(6 of 7)
Beyond death and disease statistics, there exists a steadily expanding number of the "worried well" and those with minor illnesses. Has life itself become a disease to be cured in the American culture? Some 80% of the doctor's work consists of treating minor complaints and giving reassurance. Common colds, minor injuries, gastrointestinal upsets, back pain, arthritis and psychoneurotic anxiety states account for the vast majority of visits to clinics and doctors' offices. One out of four people is "emotionally tense" and worried about insomnia, fatigue, too much or too little appetite and ability to cope with modern life. At least 10% of the population suffer from some form of mental illness, and one-seventh of these receive some form of psychiatric care. Meanwhile, the figures for longevity are the highest and for infant mortality the lowest in U.S. history, and the gap continues to narrow. We are doing better but feeling worse.
As a people, Americans have been noted for their selfcriticism. I would suggest that we give at least equal time to extolling our virtues and triumphs. Let us look at both sides of the coin:
1) We should be grateful for our medical technology and the countless lives that have been saved because of it. We should gasp at its wild abuse and overuse.
2) We should be grateful for the markedly improved health of most Americans. We should be horrified by the unmet medical and nutritional needs of nearly 25 million poor people.
3) We should applaud the development of health insurance mechanisms that have protected the patient from financial disaster. We can decry the fact that health insurance is a misnomer (it is disease insurance) and that so little effort and emphasis have been placed within the insurance system on the maintenance of health.
4) We can be grateful for the quality of care given in the majority of our 7,000-plus hospitals and 1.5 million beds. We should decry our inability to avoid costly reduplication of services, build more extended-care facilities and low-cost hospitals for the chronically ill, and reduce unnecessary surgery.
5) We can take great satisfaction that so many Americans have found fruitful work in the health system. We should worry about the low number concerned with environmental health research, health education, visiting nursing and prevention programs.
6) We can be proud of the quality and quantity of our health-related educational system: 114 medical schools with some 33,000 full-time faculty, 50,000 students and 14,000 Doctors of Medicine graduated annually. We should decry the unbelievable cost of medical education and the precarious state of financing for schools of public health.
7) We can applaud the activities of the National Institutes of Mental Health. We should decry the meager sums of money available for research in mental illness, which represents the nation's primary public health problem.