Longer looks: AIDS epidemic in the U.S.; how public health and the recession connect

May 16 2014

Every week KHN reporter Marissa Evans finds interesting reads from around the Web.

The New Republic: Why Did AIDS Ravage The U.S. More Than Any Other Developed Country?
I pull out my phone and check the Centers for Disease Control and Prevention (CDC) website, which tells me that, in the United States, 636,000 people have died since the epidemic began. That's 23 times higher than Germany, for a country with four times the population. This makes no sense. Germany has big cities, it has gay men and sex workers and drug users, it has all the same temptations for them to be uncareful that the United States does. How could so many fewer people have died? (Michael Hobbes, 5/12).

The Atlantic: What the U.S. Can Learn From Brazil's Health Care Mess
By a lot of measures, Brazil's Sistema Único de Saúde -- or SUS -- has led to huge health gains. The country now has an infant mortality rate of about 13 per 1,000 live births, down from about 27 in 2000. Maternal mortality has also been cut in half since 1990. The average Brazilian only lived to about 66 in 1990; today, life expectancy is at a respectable 74. But take a closer look, and the system seems more like "a safety net with holes," as one Brazilian doctor put it to me (Olga Khazan, 5/8).

Life Hacker: Why There's So Much Confusion Over Health And Nutrition
If you believed the internet, you'd think there's huge debate over whether eggs, coffee, or salt are good or bad for you. In reality, there's significant agreement on diet and health issues among experts, but the general public is conflicted. So why are we so confused when experts agree? Let's clear the air (Alan Henry, 5/7).

Harvard Public Health: Failing Economy, Failing Health
Five years after the Great Recession officially came to an end, the United States has yet to fully recover from the economic devastation sparked by the collapse of an $8 trillion housing bubble and the ensuing turmoil that saw global financial systems teetering on the brink of collapse. But while the economic costs of the downturn have drawn the lion's share of attention, the damage to our bodies could end up far surpassing the damage to our bank accounts. "It's quite stunning we haven't been hearing more about this," says Kasisomayajula "Vish" Viswanath, professor of health communication at Harvard School of Public Health. "We talk about poverty and inequality resulting from the recession, but we do not take the next step. We do not extend that logic to the effects on health" (Amy Gutman, 5/9).

USA Today: The Cost Of Not Caring: Nowhere To Go
Hundreds of thousands of people with serious mental illness are falling through the cracks of a mental health system in tatters, a USA TODAY special report shows. Mentally ill Americans who have nowhere to go and find little sympathy from those around them often tumble into a de facto mental health system, made up of emergency rooms, county jails and city streets. The lucky ones find homes with family. The unlucky ones show up in the morgue. "We have replaced the hospital bed with the jail cell, the homeless shelter and the coffin," says Rep. Tim Murphy, R-Pa., a child psychologist leading an effort to remodel the mental health system. "How is that compassionate?" States looking to save money have pared away both the community mental health services designed to keep people healthy, as well as the hospital care needed to help them heal after a crisis (Liz Szabo, 5/12).

NPR: 'Good Doctor' Puts Past Medical Practices Under An Ethical Microscope
Dr. Barron Lerner is a doctor and the son of a doctor. He grew up thinking his father was a wonderful, gifted and caring physician, which he was. But after Lerner started studying bioethics, he began questioning some of his father's practices -- practices which were typical of many doctors in the '60s. There were times when his father would conceal information from his patient if he thought that was in the patient's best interest; there were times he didn't reveal that a patient's cancer was terminal; there were times, in the era before do-not-resuscitate orders, that his father would make that decision for a patient without consulting the family. This kind of paternalism would be considered a breach of ethics now (5/13). 

The New York Times: Living With Cancer: Careless Care
When I consider what happened to an esteemed friend and colleague, I fume at the mayhem that ovarian cancer wreaks and at the deficient care she received at a university hospital in another town. Do instances of medical negligence sometimes go unnoticed because patients are so debilitated that they cannot testify -- especially if they are still in treatment? (Susan Gubar, 5/8).