In case you wondered about what we in the U.S. pay for health care compared with those unfree unfortunates who suffer under various forms of socialized medicine, here are some graphs from 2009 showing the advantages of what is sometimes called “the best health care system in the world.”
The graphs are from the International Federation of Health Plans. I’ve selected only four — to show the relative costs* of
an office visit
a day in the hospital
a common procedure (childbirth without complications)
a widely used drug (Lipitor)
You can download all the charts here, but be warned: it gets boring. We’re number one in every chart, at least in this one category of how much we shell out.
Since we have the best health care in the world, this must mean that you get what you pay for. Our Lipitor must be four to ten times as good as the Lipitor that Canadians take.
Hat tip: Ezra Klein.
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*These amounts are what providers are paid by governments or other insurers, not what the patient pays, which in many Eurpean countries is essentially nothing. See the footnotes for the tables in the original document. Or look at the comments on this at Boing Boing, a discussion which is remarkably civil (do they monitor comments?).
Abortion is highly politicized in the U.S. (more so than in many other countries) and the fight between those who are in favor of and against available abortion occurs on two fronts. One is familiar to just about everyone: the effort to overturn Roe v. Wade, the legislation Supreme Court decision that established the legality of abortion in 1973.
The second front, though, is less familiar. It involves reducing the ease of access to legal abortion. Efforts to increase barriers to accessing legal abortion include passing laws that require minors to notify their parents of an abortion or get their consent, requiring mandatory counseling for abortion-seekers, instituting waiting periods, and discouraging medical schools from teaching abortion procedures. Some of the issues of diminishing access are non-movement related; others are the direct result of pro-life activism.
I bring this up in order to focus on an additional barrier to access: a reduction in the number of clinics and hospitals that provide abortions. The map below, based on data from the Guttmacher Institute and compiled by ANSIRH, shows how availability varies by state. In the darkest states, up to 20% of women live in a county with no abortion provider; in the lightest states, between 81 and 100% percent do.
Living far from the nearest abortion provider is a problem especially for low-income women. Such women are less likely to have an employer who will give her a day off to travel to the clinic, less likely to get a paid sick day, and less likely to be able to afford to lose even a single day’s wages. She is also less likely to have a car, making it more difficult to get to a distant location, and less likely to have reliable day care for any existing children. If the state requires in-person counseling and has a waiting period, it means that the woman must take two days off, travel to and from the clinic twice, and arrange for child care on multiple days.
Reduction in the availability of abortion does not necessarily reduce the number of abortions. We recently posted global data showing that less liberal abortion laws actually correlate with higher rates of abortion. The data below, also from Guttmacher, show that were abortion laws are less liberal (largely in developing countries), the rate of abortion is 34/1,000 women oer year, compared to 39/1,000 in developed countries (the difference may look significant here, but imagine how trivial it would look if the horizontal axis went all the way to it’s true maximum of 1,000):
Guttmacher explains that the relevant variable isn’t availability of abortion, but the unintended pregnancy rate (which is surprisingly high in the U.S.).
Barriers to accessing abortion, then, don’t lower the abortion rate. They do, however, increase the likelihood that an abortion procedure will occur later in pregnancy and guarantee a greater logistic burden on the pregnant woman.
A great story at theNew York Times, sent in by Katrin, reveals how the evolving science of marketing is creating its own set of challengers for advertisers. Target, like many companies, tracks its customers purchases and uses the data to send packets of coupons tailored to individuals and households. In this way, they tempt us into the store by offering us deals on things they know we want.
Target is also in the business of predicting what a person will want. So the marketing company decided to try to use costumer shopping habits in order to predict pregnancy. If they could start sending the woman baby-related before she started shopping for them in earnest, the company figured, she might end up always thinking of Target when she needed to spend money on the baby.
Using an algorithm that considered the purchasing patterns typical of newly pregnant women — e.g., prenatal vitamins, scent-free instead of scented lotion, a sudden uptick in the acquisition of cotton balls — they were able to make a pretty good guess as to whether a female customer was expecting. Suddenly these women were getting coupons like this:
This caused two problems.
First was the father of the teenage girl who started getting coupons for diapers in the mail. This led to an angry phone call to Target and, later, a chagrined apology by the stunned grandpa-to-be (story here).
The second was the reaction of the intended target, the expectant moms. Some were pretty freaked out that Target knew they were pregnant! It’s one thing, it turns out, for Target to know you like vanilla better than chocolate ice cream, or you fancy scented candles; it’s different, perhaps, to suddenly realize that it knows your you’re having a baby. That could feel like a serious invasion of privacy.
So Target learned that the ability to predict our needs and desires comes with the need to do some psychological management as well. Accordingly, they began sneaking baby-related coupons into coupon books that also included other things. So far, Target reports, these women are none the wiser… and thinking of Target as their one-stop baby shop.
PBS has a gallery of images of oral contraceptives that provides a nice illustration of the way product design can be used as a form of behavior modification, while also needing to adapt to the way people actual use products — or forget to do so, the ever-present problem with the pill.
Initially , the pill came in bottles, like other prescriptions:
Notice the bottle contains 100 pills; there was no effort to package it into quantities for a single month. Women were supposed to take 20 pills in a row, then none during their period. It was up to them to keep track of everything and remember when it was time to start taking the pills again.
In 1962, an engineer created a prototype of a dispenser pack, designed to hold exactly a month’s worth of pills and help women remember to take them correctly:
The first contraceptive in a pack of this type, Dialpak, appeared the next year; oral contraceptives packaging has been designed to help women remember to take them accurately ever since. This became a major selling point, with Dialpak 21 even offering a small calendar you could attach to a special watch band so you could more easily keep track of whether you’d taken the pill:
In 1965, Eli Lilly introduced a new packaging design, with differently-colored pills arranged in a sequence; however, it didn’t label the days of the week, so it didn’t help women figure out if they’d remembered to take their pill on any given day:
Norinyl came in a package that took the sequential design but added several features that enhanced compliance. An extra pill was added, so that pills with active ingredients were taken for 21 days, not 20. Then a row of placebo pills were added so that women took a pill every day of the month, so they were less likely to forget to start a new pack:
When we think about the emergence and success of the pill, we tend to focus on the product itself. But the packaging tells an interesting story on its own. The pharmacological effectiveness of oral contraceptives meant little if women forgot to take them reliably. The design of the packaging helped play a crucial role, increasing users’ ability to follow the prescribed schedule.
Today, there’s an entire trade organization, the Healthcare Compliance Packaging Council, dedicated to promoting attention to the design of packaging as an important element in all areas of healthcare. The pill was the first prescription drug sold in a so-called “compliance pack,” serving as an example of the potential effectiveness of packaging design as a way to encourage patients’ conformity to prescribed medication regimens.
Andrew S. let us know that The Lancet has just released a study on global trends in abortion, focusing on overall rates, access to safe vs. unsafe abortions, and how the legal status of abortion impacts abortion rates. The results shed some interesting light on the effects of efforts to reduce abortion by outlawing or restricting access to it. Looking at data from 1995 to 2008, the authors found that abortion rates were actually lower in areas of the world with less restrictive abortion laws:
The Guttmacher Institute provides a full summary of the article. Not surprisingly, the more restrictive abortion laws are, the higher the proportion of unsafe abortions (with Eastern Europe being a significant outlier, with the highest global abortion rates). About half of all abortions are unsafe, leading to the deaths of roughly 47,000 women each year, or 13% of all global maternal deaths — almost entirely in developing nations, where restrictive abortion laws are more common and access to contraception and medical care are generally lower.
UPDATE: A couple of commenters pointed out that I was sloppy with my wording, and it seems like I’m making a direct causal argument (i.e., fewer restrictions leads to fewer abortions). The situation is more complicated than that; the very fact that some nations have more restrictions than others likely reflects a variety of issues that themselves influence the abortion rate, so that while there might be *some* causation, it’s also probable that laws on abortion and abortion rates are both influenced by other variables. I don’t think that getting rid of all restrictive laws in, say, Southeastern Asia, without making any other change at all, would necessarily lead to a dramatic shift in abortion rates. That said, what I find more interesting is the opposite proposition: the idea that imposing restrictions on abortion will automatically reduce abortion rates, which doesn’t seem true, at least on a global level.
If you’re looking for basic global demographic information, World Health Rankings provides a great overview, using World Health Organization, World Bank, UNESCO, and other data. The website allows you to select a country, then provides a detailed breakdown of many demographic details, such as population pyramids (you can select different years in the past, or look at predictions for the future), leading causes of death, etc. Here’s the 2010 population pyramid for the U.S.:
You can also easily access all the age pyramids here. The 2020 projections for Brazil show the changing demographics due to the dramatic decrease in the fertility rate, which Lisa posted about this weekend:
Also, as I wrote this post I realized that now every time I see a population pyramid of the U.S., Community‘s song “Baby Boomer Santa” is going to play through my head.
The declining birth rate in Latin America, depicted in this graph, is a nice example of the way that both cultural and social change affects individual choices. Brazil is highlighted as an extreme case. It’s birthrate has fallen from over six children/woman in 1960 to under 1.9 today.
The accompanying Washington Postarticle, sent in by Mae C., explains that the decrease in the birthrate since the 1960s is related to migration to cities. In rural areas children are useful. They can help with crops and animals. In crowded and expensive cities, however, they cost money and take up space. Economic change, then, changed the context of individual choices.
This transition — from a largely rural country with high birthrates to an industrialized one with lower birthrates — has been observed across countries again and again. It’s no surprise to demographers (social scientists who study changes in human population). But Brazil did surprise demographers in one way:
…Brazil’s fertility rate fell almost uniformly from cosmopolitan Sao Paulo, with its tiny apartments and go-go economy, to Amazonian villages and the vast central farming belt.
The decline in birthrate, in other words, has occurred across the urban/rural divide. Demographers attribute this to cultural factors. The idea of “an appealing, affluent, highflying world, whose distinguishing features include the small family” has been widely portrayed on popular soap operas, while Brazilian women in the real world have made strong strides into high-status, well-paid, but time-intensive occupations. They mention, in particular, Brazil’s widely-admired first female president, Dilma Rousseff, who has one child.
Ultimately, then, the dramatic drop in the birthrate is due to a combination of both economic and cultural change.
In an interview discussing whether teen sleepovers can actually prevent teen pregnancy, CNN’s Ali Velshi says flatly, “This is a little bit counter-intuitive.” But as his interviewee, UMass sociologist Amy Schalet (who wrote on this subject in Contextsin “Sex, Love, and Autonomy in the Teenage Sleepover” in the Summer of 2010), explains:
Let me clarify: it’s not a situation where everything goes… It’s definitely older teenage couples who have established relationships and whose parents have talked about contraception.
Which is to say, as Velshi puts it, sex and sex education in countries like the Netherlands, in which parents are more permissive—or as Schalet says, “parents are more connected with their kids”—about allowing boyfriends and girlfriends to sleep over, take “a holistic approach.”
Schalet’s research, explored more deeply in her new University of Chicago book Not Under My Roof, takes a look at American parenting practices surrounding teen sex and the practices of parents in other countries. Using in-depth interviews with parents and teens and a host of other data, she finds:
The takeaway for American parents… isn’t necessarily “You must permit sleepovers.” Many parents are going to say, “Not under my roof!” That’s why it’s the title of my book. The takeaway is that you can have more open conversations—you should probably have more open conversations—about what’s a good relationship, sex and contraception should go together, what does it mean to be “ready,” how to get rid of some of these damaging stereotypes (gender stereotypes). Those are all things that are going to help promote teenage health and better relationships between parents and kids.
Schalet is clear that parental approaches are nowhere near the only factor in the stark differences in teen pregnancy rates between the U.S. and the Netherlands, but says they are, in fact, particularly important. “Kids are having sex, clearly,” Velshi says. And that’s precisely the point, no matter whether parents believe their kids should be able to have sex in their own homes, Schalet believes: “I think what you emphasize is that, above all, the conversation is important, and the conversation itself does not make kids have sex.” Ideally, she points out, that conversation will take place at home with parents, but a holistic talk about sexuality, relationships, and health can also take place in schools, with clergy, and in many other locations.
Dr. Schalet on CNN (we apologize for the commercial):
Letta Page is the Associate Editor and Producer of The Society Pages. She has a decade of experience in academic editing across a range of disciplines, including two years as the managing editor of Contexts. Page holds degrees in history and classical studies from Boston University and an art degree from the University of Minnesota.
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