Monday, December 17, 2007

The Health of Nations

A very interesting recent publication is the OECD's Health at a Glance, a summation of measurements and indicators of health status for the 30 OECD member countries.

There will be reliability and comparability issues with some of the statistics provided in the report. Generally, the high-level outcome data such as life expectancy should be accurate (although there are quibbles about things like the definition of a live birth). The detailed information such as pay rates of doctors and items of equipment should probably be taken more lightly. It's evident just by looking at these details for New Zealand that the OECD has in some cases obtained only partial information or used unreliable sources.

The publication provides demographic and economic data for context. As we know, and periodically get angsty about, New Zealand is 22nd out of 30 in GDP per capita. We're now outstripped by Spain, and just hovering above Greece. In many respects, the indicators in the report reflect this status, and place us alongside countries like the Czech Republic and Korea. New Zealand health expenditure per capita is the 10th lowest in the OECD.

Despite this, our overall life expectancy is the 11th highest in the OECD. For life expectancy at age 65, we're 11th for females and 5th for males.

This relatively good health does not appear to be due to healthy living or judicious behaviours. We're about in the middle for tobacco and alcohol consumption, but right near the bottom for several other measurements. We're 10th worst for children's dental health, 9th worst for suicide, 8th worst for deaths from road accidents, and 6th worst for obesity.

The areas we do best may surprise some people. While New Zealanders are used to moaning about our health system 'going downhill', it actually appears to do better than average.

In 30-day mortality after hospital admission for a heart attack, New Zealand is number 1. We don't do so well on the same indicator for stroke, where we are 20th. A couple of clinical people I've talked to have expressed skepticism about these results, suggesting that we may not do either as well or as badly as depicted. Australia mirrors us closely, coming 2nd for heart attack and 19th for stroke, so there may be mesurement or other issues confounding the data.

Elsewhere, our relative five-year survival rate for colorectal cancer is 4th (out of only 12 countries that can measure it) and 3rd out of 19 for cervical cancer. For breast cancer survival, New Zealand is at the OECD average, but has made the biggest improvement of any country since the last measurement period

Another of the things measured is 'perception of health status', which is the percentage of adults who report being in good health. Where do you think New Zealand would come here? Yes, we're Number 1*.

The amusing thing is that this range of dry statistics more or less reconstructs the popular stereotypes. There's evidence that the Kiwi 'she'll be right' attitude persists -- people are generally positive about their health despite not living officially very healthy lifestyles. They also like to grumble about a health system that, in its traditional role of responding to acute illness, does well by international standards.

It's interesting to look at how other countries do on the various indicators. As expected, the United States comes out near the top on some (overall expenditure and resources, some clinical outcomes) and very low down for others (obesity, road accidents, low infant birth weight, and overall life expectancy). Like New Zealand, it has positive perceptions of health status. It also has a low suicide rate and is one of five countries (along with New Zealand, Iceland, Turkey and Mexico) to have a fertility rate above two children per woman.

Another interesting case is Japan, which has the highest life expectancy of all but comes right at the bottom for perceptions of health, fertility, and suicide. People with a knowledge of Japan may have some comment on those statistics.

For some indicators, the English-speaking countries cluster together. The highest mortality rates for asthma are, in order, the UK, Australia, Ireland, New Zealand and the US. I'm not sure that anyone fully understands why this is. For obesity, the UK, US, Australia and New Zealand are four of the bottom six. The other two are Mexico and Greece, which is somewhat surprising.

One thing that interested me was the data on smoking rates. The two more developed countries that have the highest rates of smoking are Greece and the Netherlands. These countries do have higher rates of lung cancer, but are in the middle on overall life expectancy. They are also two of the countries with the lowest suicide rates. Make of that what you will.

The pattern that appears most apparent, however, is that the 'fringe' OECD countries with a GDP per capita between $10,000 and $20,000 are grouped near the bottom on many of the indicators. Up to a certain point, wealth appears to matter to health status. Past about $25,000 per capita, however, it doesn't seem to make much difference.

* As explained in the report, there are comparability issues between NZ, the US, Australia and Canada, and the other countries, but even so New Zealand is top among this group.

Wednesday, December 05, 2007

US Senate Passes Peru Free Trade Deal

After all kinds of delays and false starts , the US-Peru free trade agreement was passed on Tuesday by the US Senate with a vote of 77-18.

The Peruvians are pleased with the fact that this was an unprecedented vote in favour of a trade agreement. By comparison, the Chile agreement was passed by 65-32 while the Central American Free Trade Agreement (CAFTA) scraped through by 54-45 and is not counted as a 'treaty' by US law.

For Americans from both the main parties, the Peru deal has ended up being something of a no-brainer, for strategic rather than economic reasons. With Colombia unacceptable for the Democrats at the moment, and the rest of South America hostile or disinterested, the US was in danger of being left with no real friends between Costa Rica and Chile.

From Peru's perspective, there's not much doubt that the trade agreement will lead to further economic growth and more money flowing into the country. Whether that translates into material improvements for the majority of Peruvians depends greatly on the competence and commitment of the government. What is needed is the 'free trade agreement for the interior' promised by president Alan Garcia during the 2006 election campaign.

A good start would be to establish a system of compensation and assistance for the small agricultural producers who will be affected by competition from subsidised US imports. However, La Republica reports that the Peruvian government is still not sure of how such compensation will be provided, nor to whom. There is less than $40 million USD earmarked for this purpose, compared to a $4 billion fund in Mexico and $100 million in Chile. Minister of Argriculture Ismael Benavides said he couldn't explain the reasoning for this amount, since it was determined by the previous government. "I don't know who was the genius that came up with those figures", he said.

Monday, December 03, 2007

Chavez Not President for Life

This is an interesting turn up for the books. Venezuela's referendum on a raft of consitutional reforms, including indefinitely extending the ability of Hugo Chavez to run for president, has been won by the "No" vote.

I believe this is the right result and hope that it will be the end of the matter. I think Chavez is a bit of a clown, with the annoying habit of trying to meddle in other Latin American countries' democratic processes. I also haven't seen any convincing arguments that he's done much to sustainably improve the wellbeing of people in Venezuela.

In that respect, he's no different from anybody else who has run Venezuela. And at least his largesse with oil money has given some short-term benefits to the poor masses.

It's also highly irritating to see Chavez hyped as a major threat to freedom and democracy by the US government and elements of the media, a depiction which is lamely lapped up by the mainstream American public. The average news piece cannot mention Chavez or Venezuela without throwing in one 'dictatorial' per paragraph. Can we please remember that the leaders of the free world continue to be best buddies with Saudi Arabia? And, I mean, would you buy a used policy from this guy?

However, regardless of how good or bad a president Chavez has been, constitutional term limits are a good thing, and so are bureaucratic checks and balances. No one person is the saviour of a nation, and all power should be limited.