Archive for the 'Sickness & health' Category

Howard Derangement Syndrome a lasting condition

Some evidence that Howard Derangement Syndrome is not cured by three years of Labor government.

At least even an ABC audience is tired of these silly stunts.

Be careful what you wish for #2

Back in August Kristy Fraser-Kirk courted publicity for her claim against David Jones and its former CEO Mark McInnes, filing an outlandish and attention-seeking $37 million lawsuit and calling a press conference to publicise her grievances.

But now she is complaining about all the media attention, claiming through her lawyers that ‘it has induced a psychiatric illness’, and that she now regularly ‘checks under her car’. For what we are not told.

This appears to be in support of yet another preposterous claim, that women who claim to have been previously harassed by McInnes should not have to be named so that their allegations can be investigated. From the judge’s comments last week, this part of the action looks like it will be struck out, as justice requires.

Are foreign students at high risk of death?

I’d never seen any data on the deaths of international students while in Australia, so I was interested in this story in The Age this morning reporting 54 deaths in the year to November 2008 (though annoyed at the beat-up elements – claiming the information was ‘suppressed’ by the coroner, when there is no evidence of anything other than reluctance to publish possibly unreliable data).

Obviously 54 deaths is 54 too many, but so far as I can work out this a death rate below that of the general population. Though there are statistical problems in working out the base population for overseas students (because the number of overseas students who will be in Australia at some time during a year will give a too-high number, due to short courses, mid-year starts and finishes etc), my estimate is that this gives a death rate of about .02%.

For a local comparison, I looked at deaths of 20-somethings in Australia. That works out at around .04% of the base population, or around double the death rate of overseas students. On the other hand, perhaps the relevant comparison group is Australian students – if we assume that the local death rate is increased by including the kinds of risk-taking and underlying illness that is under-represented in the student population. (The death rate of Australian students is not ‘suppressed’, it is just not recorded.)

Indians appear to be over-represented among the deaths, so perhaps another comparison point is the death rate of young Indians of similar backgrounds in India. I would have thought that the risk of death from accidents or disease was much lower here.

4 July update: Coroner to improve statistics on international student deaths.

Are 5,000 kids a day injured in serious accidents?

I received my 2009-10 White Pages this week, and on the back there is an ad from the Kids Foundation, a charity aimed at reducing preventable injury to children. The ad says:

On an average day 5,000 kids are injured in serious accidents.

This sounded like a lot, so I went to the Foundation’s website looking for a source. None is to be found, though they offer another statistic saying that this results in 100 hospitalisations.

At the Australian Institute of Health and Welfare website I found statistics on hospitalisations but not all injuries. This suggests the hospitalisations figure is conservative – I calculate for 2004-05 an average of 158 hospital admissions a day for 0-14 year olds for injuries or poisonings (though this includes deliberate as well as accidental injuries and poisonings).

But even with this higher number, how serious could the injuries be if only 3% require hospital treatment?

The ABS reports all injuries whether requiring hospital treatment or not, with a quarter of 0-14 year olds reporting an injury in the previous 4 weeks. That’s around a million a month, which would certainly get us to 5,000 a day. On the other hand, a lot of these injuries are minor such as cuts, falls below one metre, and stings – things that are painful at the time but usually do no lasting or major harm. They are a normal part of growing up, not ‘serious accidents’.

The Kids Foundation sounds like a worthy cause, and certainly the super-protective parenting since I was growing up is paying off in greatly reduced death rates for kids. But when I read shock! horror! numbers with no source I get the feeling I am being subject to spin, and become less inclined to support the organisation involved.

If someone can point me to the source of this number, I will of course happily acknowledge it and remove the ‘factoid’ category from the post.

Is Australia the world’s fattest nation?

According to yesterday’s SMH,

Australia has overtaken the US to become the fattest nation in the world, with more than 9 million adults rated as obese or overweight.

But is this true? According to the most recent Australian National Health Survey, 35.4% of Australians over the age of 18 are overweight, and another 17.9% are obese, making 53.3% of us fat. That’s about 7.4 million people.

According to the American National Health and Nutrition Examination Survey, 66% of Americans are overweight or obese, with 31.4% obese.

Both surveys class people with a Body Mass Index of over 30 as obese, and those with a BMI of 25 or more but less than 30 as overweight.

So while we are a nation of fatties, on these statistics we are still a fair way from being the world’s fattest, our 53% lagging well behind the American 66%.

So where did the SMH claim come from?
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Unhealthy federalism

This morning’s ACNielsen poll attracted most attention for adding another week to Labor’s remarkable lead in the polls, but it also reported some interesting issue polling.

Alas, support for federalism – at least so far as it concerns hospitals – is no stronger than the Coalition primary vote. 40% think that it would be better if hospitals were run by the states, compared to 42% who think the federal government should do it.

I doubt that this is an ideological thing; federalism (as opposed to parochial concerns with ‘state’s rights’) has never really been widely understood among the politically active, much less the masses. It is a pragmatic assessment of which level of government seems most competent, with 55% of those polled agreeing that the health system is ‘not very well run’, and nearly twice as many people (46%) blame the states for this as blame the federal government (24%).

Personally, I doubt the federal government would do a better job. The Canberra bureaucracy has relatively little experience of service delivery compared to their state counterparts, and with the added disadvantage of being very remote from the places they need to service. The one advantage of the otherwise poor policy on display in Mersey hospital takeover may be to provide evidence that the Commonwealth does no better at running hospitals than the states.

Is mental ill-being increasing?

One much-publicised finding of the National Health Survey carried out by the ABS is that the self-reported mental health of Australians is declining. In the 1995 survey, 5.9% of the sample reported ‘mental and behavioural problems’, which increased to 9.6% in 2001 and 10.7% in 2004-05. An earlier ABS survey, carried out in 1989-90, came up with lower figures than 1995 – 3.8% reporting ‘nerves, tension, nervousness, emotional problems’ and 0.9% reporting depression. However, its question was different so comparisons should be made with caution.

The rapid increase has led to widespread concern, but also suspicion that there is something wrong with the numbers. Will Wilkinson has long argued that the depression trends (which are similar in the US) are fishy because they don’t match the happiness data. If there was a big increase in depression there should be a substantial increase in those with lower happiness ratings in subjective well-being surveys, but there is not in the US or UK.

In Australia, it’s harder to test this hypothesis because of inconsistent survey formats. In 1983 and 1984, two surveys giving very/fairly/not too happy options found 6% giving the ‘not too happy’ response. The two most recent surveys, the 2003 and 2005 Australian Survey of Social Attitudes, used 0-10 scales. If we count 0 to 4 as ‘unhappy’ we get 6.5% and 8.2% of respondents respectively as ‘unhappy’. The 2003 survey would seem to show little change in 20 years, consistent with what Will finds. The 2005 survey shows a more significant change. But both are below the mental problems reported in the National Health Survey.
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Unhealthy central planning

My new CIS paper (pdf) on mismatches in the graduate labour market is getting off to a rather slow media start (only the Courier-Mail so far, though a couple of other papers requested opinion pieces as well). The Australian and The Age are however running different stories on foreign doctor recruitment – and there is no better illustration than these of the problem I am talking about.

In fact, doctors provide a double tale in what goes wrong when governments intervene. This story starts in 1984, when the then Hawke government introduced the Medicare system, and in so doing ensured that the government picked up most of the tab for visits to the doctor. This in turn led to concern about escalating costs, on the (plausible) theory that if you charge people nothing or very little to go to doctor they will be more likely to do so.

In the early 1990s, the government formed the view that an over-supply of doctors was part of the problem. According to one report (no. 12 in the link)
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Can the mentally distressed also be happy?

In the comments on my marriage and happiness post last week Andrew Leigh and I differed on the link between mental distress and well-being. It started when Andrew pointed to this paper (pdf) to argue that, as he put it, ‘divorce makes you happier’ (compared to a bad marriage, that is).

On average, I am pretty sure that’s right. But the paper he cited did not use the standard tests for well-being, which ask people to rate themselves on a scale according to how happy they feel, or how satisfied they are with their lives. Instead, it used the General Health Questionnaire (GHQ), which

is used to detect psychiatric disorder in the general population and within community or non-psychiatric clinical settings such as primary care or general medical out-patients. It assesses the respondent’s current state and asks if that differs from his or her usual state. It is therefore sensitive to short-term psychiatric disorders but not to long-standing attributes of the respondent.

When I replied that I did not think the GHQ’s measures of distress could be easily extrapolated to a measure of happiness, Andrew’s response was that

I think of them as measuring the same underlying stuff. See for example Blanchflower & Oswald’s recent paper that ‘validates’ cross-country happiness measures by showing that they correlate negatively with hypertension.

Though it seems intuitively plausible that the GHQ and subjective well-being indicators measure the same ‘underlying stuff’, as with happiness and marriage this is an area of disagreement among happiness researchers. In Understanding Happiness: A Theory of Subjective Well-being, now quite old (1992) but still one of the most interesting books on the subject, Bruce Headey and Alex Wearing note that:

a large minority give themselves scores which are surprising either because they rate high on both well-being and psychological distress, or low on both.

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Matt Wade impersonates Ross Gittins

“Ross Gittins is on leave” the SMH‘s opinion page noted this morning, but we have not been spared a Wednesday Ross Gittins column. If anything, stand-in columnist Matt Wade’s effort this morning is lamer even than Ross’s standard debunking of economic growth.

Commenting on the fact that though the US has a per capita GDP it ranks well down the global list for life expectancy (29th, compared to 7th for Australia, according to Wikipedia), Wade says:

The figures suggest Americans have, on average, traded longevity for higher incomes over the past 50 years.

Huh? Life expectancy figures aren’t like happiness statistics, where there is an apparent paradox of stable self-reported happiness while GDP per capita has grown significantly. Life expectancy has gone up almost continually just as GDP in Western countries has increased almost continuously in the post-war period. That’s true of the US and it is true of Australia.

As Wade says, there are various idiosyncracies of the US that help explain why despite on-going improvement it ranks below other developed countries. These contribute to the stark differences between white and black life expectancy, apparent too in Australia on an even greater scale, but our Indigenous population is too small for it to have the same impact on average life expectancy.

But none of Wade’s explanations, with the possible exception of disputed theories about social structures and work conditions, suggest a trade-off between GDP and life expectancy. And to the extent that there is a trade-off, it works in life expectancy’s favour. As annual income grows so too does public and private expenditure on health. The long period of prosperity in Australia over the last decade has seen per capita federal spending on health increase by more than 35% in real terms. This has almost certainly contributed to increased life expectancy over that time.

While nobody thinks that GDP growth alone improves health (as opposed to providing some of the means for doing so), the reasonable inference from Wade’s article that we should not be so concerned about economic growth is wrong. Not only would it deprive us of resources needed to finance improved health care, it would add to the life stresses he suggests are harmful, as unemployment went up again and employed people’s jobs became less secure.