iv. Does health care make us healthy?

At first sight this might seem to be rather a strange question. If health care did not make us healthy why would we demand it? Clearly most people believe that there is a strong and positive link between the two - we demand health care because we want to be healthy and we believe that health care will make us healthy. But are we correct?

One way of finding out is to use data on life expectancy at birth to gain a picture of how and why health has changed historically. A man born in 1841 in England and Wales could only expect to live 40.2 years and a woman 42.2 years, but by 1998 a man's life expectancy had increased to 75.1 years and a woman's to 80.0 years. These figures indicate a dramatic improvement in the general level of health over the period. Research has shown that this was mainly due to a reduction in infectious diseases carried by air, water and food - diseases such as tuberculosis, cholera and gastro-enteritis.

Why has the death rate fallen?

What caused the death rate from these diseases to fall so dramatically? Was it improvements in health care such as new drugs, better medical treatments and more doctors? These things helped but the main factors were improvements in nutrition and in hygiene. Better nutrition made people more able to fight disease with their bodies' own defence mechanisms, while improved hygiene due to proper sewage disposal, clean water and the development of techniques such as pasteurising for milk helped eradicate diseases carried by water and food. Health care played a relatively minor role in this process.

Diet and lifestyle

But surely modern medical techniques and the development of new operations and new medicines have changed this picture? Again the evidence suggests yes but not greatly relative to diet and other factors. Figure 13 on the right shows current statistics on deaths from ischaemic (coronary) heart disease from a range of countries. If the quantity and quality of health care was a key variable then one would expect relatively poor countries such as Portugal to perform worse than relatively rich countries such as Norway. In fact the main variable appears to be diet. Countries at the top of the heart disease league all tend to be large consumers of dairy products and saturated animal fats while those at the bottom of the table tend to use vegetable oils and eat large quantities of fruit and vegetables.

Smoking is also a major factor. In the UK generally, coronary heart disease and cancers are the main killers, together accounting for approximately half the deaths from natural causes in England and Wales in 1995. Coronary heart disease and cancer are strongly associated with smoking. Heavy smokers (over 40 cigarettes a day) are four times as likely to die from coronary heart disease as non-smokers, moderate smokers twice as likely, while 40% of all cancer deaths and 90% of lung cancer deaths are due to cigarette smoking. So if we want to be healthier, perhaps we should change our diet and give up smoking rather than visit our doctor and demand health care.

Modern health care

In fact, this misses the point of much modern health care. Most treatment provided by doctors and hospitals is not concerned with saving people's lives. Modern developments in medical technology, surgical techniques and medicines have enabled doctors to treat many conditions which previously caused patients considerable pain and discomfort. 
 
For instance, stomach ulcers can now be controlled and managed by modern drugs. This helps to explain why the demand for health care seems to be infinite - everybody wants improvements to the quality of their life.

So we are still faced with the problem of deciding how much health care we should have. Some people argue that we can never have too much - we should aim for the highest level of health care provision possible. But this is to confuse health - a basic human right - with health care. As we have seen, health care is, in most cases, just like any good or service which gives consumers utility. If this is the case, then the optimum level of health care will be the efficient level - the quantity where marginal cost equals marginal benefit. This will give us the maximum satisfaction from our scarce resources. The questions that remain are those which we have discussed throughout this e_source - which mixture of market and planning will produce the most efficient allocation and how should the health care which is produced be distributed between different people (equity)?