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Fixin' Healthcare

Sunday, March 26, 2006

The Lifestyle Chronicles - The Frankenstein Syndrome

The evidence is mounting that something(s) happened in the American culture with consequences that began to manifest during the 1970s. Prior to the 1970s the incidence of overweight and obesity was generally stable and since then the incidence of both has doubled. Other consequences are the increasing incidence of chronic diseases such as type-2 diabetes and systemic hypertension.

American society needs to recognize there are long-term consequences of lifestyle decisions that may not be obvious. Even after the consequences become manifest the specific cause(s) and contributing factors may not be obvious.

Attitudes are a major contribution to lifestyle. It is entirely possible that health care became an unwitting co-conspirator with the American public to create an unhealthy environment. Since the 1970s there has been an explosion of capabilities and utilization of high technology health care. The American public has placed a high value upon the capability of medical technology to cure health problems regardless of how they live.

For example, what is going on with care during pregnancy and delivery? This is a biological process that in the absence of complications cannot be improved upon with technology. Pregnancy demands a healthy diet and a minimum of drugs. Until the natural time for delivery there is no better environment for the baby than the uterus. Yet, beginning in the 1970s the incidence of C-sections rapidly increased.

In 1970 the national rate for C-sections was 5%. It rose to more than 20% by the mid-1980s. According to the CDC's National Center for Health Statistics, nearly 1.2 million C-sections were performed in 2004 or 29.1% of all births. That was up from 27.5% in 2003 and 20.7% in 1996.

In 2000 a national public health goal was to reduce the C-section rate for healthy, first-time, full-term pregnancies to 15% by 2010. The rate of C-sections among women who have not previously had a C-section was 14.6% in 1996, 19.1% in 2003 and 20.6% in 2004.

One of every five births in America was induced in 2003. This was double the incidence in 1990. Tracking inductions at New York Presbyterian Hospital determined that they represented 34.4% of all births in 2005.

More than half-million infants were born preterm (less than 37 weeks gestation) in 2004 and the proportion of infants with low birth weight rose to 8.1% from 7.9% the year before.

According to a March of Dimes analysis, one-quarter of all singleton babies were born full-term at 39 weeks in 2002. Births at or near 40 weeks decreased by nearly 21% over the decade from 1992 to 2002 and there was a 12% increase in births occuring between 34 and 36 weeks (late preterm or near-term births).

Some babies born just a few weeks early need medical and nursing attention betond that given to full-term babies. Late preterm babies have increased risk of respiratory problems, feeding difficulties, hypothermia, jaundice and reduced brain development. The long-term consequences to health are undetermined.

Induction of labor has an increased risk for fetal distress, ruptured uterus and C-section.

Induced labor requires 24 to 36 hours of regular monitoring. Recovery from a C-section usually requires four days in the hospital.

American society requires that health decisions cause no harm. The requirement to demonstrate benefit is less clear but there is emphasis upon the relationship between benefit and cost. Assessing and managing health risk is a decision-making process of increasing importance to achieving and maintaining optimum health status. Risk based decision making begins a division of labor (no pun intended) between health care and medical care.

Thanks to Elisa at Healthy Concerns for bringing Frankenstein to my attention.

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