Thursday, June 30, 2011

More smoking, more eating = less economic burden?

Smokers, obese save us money!

So, in addition to the above picture of the ubiquitous headless fatty, I bring you one of the most controversial articles I've read all year. I tell all kinds of people about this study, but no one seems to believe me, and they also think I've lost my mind and/or soul when I bring up this important point:

Healthy people cost the healthcare system more money than chubbies/smokers do.

"How can this be?" you might ask. I was with you at first. I used to vilify people for making bad health decisions because I thought I'd end up paying thousands of dollars to fix their medical problems. I resented diabetes, lung cancer, hypertension, COPD and the whole panoply of medical conditions that accompany obesity and smoking. 

Consider this ... if you're eating healthy, exercising, and living to a ripe old age of, say, 90, you're ruining it for the rest of us. Would you rather pay for 2 years of cancer treatment (and die at, what, 65?), or 15 years of Medicare-sponsored assisted living expenses?

Our profession ostensibly strives to overcome health problems to improve the quality of life rather than simply its duration, which is the only argument I really have against allowing people to kill themselves earlier so we can reap economic gain. That, in itself, should be the fundamental tenet of public health, not saving the almighty dollar. Still, information like this is hard to ignore; again, as public health professionals, how are we supposed to "sell" improvements in health when they might actually harm society? Great question.

Articles like the link above provide us with stimulating information that ought to fuel our continuous debate about how to best spend our public health dollars. When it comes down to it, we really do have to think in economic terms; although it may seem cold, would you rather save 400 people with a guardrail (for example) or one child who needs a liver transplant (thus condemning 400 people to death)?

Economically, I'd go for the former, despite the plight of the kid tugging at my heart strings. But then everyone looks at you as though you shot their dog, accuses you of being heartless, and spends the money on the sick child anyway.

I feel very clinical and almost ... Third Reich-ish ... when speaking like this, but this is just another example of humans failing to examine facts and make decisions based on reality. I'm guilty of choosing with my gut more often than not, but when we're dealing with population-based health measures, that's a dangerous way of doing things.

Our responsibility is to serve the best interests of the general populace; can we do this best by saving money, or by lengthening lives?

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