Transcript 1. Health care in the United States

1. General Introduction about Health
care in the United States
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Health care in the United States is
provided by many separate legal entities.
More is spent on health care in the United
States on a per capita basis than in any
other nation in the world. A study of
international health care spending levels
published in the health policy journal Health
Affairs in the year 2000 found that the U.S.
spends more on health care than other
countries in the Organization for Economic
Co-operation and Development (OECD),
and that the use of health care services in
the U.S. is below the OECD median by most
measures. The authors of the study conclude
that the prices paid for health care services
are much higher in the U.S. Medical debt is
the principal cause of personal bankruptcy in
the United States, weakening the whole
economy.
According to data compiled and published by
the international pharmaceutical industry , the
US is the world leader in biomedical research
and development as well as the introduction
of new biomedical products; pharmaceutical
industry trade organizations also maintain
that the high cost of health care in the U.S.
has encouraged substantial reinvestment in
such research and development. Despite
that, the US pays twice as much yet lags
other wealthy nations in such measures as
infant mortality and life expectancy, which
are among the most widely collected, hence
useful, international comparative statistics.
For 2006-2010, the USA's life expectancy
will lag 38th in the world, after most rich
nations, lagging last of the G5 (Japan,
France, Germany, UK, USA) and just after
Chile (35th) and Cuba (37th).
Active debate over health care reform in
the United States concerns questions of a
right to health care, access, fairness,
efficiency, cost, and quality. The World
Health Organization (WHO), in 2000, ranked
the U.S. health care system as the highest in
cost, first in responsiveness, 37th in overall
performance, and 72nd by overall level of
health (among 191 member nations included
in the study). The WHO study has been
criticized, in an article published in Health
Affairs, for its failure to include the
satisfaction ratings of the general public.
A 2008 report by the Commonwealth Fund
ranked the United States last in the quality
of health care among the 19 compared
countries. The U.S. has a higher infant
mortality rate than all other developed
countries. According to the Institute of
Medicine of the National Academy of
Sciences, the United States is the "only
wealthy, industrialized nation that does not
ensure that all citizens have coverage" (i.e.
some kind of insurance).
2. Health Care Facilities in the U. S.
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In the United States, ownership of the health
care system is mainly in private hands,
though federal, state, county, and city
governments also own certain facilities.
 The non-profit hospital's share of total
hospital capacity has remained relatively
stable (about 70%) for decades. There are
also privately owned for-profit hospitals as
well as government hospitals in some
locations, mainly owned by county and city
governments.
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There is no nationwide system of
government-owned medical facilities open to
the general public but there are local
government-owned medical facilities open to
the general public. The federal Department of
Defense operates field hospitals as well as
permanent hospitals (the Military Health
System), to provide military-funded care to
active military personnel. The federal
Veterans Health Administration operates VA
hospitals open only to veterans, though
veterans who seek medical care for
conditions they did not receive while serving
in the military are charged for services. The
Indian Health Service operates facilities open
only to Native Americans from recognized
tribes. These facilities, plus tribal facilities
and privately contracted services funded by
IHS to increase system capacity and
capabilities, provide medical care to
tribespeople beyond what can be paid for by
any private insurance or other government
programs. Hospitals provide some
outpatient care in their emergency rooms
and specialty clinics, but primarily exist to
provide inpatient care. Hospital emergency
departments and urgent care centers are
sources of sporadic problem-focused
care"Surgicenters" are examples of
specialty clinics. Hospice services for the
terminally ill who are expected to live six
months or less are most commonly
subsidized by charities and government.
Prenatal, family planning, and "dysplasia"
clinics are government-funded obstetric and
gynecologic specialty clinics respectively,
and are usually staffed by nurse
practitioners.
3. Medical products, research and
development in the U.S.
The United States is a leader in medical
innovation. In 2004, the health care industry
spent three times as much as Europe per
capita on biomedical research. Companies
provide medical products such as
pharmaceuticals and medical devices. In
2006, the United States accounted for three
quarters of the world’s biotechnology
revenues and 82% of world R&D spending
in biotechnology. The amount of financing by
private industry has increased 102% from
1994 to 2003. Most medical research is
privately funded. As of 2003, the NIH was
responsible for 28%—about $28 billion—of
the total biomedical research funding spent
annually in the U.S., with most of the rest
coming from industry. The National
Institutes of Health play a larger role in
funding basic research.
The top five U.S. hospitals carry out more
clinical trials than all the hospitals in any
other country. Between 1975 and 2008, the
Nobel Prize in medicine or physiology has
gone to U.S. residents more often than
recipients from all other countries combined.
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In 29 of the 34 years between 1975 and
2008, a scientist living in the U.S. either won
or shared in the prize. Despite all the
foregoing, and because of government
priorities slighting immediate public health in
favor of long-term research, the US pays
twice as much yet lags other wealthy
nations in such measures as infant mortality
and life expectancy, which are among the
most widely collected, hence useful,
international comparative statistics.
4. Health Diet
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A healthy diet is one that helps maintain or
improve health. It is important for the
prevention of many chronic disease such as:
obesity, heart disease, diabetes, and cancer.
 A healthy diet involves consuming
appropriate amounts of all nutrients, and an
adequate amount of water. Nutrients can be
obtained from many different foods, so there
are a wide variety of diets that may be
considered healthy diets.
Fresh vegetables are important
components of a healthy diet.
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The World Health Organisation (WHO)
makes the following 5 recommendations with
respect to both populations and individuals:
* Achieve an energy balance and a healthy weight
* Limit energy intake from total fats and shift fat
consumption away from saturated fats to
unsaturated fats and towards the elimination of
trans-fatty acids
* Increase consumption of fruits and vegetables,
legumes (豆类), whole grains and nuts
* Limit the intake of simple sugars
* Limit salt / sodium(钠) consumption from all
sources and ensure that salt is iodized
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Other recommendations include:
* Sufficient essential amino acids (氨基酸)
("complete protein") to provide cellular
replenishment and transport proteins. All
essential amino acids are present in animals. A
select few plants (such as soy and hemp) give all
the essential acids. A combination of other plants
may also provide all essential amino acids. Fruits
such as the Avocado(鳄梨), and Pumpkin Seeds
also have all the essential amino acids.
* Essential micronutrients such as vitamins and
certain minerals.
* Avoiding directly poisonous (e.g. heavy metals)
and carcinogenic(致癌的) (e.g. benzene)
substances;
* Avoiding foods contaminated by human
pathogens(致病菌) (e.g. tapeworm(绦虫) eggs).
5. American Food guide pyramid (1992)
Chinese Food Pyramid
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The food guide pyramid (historical) known
as the food pyramid, and formally titled the
Improved American Food Guide Pyramid,
was published by the USDA(United States
Department of Agriculture) in 1992 to replace
the earlier food groups classification system.
The food guide pyramid suggested optimal
nutrition guidelines for each food category,
per day, using a mnemonic graphic of a
pyramid with horizontal dividing lines, to
represent suggested percentages of the daily
diet for each food group. Currently published
every five years, an update to the 2005
system is expected in 2010.
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MyPyramid, released by the United States
Department of Agriculture (USDA) on April 19,
2005, is an update on the American food
guide pyramid. The new icon stresses activity
and moderation along with a proper mix of
food groups in one's diet. As part of the
MyPyramid food guidance system,
consumers are asked to visit the MyPyramid
website for personalized nutrition information.
The six divisions of the pyramid
MyPyramid contains eight divisions. From left
to right on the pyramid are a person and six
food groups:
 Physical activity, represented by a person
climbing steps on the pyramid, to illustrate
moderate physical activity every day, in
addition to usual activity. The key
recommendations for 2005 (other specific
recommendations are provided for children
and adolescents, pregnant and breastfeeding
women, for older adults and for weight
maintenance) are:
1) Engage in regular physical activity and
reduce sedentary activities to promote health,
psychological well-being, and a healthy body
weight. (At least 30 minutes on most, and if
possible, every day for adults and at least 60
minutes each day for children and teenagers,
and for most people increasing to more
vigorous-intensity or a longer duration will
bring greater benefits.)
2) Achieve physical fitness by including
cardiovascular conditioning, stretching
exercises for flexibility, and resistance
exercises or calisthenics for muscle strength
and endurance.
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Grains, recommending that at least half of
grains consumed be as whole grains
Vegetables, emphasizing dark green
vegetables, orange vegetables, and dry
beans and peas
Fruits, emphasizing variety and
deemphasizing fruit juices
Oils, recommending fish, nut, and
vegetables sources
Milk, a category that includes fluid milk and
many other milk-based products
Meat and beans, emphasizing low-fat and
lean meats such as fish as well as more
beans, peas, nuts, and seeds
There is one other category:
 Discretionary calories, represented by the
narrow tip of each colored band, including
items such as candy, alcohol, or additional
food from any other group.