I wanted to bring up a news story I saw this morning, having to do with the US infant mortality rates dropping even further, putting us below nations such as Cuba and Lithuania. In my opinion, there is a two pronged reason for this. The first one being the obvious one: lack of access to healthcare, plain and simple. My wife, who is currently working in a contract position has had the misfortune of trying to find and pay for insurance independently. For those of you who haven't had to do this because of a steady job or pension plan, or whatever, take a few minutes and just look around and see what is available out there. We're looking at paying nearly $200/month for a plan that has a $5000 deductible, and maybe, just maybe some of the preventative visits might not be included under the auspices of the deductible. Oh, there is always a $75 copay no matter what. Thanks to recent legislation, she is actually able to get insurance, whereas before she was only able to get catastrophic medical due to "preexisting conditions." Anyway, without getting all "political," in my opinion, those who say there is no need for change are quite delusional. What kind of change needs to happen is up for solid debate, but again, in my opinion (coming from someone who has worked in and ER as a Patient Access "specialist," AKA the guy who gets your information, verifies insurance and then comes back for your credit card) the for profit model of health insurance is not the way out of this mess, especially considering (again, in my opinion) they are a big part of the reason we are in this deathly expensive hole.
The other part of the problem has to do with my perception of the American public as a whole, especially the younger generations, which I still consider myself to be a part of. You know, those in the age group who are having children. I think that the lack of overall ability (including know-how and to a certain degree, willingness) to take care of one's self is to blame. There really are people who think that fast food is just fine for everyday consumption -- mother's who think that feeding their children via a drive-thru provides all sustenance a growing body needs. Despite growing up in a household that ate more than it's fair share of fast food, I don't think there was ever the idea that is was the healthy thing to do. However, above and beyond this delusional subsection of society, there is also the overwhelming majority of people who know quite well what it is to be healthy, but just don't care enough to do anything about it. If this is the state of mind you exist in, and then you find yourself pregnant, well, why would there be any difference during those nine months? Some might say that there is more reason during those nine months than at any other time of their lives, and, I would agree. Say the mother decides to quit smoking (or decrease her habit) during her pregnancy but prior to conception didn't really take care of herself. Obviously, the child is still at a disadvantage from the get-go.
I was inspired to write this when I read the article about the infant mortality rate (which, it should be clarified that the infant mortality rate actually decreased in the US, but just not as much as the 40 or so countries that have a lesser rate) the main onus of blame was placed on the health care system, specifically OB-GYN and the surrounding services. Undoubtedly there are issues here, but I'm not really in a position to discuss them as I don't yet know what they are, at least, from the inside. I also want to make a note that when I was working in the ER, I was almost always on the weekend shifts (as I was still a full-time undergrad student) and that in the hospital that I worked in had expecting mothers come through the ER registration in order to get to the OB floor anytime other than weekday office hours. No one outside of those with the purse-strings of the hospital thought this was a good idea. Can you imagine making pregnant women sit in a waiting room in the ER which is often populated with sick people just because the hospital didn't want to pay another registrar (who at most makes $13.00/hour) to do the registration outside the confines of the ER? Anyway, I'm getting off track here, but my point is that I registered hundreds if not thousands of mothers in my time there. The scary part is this, since I worked in a privately owned hospital, I saw the "better" portion of all expecting mothers, in that I wasn't at the community hospital. There is something to be said about the adage that those who should be having kids are not, and those who are having children should not be. This doesn't have anything to do with race, creed or color. It might have a little something to do with socioeconomic status, but even this isn't the whole of it. It has more to do with the fact that, from what I saw in my time registering all those mothers, way too many of them didn't want to be pregnant. On the other hand, it could be that they were just upset from being made to wait for 30 minutes, sitting between the guy with FLS (flu like symptoms) with vomiting and the 3 little kids who have runny noses and are screaming like crazy while the mom watches movies on her iPhone. What do I know? I don't even have kids much less the ability to become pregnant.
Seeing as how I am a student-doctor, I should be thankful for all the job security that the unhealthy will provide. But, it sure is hard to find bony-landmarks on the obese.