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Suicide rates rise among soldiers in Iraq
MEDICINE AND HEALTH POLICY
IOM calls for universal health coverage by 2010 he US government must find a way to make health care available to all US citizens by 2010, the Institute of Medicine (IOM) said on Jan 14. This deadline mirrors one set out in the US government’s Healthy People 2010 plan, which also calls for 100% health coverage. According to an IOM panel, 18 000 Americans die each year due to lack of insurance coverage, and the economy loses US$65–130 billion each year as a result of poor health and early deaths. “We have to strengthen our health-care system”, said panel co-chairman Arthur Kellermann of Emory University in a press briefing, “and the best way to do that is to cover everyone”.
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The committee’s report offers guiding principles, but it does not include specific strategies on how to reach that goal. “There are many thoughtful plans for extending health insurance already on the table”, said panel co-chair Mary Sue Coleman, president of the University of Michigan (Ann Arbor). “We leave the debate about the specifics and exact design of the necessary health insurance reforms to elected officials, policymakers and the public.” All the Democratic presidential candidates have offered a health-coverage plan, and President Bush is considering a broad plan that might offer tax credits to the uninsured to buy
coverage, say advisers. A recent poll by Democratic and Republican strategists found that affordable health care was the second most important issue to voters, behind the economy. Other pollsters have found that Americans’ dissatisfaction with health care is the highest since 1992—the year of Bill Clinton’s ill-fated proposal to overhaul the system. Former Senator and presidential candidate Bob Dole said at the IOM briefing: “Both parties are looking for some juice”, and that health coverage might be it. He added, “Everyone knows it’s the right thing to do.” But, Dole said, even though politicians are more
attuned to the public’s desires during election years, he still doubts there is the will to tackle such a tough issue. IOM panel members did not back any particular plan, but said piecemeal fixes were not feasible. The committee said health-care coverage should be universal, continuous, affordable to individuals and families, and “should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centred, and equitable”. Any federal scheme should be affordable and sustainable, the panel added. Alicia Ault
Suicide rates rise among soldiers in Iraq t least 22 members of the US military have committed suicide while on duty in Iraq during 2003, government officials reported last week. Most of the suicides occurred since May 1, after major combat operations were declared ended, and the high suicide rate prompted the Army to dispatch a mental health assessment team to Iraq last October. Of the 22 suicides, 19 were Army soldiers, representing a suicide rate of about 13·5 per 100 000 troops, William Winkenwerder, Assistant Secretary of Defence for Health Affairs, said at a breakfast meeting of Pentagon reporters. During recent peacetime years, the suicide rate for Army soldiers has hovered around 10·5 to 11 per 100 000, Winkenwerder said. Several suspected suicides are still being investigated, so the final figures for 2003 could end up being greater. Only two confirmed suicides were reported during the 1991 Gulf War; however, that is an unfair comparison, said Martha Rudd, an Army spokesperson, as that conflict only lasted about 6 weeks. “It is a fact that we have suicides in Iraq, and we are upset by even one suicide”, said Rudd. “But it’s difficult to compare this to other situations, to say that these troops are committing suicide at a higher rate, because we really have nothing to compare it to. We
haven’t had anything like this in a long time.” The reasons for committing suicide were generally similar to those attributed to cases throughout the Army, and among the general population, Rudd noted. “Depression, loss of a significant relationship, financial and legal problems, and we also have more males—the force in Iraq has a higher percentage of men than the rest of the army, and men commit suicide more
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300
frequently than women do.” Both the Iraq rate and the overall Army rate are well below that for the civilian male population, however, is about 17·5 per 100 000. Military health officials have not noted any trends or identified specific steps that the Army might have taken to prevent these suicides, Winkenwerder said. Roxanne Nelson
AP
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
US soldiers in Iraq have an unusually high rate of suicide
THE LANCET • Vol 363 • January 24, 2004 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet publishing Group.
IOM calls for universal health coverage by 2010 he US government must find a way to make health care available to all US citizens by 2010, the Institute of Medicine (IOM) said on Jan 14. This deadline mirrors one set out in the US government’s Healthy People 2010 plan, which also calls for 100% health coverage. According to an IOM panel, 18 000 Americans die each year due to lack of insurance coverage, and the economy loses US$65–130 billion each year as a result of poor health and early deaths. “We have to strengthen our health-care system”, said panel co-chairman Arthur Kellermann of Emory University in a press briefing, “and the best way to do that is to cover everyone”.
T
The committee’s report offers guiding principles, but it does not include specific strategies on how to reach that goal. “There are many thoughtful plans for extending health insurance already on the table”, said panel co-chair Mary Sue Coleman, president of the University of Michigan (Ann Arbor). “We leave the debate about the specifics and exact design of the necessary health insurance reforms to elected officials, policymakers and the public.” All the Democratic presidential candidates have offered a health-coverage plan, and President Bush is considering a broad plan that might offer tax credits to the uninsured to buy
coverage, say advisers. A recent poll by Democratic and Republican strategists found that affordable health care was the second most important issue to voters, behind the economy. Other pollsters have found that Americans’ dissatisfaction with health care is the highest since 1992—the year of Bill Clinton’s ill-fated proposal to overhaul the system. Former Senator and presidential candidate Bob Dole said at the IOM briefing: “Both parties are looking for some juice”, and that health coverage might be it. He added, “Everyone knows it’s the right thing to do.” But, Dole said, even though politicians are more
attuned to the public’s desires during election years, he still doubts there is the will to tackle such a tough issue. IOM panel members did not back any particular plan, but said piecemeal fixes were not feasible. The committee said health-care coverage should be universal, continuous, affordable to individuals and families, and “should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centred, and equitable”. Any federal scheme should be affordable and sustainable, the panel added. Alicia Ault
Suicide rates rise among soldiers in Iraq t least 22 members of the US military have committed suicide while on duty in Iraq during 2003, government officials reported last week. Most of the suicides occurred since May 1, after major combat operations were declared ended, and the high suicide rate prompted the Army to dispatch a mental health assessment team to Iraq last October. Of the 22 suicides, 19 were Army soldiers, representing a suicide rate of about 13·5 per 100 000 troops, William Winkenwerder, Assistant Secretary of Defence for Health Affairs, said at a breakfast meeting of Pentagon reporters. During recent peacetime years, the suicide rate for Army soldiers has hovered around 10·5 to 11 per 100 000, Winkenwerder said. Several suspected suicides are still being investigated, so the final figures for 2003 could end up being greater. Only two confirmed suicides were reported during the 1991 Gulf War; however, that is an unfair comparison, said Martha Rudd, an Army spokesperson, as that conflict only lasted about 6 weeks. “It is a fact that we have suicides in Iraq, and we are upset by even one suicide”, said Rudd. “But it’s difficult to compare this to other situations, to say that these troops are committing suicide at a higher rate, because we really have nothing to compare it to. We
haven’t had anything like this in a long time.” The reasons for committing suicide were generally similar to those attributed to cases throughout the Army, and among the general population, Rudd noted. “Depression, loss of a significant relationship, financial and legal problems, and we also have more males—the force in Iraq has a higher percentage of men than the rest of the army, and men commit suicide more
A
300
frequently than women do.” Both the Iraq rate and the overall Army rate are well below that for the civilian male population, however, is about 17·5 per 100 000. Military health officials have not noted any trends or identified specific steps that the Army might have taken to prevent these suicides, Winkenwerder said. Roxanne Nelson
AP
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
US soldiers in Iraq have an unusually high rate of suicide
THE LANCET • Vol 363 • January 24, 2004 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet publishing Group.