PHA-Exchange> FW: [spiritof1848] [Pophealth] Why Billionaires die (fwd)

[mohammad ali barzgar]

Dear Fran & Claudio

Greeting from Iran.I thought you may be interested to read the subject paper 
and use it for the debate initiated by AK and whim in the commission or 
PHA-Exchange.Kindest regards.Mohammad.

>From: "Luisa N. Borrell, DDS, PhD" <lnb2 at columbia.edu>
>To: spiritof1848 at yahoogroups.com
>Subject: [spiritof1848] [Pophealth] Why Billionaires die  (fwd)
>Date: Sat, 09 Apr 2005 17:11:10 -0400
>
>
>
>FYI-
>
>------------ Forwarded Message ------------
>Date: Saturday, April 09, 2005 1:30 PM -0700
>From: Stephen Bezruchka <sabez at u.washington.edu>
>To: Population Health Forum <pophealth at u.washington.edu>
>Subject: [Pophealth] Why Billionaires die
>
>Sorry to put that link out there and have it expire soon afterwards. For
>those of you with access to the New Scientist, the March 12, 2005 issue has
>a useful article on page 6-7 about the rich getting richer and the poor
>remaining poor as almost a law of economics. A conference was held in
>Kolkata last month, titled:  "econophysics of wealth distribution" looking
>at this phenomenon (sorry there apopears to be no web version available).
>Here is the text of why billionaires die later:
>
>Finance Home > Yahoo! Finance Weekend > What Kills Billionaires
>http://biz.yahoo.com/weekend/killsbills_1.html  April 9, 2005
>   Health
>What Kills Billionaires Forbes.com  By Vanessa Gisquet
>
>Think trophy wives, boating accidents and feckless dependents are the
>primary causes of death for billionaires? Think again. Billionaires are
>killed by the same unglamorous things that kill the rest of us: diseases
>such as cancer, heart attacks, kidney failure and others.
>The only difference is they may live a little longer.
>The average age of death for the 20 billionaires featured in the 2004 and
>2005 "In Memoriam" sections of the annual Forbes Billionaires list was 78.
>(http://biz.yahoo.com/special/bill05.html) We compared this number with the
>average male life expectancy in the U.S., since all but one of the 20
>billionaires on our list that died were males: the billionaires lived 3.5
>years longer than average American males. The results would be even more
>dramatic if we took into account average life expectancies from around the
>world, since the billionaires on our list are of all different
>nationalities.
>
>Go to Forbes.com to view a slideshow of what kills billionaires.
>http://www.forbes.com/2005/04/04/cx_vg_0405featslide.html?partner=yahoo
>
>According to a 1999 study in the British Medical Journal, higher income is,
>in fact, "casually associated with greater longevity." But when it comes to
>living longer, billionaires may not be that much better off than mere
>millionaires. "While an extra dollar of income is protective," the study
>reads, "the amount of protective effect tails off as total income rises."
>
>The rich not only tend to live longer, but are healthier as well. According
>to the National Center for Health Statistics, 23% of people below the
>poverty threshold, defined as "poor," are limited by chronic disease,
>whereas only 10% of "non-poor," those with an income 200% or greater than
>the poverty threshold, are.
>
>What accounts for these gaps? Traditional theories espouse that greater
>wealth means greater access to medical care. But as Forbes' Dan Seligman
>points out in his June 2004 article, "Why the Rich Live Longer," if access
>was the key, the health gap between the upper and lower classes should have
>shrunk with the advent of America's Medicare and Medicaid, not to mention
>employer-sponsored health insurance.
>
>Some use the "inequality is a killer" theory, arguing that the health gap
>between the rich and the poor exists because low social status increases
>stress and anxiety, which increases susceptibility to disease. It's not
>entirely clear, though, whether lower-level civil servants suffer less
>anxiety than, say, chief executives and billionaires. Struggling to pay
>your bills and having to answer to angry stockholders are both stressful,
>each in their own way.
>
>Some studies contend that rich live longer because of intellectual
>Darwinism. "Social status," Seligman writes, "correlates strongly and
>positively with IQ and other measures of intelligence, and intelligence
>correlates strongly with health literacy--the ability to understand and
>follow a prescription for disease prevention and treatment." This theory is
>not without evidence: Seligman cites a 2003 study by psychologist Ian Deary
>of the University of Edinburgh that found mortality rates to be 17% higher
>for each 15-point falloff in IQ.
>
>Since most of what kills Americans today is chronic disease, health
>literacy may, in fact, be a key to longevity. Understanding and monitoring
>risk factors for the major conditions that predispose us to death--heart
>disease, cancer, diabetes, obesity, high blood pressure--requires a
>considerable amount of awareness, discipline and foresight.
>
>Go to Forbes.com to view a slideshow of what kills billionaires.
>
>And when it comes to prevention, being rich certainly doesn't hurt.
>So-called executive physicals, offered at places like the Princeton
>Longevity Center, Canyon Ranch and the Mayo Clinic, cost anywhere from
>$2,000 to $7,000, and most insurers cover only a small percentage of that.
>These pricey super-physicals get done in one day, in one office, instead of
>what would normally involve a half-dozen different doctor's appointments
>with various specialists. Included are usually the latest diagnostic
>imaging techniques, like CT-scans of the heart, which detect calcium
>buildup in arteries that can signal heart disease, and virtual
>colonoscopies, as well as advanced blood tests that might detect early
>stages of disease, and nutrition and fitness assessments.
>
>Many of the facilities that offer executive physicals have on-site labs
>that provide same-day results, which give "executive" patients the added
>benefit of being able to discuss the results--and any suggested targeted
>therapies--with the team of doctors, without any hassle.
>
>Enough money can even make an otherwise dreary hospital stay that much more
>comfortable. A handful of the nation's top hospitals have "luxury"
>accommodations, an indulgence that must be, of course, paid for
>out-of-pocket. The rooms and suites in the 16th-floor Shapiro Pavilion at
>Brigham and Women's Hospital in Boston, Mass., for example, are priced at
>$325 to $800 out-of-pocket. The 14 rooms feature bidets in all bathrooms,
>300-thread-count sheets, kitchenettes, flat-screen TVs and pull-out couches
>for guests who want to spend the night. The unit has a gourmet chef, and is
>even locked for high-security. Other hospitals such as Johns Hopkins,
>Massachusetts General and Cedars-Sinai--just to name a few--all have
>similar luxury units.
>
>Most people don't think of themselves as lucky if their health or mental
>status require around the clock home health care, but the
>alternative--being in a nursing home--might make them feel fortunate.
>Perhaps not surprisingly, home health care costs, on average, more than
>double what it costs to be in a nursing home.
>
>According to the 2004 MetLife Market Survey of Nursing Home and Home Care
>Costs, the average daily cost of a private room in a nursing home in the
>U.S. is $70,080 per year, or $192 per day. The study found that the cost of
>a home health care aide averaged $18 per hour nationally, which turns out
>to be $432 per day.
>
>Three of the billionaires were not included in the list because their
>causes of death were not specified. Marvin Davis, famous for buying 20th
>Century Fox and selling it four years later to Rupert Murdoch's News Corp.,
>and also for owing Pebble Beach Co., the Aspen Skiing Co., and the Beverly
>Hills Hotel, for instance, died after a "long illness." Friends say he had
>long suffered from heart trouble, diabetes and other effects of obesity,
>but what actually caused his death was not released. Portugal's richest
>man, Antonio Champalimaud, who passed away in May of 2004, suffered a
>"prolonged illness," and reportedly died in his home in Lisbon. Saudi
>billionaire Abdulaziz Bin Hamad Algosaibi's cause of death was also not
>specified.
>
>Around the clock personal nurses and 300 thread-count sheets aside, even
>all their money can't buy billionaires immortality.
>
>To see a list of the leading causes of death among billionaires, click 
>here.
>
>Video: How Billionaires Die
>
>
>**And the above piece by Seligman
>There's a stunning new explanation for upscale longevity, and it's quite
>contrary to what the world's health bureaucrats have been telling us.
>One of the great mysteries of modern medicine: Why do rich people live
>longer than poor people? Why is it that, all around the world, those with
>more income, education and high-status jobs score higher on various
>measures of health? As stated in a World Health Organization pamphlet:
>"People further down the social ladder usually run at least twice the risk
>of serious illness and premature death of those near the top."
>
>The traditional answer to these questions has been that greater wealth and
>social status mean greater access to medical care. But even ten years ago,
>when this magazine last delved into the topic (FORBES, Jan. 31, 1994), the
>available answers seemed inadequate. If access was the key, then one would
>have expected the health gap between upper and lower classes to shrink or
>disappear with the advent of programs like Britain's National Health
>Service and America's Medicare and Medicaid, not to mention
>employer-sponsored health insurance. In fact, the gap widened in both
>Britain and America as these programs took effect. The 1994 article cited a
>study of British civil servants--all with equal access to medical care and
>other social services, and all working in similar physical
>environments--showing that even within this homogeneous group the
>higher-status employees were healthier: "Each civil service rank outlived
>the one immediately below." How could this be?
>
>Today the standard answer--or, at least, the answer you are guaranteed to
>get from the WHO and other large health bureaucracies--is that inequality
>itself is the killer. The argument is that low status translates into
>insecurity, stress and anxiety, all of which increases susceptibility to
>disease. This psychosocial case is lengthily elaborated in Social
>Determinants of Health, a 1999 publication collectively created by 22
>medical specialists and endorsed by the WHO. "Is it plausible," the book
>asks at one point, "that the organization of work, degree of social
>isolation and sense of control over life could affect the likelihood of
>developing and dying from chronic diseases such as diabetes and
>cardiovascular disease?" The authors' answer is a resounding yes. Pushing
>their case to the outer limits, the authors supply data indicating that in
>the world of African wild baboons, those who are socially dominant tend to
>be most healthy (as mainly evidenced in their higher levels of good
>cholesterol).
>
>This revised standard answer has some plausibility, but also some serious
>weaknesses. One of its problems is that we lack serious comparative data on
>tension and anxiety levels in low- and high-status jobs. It is far from
>clear that barbers, elevator operators and lower-level civil servants
>suffer more tension than do surgeons, executive vice presidents and
>higher-level civil servants. Another problem is that psychosocial
>explanations don't tell us why the health gap would widen when employers
>and governments provide more health care. Nor do they explain one
>well-known source of the health gap: the notoriously high rate of smoking
>in the low-status population.
>
>An explanation not presenting these problems has recently been proposed in
>several papers by two scholars long associated with IQ studies: Linda
>Gottfredson, a sociologist based at the University of Delaware, and
>psychologist Ian Deary of the University of Edinburgh. Their solution to
>the age-old mystery of health and status is at once utterly original and
>supremely obvious. The rich live longer, they write, mainly because the
>rich are smarter. The argument rests on several different propositions, all
>well documented. The crucial points are that (a) social status correlates
>strongly and positively with IQ and other measures of intelligence;(b)
>intelligence correlates strongly with "health literacy," the ability to
>understand and follow a prescription for disease prevention and treatment;
>and (c) intelligence is also correlated with forward planning--which means
>avoidance of health risks (including smoking) as they are identified.
>
>The first leg of that argument has been established for many decades. In
>modern developed countries IQ correlates about 0.5 with measures of income
>and social status--a figure telling us that IQ is not everything but also
>making plain that it powerfully influences where people end up in life. The
>mean IQ of Americans in the Census Bureau's "professional and technical"
>category is 111. The mean for unskilled laborers is 89. An American whose
>IQ is in the range between 76 and 90 (i.e., well below average) is eight
>times as likely to be living in poverty as someone whose IQ is over 125.
>
>Second leg: Intelligent people tend to be the most knowledgeable about
>health-related issues. Health literacy matters more than it used to. In the
>past big gains in health and longevity were associated with improvements in
>public sanitation, immunization and other initiatives not requiring
>decisions by ordinary citizens. But today the major threats to health are
>chronic diseases--which, inescapably, require patients to participate in
>the treatment, which means in turn that they need to understand what's
>going on. Memorable sentence in the Gottfredson-Deary paper in the February
>2004 issue of Current Directions in Psychological Science: "For better or
>worse, people are substantially their own primary health care providers."
>The authors invite you to conceptualize the role of "patient" as having a
>job, and argue that, as with real jobs in the workplace, intelligent people
>will learn what's needed more rapidly, will understand what's important and
>what isn't and will do best at coping with unforeseen emergencies.
>
>It is clear that a lot of patients out there are doing their jobs very
>badly. Deary was coauthor of a 2003 study in which childhood IQs in
>Scotland were related to adult health outcomes. A central finding:
>Mortality rates were 17% higher for each 15-point falloff in IQ. One reason
>for the failure of broad-based access to reduce the health gap is that
>low-IQ patients use their access inefficiently. A Gottfredson paper in the
>January 2004 issue of the Journal of Personality & Social Psychology cites
>a 1993 study indicating that more than half of the 1.8 billion
>prescriptions issued annually in the U.S. are taken incorrectly. The same
>study reported that 10% of all hospitalizations resulted from patients'
>inability to manage their drug therapy. A 1998 study reported that almost
>30% of patients were taking medications in ways that seriously threatened
>their health. Noncompliance with doctors' orders is demonstrably rampant in
>low-income clinics, reaching 60% in one cited study. Noncompliance is often
>taken to signify a lack of patient motivation, but it often clearly
>reflects a simple failure to understand directions.
>
>A new Test of Functional Health Literacy of Adults can evaluate the problem
>in a mere 22 minutes. It measures comprehension of the labels on
>prescription vials, of appointment slips, of what the patient is expected
>to do before diagnostic tests, etc. The results turn out to be somewhat
>horrifying. In a sample of 2,659 clinic patients in two urban hospitals,
>42% did not understand the instructions for taking medicine on an empty
>stomach, and 26% did not understand when the next appointment was
>scheduled. The problem is maximized for patients with chronic illnesses.
>Asthma, diabetes and hypertension all require patients to make a lot of
>decisions daily as well as in emergencies, but many patients are simply not
>up to it. A study cited in the Gottfredson-Deary paper mentions that a high
>proportion of insulin-dependent diabetics did not know how to tell when
>their blood sugar was too high or too low or how to get it back to normal.
>
>And then there is the third leg of the IQargument: the lifestyle question.
>Smoking, obesity and sedentary living are more prevalent among low-status
>citizens. A 2001 study by the Centers for Disease Control & Prevention
>found that college graduates are three times as likely to live healthily as
>those who never got beyond high school. Not clear is what the government
>can do about this.
>
>The data on IQ, social status and health present some huge conundrums for
>policymakers. For years Americans debated what to do for, and about, poor
>people unable to pay for health care. Ultimately they decided it simply had
>to be paid for. But now, with money ordinarily not a barrier to medical
>care, we are discovering another obstacle: "regimen complexity." As this
>fact of life sinks in, the system will be under pressure to find ways to
>deliver high-quality care to the low-status population much more simply,
>understandably--and economically. Not an easy task.
>
>Population Health Forum's mailing list PHF website:
>http://depts.washington.edu/eqhlth/
>to un-subscribe go to
>http://mailman1.u.washington.edu/mailman/listinfo/pophealth
>
>---------- End Forwarded Message ----------
>
>
>
>"Expect nothing, live frugally on surprise"
>Alice Walker
>
>******************************************************************************
>
>Luisa N. Borrell, DDS, PhD
>Department of Epidemiology
>Mailman School of Public Health
>School of Dental and Oral Surgery
>Columbia University
>722 West 168th Street
>16th Floor Room 1611
>New York, NY 10032
>V  212-305-9339
>F  212-342-0148
>
>******************************************************************************
>
>
>
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