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The USA's crisis of the uninsured
Editorial
The USA’s crisis of the uninsured
For the IOM report see http:// www.iom.edu/CMS/3809/ 54070/63118.aspx
Roughly 45·7 million Americans—15% of the country’s population—lack health insurance. Both wealthy and poorer states have almost a quarter of residents between the ages of 18 years and 64 years uninsured. The US Congressional Budget Office predicts that, nationwide, the number of uninsured people will rise by 10 million in the next decade. And this in a country where health-care expenditure alone is estimated to exceed US$2·5 trillion this year. That a lack of health insurance matters and has devastating consequences on people’s health is the conclusion of the just released report by the US Institute of Medicine entitled America’s Uninsured Crisis: Consequences for Health and Health Care. The report shows that there is a direct link between ill health and being uninsured, and a health benefit when health insurance is acquired. The research resulted from an independent assessment of published scientific studies and surveys by a broad team of experts in medical care, emergency medicine, health policy, business, and economics.
The alarming decline in the US health insurance coverage will be exacerbated by a weakened economy, growing unemployment, rising health-care and health insurance costs, and losses in employment-based health insurance coverage. Public health-care programmes for low-income individuals are threatened because of the recession. Insured individuals are adversely affected too, because financial impact of health-care providers in highrate uninsured communities takes a toll on the access, quality, and satisfaction of the health care provided. The US health insurance system is in a state of crisis. It needs an immediate reform—health insurance must be provided for all citizens, not just those who can afford it. Universal health care is not only likely to have positive economic benefits, but would also be an intrinsically good act that could prove a defining statement by the new Obama administration. The upcoming White House health-care reform summit could be a step in the right direction. ■ The Lancet
Acting responsibly
iStockphoto
The printed journal includes an image merely for illustration
For more on the Which? survey see http://www.which.co.uk/ about-which/press/productpress-releases/which-magazine/ 2009/02/brain-trainers-claimsstrain-credibility.jsp For the Lancet editorial on junk food advertising see Editorial Lancet 2003; 362: 1593
782
Worldwide, celebrities sell. Whether it is Oscar-winning actors appearing in drug advertisements in the USA or Bollywood stars promoting soft drinks in India, celebrities can have considerable sway when it comes to consumers’ behaviour. Companies who use celebrities to endorse their products can benefit from healthy profits and celebrities usually receive substantial sums of money for their efforts. But what if the product has an unhealthy effect on consumers? Should celebrities just be allowed to quietly exit stage right when something goes wrong? On March 2, China passed a law which makes celebrities who recommend unsafe food products liable, along with food producers, for harm caused to consumers. The legislation is part of the government’s response to the melamine scandal, in which six children died and 300 000 fell ill after drinking contaminated baby milk. Celebrities were involved in the marketing of the baby milk. However, it is not clear if they were aware that the products were contaminated. Why stop there? Should celebrities be rapped on the knuckles for promoting products that make misleading claims? Brain-training games promoted in television
advertisements by several celebrities have recently come under the scrutiny of UK consumer watchdog Which? Manufacturers of some of these devices claim that using them will improve memory or even prevent decline in later life. But Which? found that “none of the manufacturers’ claims are supported by evidence that meets the minimum standard by which scientific research is judged”. The worst kind of celebrity endorsement, however, is that which unashamedly promotes unhealthy behaviour. Sports and pop stars, whose behaviour can have substantial influence on children, are often wheeled out by junk-food advertisers to promote their products. The Lancet has previously called for celebrity endorsement of junk food to be banned. But it is not all bad. Celebrities can also use their status as a force for good when they raise money for charitable causes or promote public health messages. Perhaps stars should stick to philanthropic exercises such as these or at least be more careful and responsible about the products they peddle to the public. China’s move, though extreme, should serve as a wake-up call to cash-hungry celebrities in other countries. ■ The Lancet www.thelancet.com Vol 373 March 7, 2009
The USA’s crisis of the uninsured
For the IOM report see http:// www.iom.edu/CMS/3809/ 54070/63118.aspx
Roughly 45·7 million Americans—15% of the country’s population—lack health insurance. Both wealthy and poorer states have almost a quarter of residents between the ages of 18 years and 64 years uninsured. The US Congressional Budget Office predicts that, nationwide, the number of uninsured people will rise by 10 million in the next decade. And this in a country where health-care expenditure alone is estimated to exceed US$2·5 trillion this year. That a lack of health insurance matters and has devastating consequences on people’s health is the conclusion of the just released report by the US Institute of Medicine entitled America’s Uninsured Crisis: Consequences for Health and Health Care. The report shows that there is a direct link between ill health and being uninsured, and a health benefit when health insurance is acquired. The research resulted from an independent assessment of published scientific studies and surveys by a broad team of experts in medical care, emergency medicine, health policy, business, and economics.
The alarming decline in the US health insurance coverage will be exacerbated by a weakened economy, growing unemployment, rising health-care and health insurance costs, and losses in employment-based health insurance coverage. Public health-care programmes for low-income individuals are threatened because of the recession. Insured individuals are adversely affected too, because financial impact of health-care providers in highrate uninsured communities takes a toll on the access, quality, and satisfaction of the health care provided. The US health insurance system is in a state of crisis. It needs an immediate reform—health insurance must be provided for all citizens, not just those who can afford it. Universal health care is not only likely to have positive economic benefits, but would also be an intrinsically good act that could prove a defining statement by the new Obama administration. The upcoming White House health-care reform summit could be a step in the right direction. ■ The Lancet
Acting responsibly
iStockphoto
The printed journal includes an image merely for illustration
For more on the Which? survey see http://www.which.co.uk/ about-which/press/productpress-releases/which-magazine/ 2009/02/brain-trainers-claimsstrain-credibility.jsp For the Lancet editorial on junk food advertising see Editorial Lancet 2003; 362: 1593
782
Worldwide, celebrities sell. Whether it is Oscar-winning actors appearing in drug advertisements in the USA or Bollywood stars promoting soft drinks in India, celebrities can have considerable sway when it comes to consumers’ behaviour. Companies who use celebrities to endorse their products can benefit from healthy profits and celebrities usually receive substantial sums of money for their efforts. But what if the product has an unhealthy effect on consumers? Should celebrities just be allowed to quietly exit stage right when something goes wrong? On March 2, China passed a law which makes celebrities who recommend unsafe food products liable, along with food producers, for harm caused to consumers. The legislation is part of the government’s response to the melamine scandal, in which six children died and 300 000 fell ill after drinking contaminated baby milk. Celebrities were involved in the marketing of the baby milk. However, it is not clear if they were aware that the products were contaminated. Why stop there? Should celebrities be rapped on the knuckles for promoting products that make misleading claims? Brain-training games promoted in television
advertisements by several celebrities have recently come under the scrutiny of UK consumer watchdog Which? Manufacturers of some of these devices claim that using them will improve memory or even prevent decline in later life. But Which? found that “none of the manufacturers’ claims are supported by evidence that meets the minimum standard by which scientific research is judged”. The worst kind of celebrity endorsement, however, is that which unashamedly promotes unhealthy behaviour. Sports and pop stars, whose behaviour can have substantial influence on children, are often wheeled out by junk-food advertisers to promote their products. The Lancet has previously called for celebrity endorsement of junk food to be banned. But it is not all bad. Celebrities can also use their status as a force for good when they raise money for charitable causes or promote public health messages. Perhaps stars should stick to philanthropic exercises such as these or at least be more careful and responsible about the products they peddle to the public. China’s move, though extreme, should serve as a wake-up call to cash-hungry celebrities in other countries. ■ The Lancet www.thelancet.com Vol 373 March 7, 2009