

    • Black Canadians are predominantly Afro-Caribbean ancestry, drawn from the same ethnic/genetic background as US blacks, and with the same history in terms of slavery. The second biggest group of black Canadians are African American immigrants, who made the trip anywhere from the days of the underground railway to the immediate recent past. The US actually has a larger population of African immigrants than Canada, with more African blacks living in New York City than all of Canada.

      Interestingly, Afro-Caribbeans have the worst health statistics in Britain, just slightly worse than Pakistanis.

      As to the comment about IQ, that has pretty much been laid to rest among scientists 20 years ago after the “Bell Curve” farce.

      Finally, the fact is that Japanese and Swedish Americans have markedly different health statistics in terms of disease profiles, life expectancy, and so on than the residents of their respective national homelands.

      As Aaron indicates, most attempts to attack cross national health data tends to ignore or be ignorant of the facts about the make-up of national populations. The US is just not that special in terms of its make-up compared with many other countries (Canada, Australia, New Zealand, France, Britain, and so on.) It is just a lot bigger, and has an extremely idiosyncratic health care system by world standards.

    • To back up the assertion that Canada is not “The Great White North”, here’s a recent attempt to compare the diversity of Canadian and American populations, using 2006 data. (I recently came across this and at first glance, it looks like the 3% of Canadians who are Aboriginal peoples are lumped into the “White” category – the “racist expression” visible minority is defined by Statistics Canada not to include First Nations people.) The 2011 Canadian Census just recently completed will show even more diversity as the 250,000 new immigrants each year are primarily from the Far East and South Asia at the same time as older, whiter Canadians expired. P.S. You do know from your American history that the Underground Railway headed towards “the Promised Land”?