It is graduation time, when proud valedictorians bow to plaudits. Far back in the audience sit their families, the ones who coached the not-yet-budding geniuses in the multiplication tables, who paid for computer camps, who stayed the sometimes unpleasant course of parenthood. Maybe the winner will thank them, but often s/he judges them as secondary to his/her success.
So it is with the recent announcements of public health successes. We welcome the good news, cheer the statistical affirmation that the country is succeeding on a few fronts. The Centers for Disease Control and Prevention has proclaimed the good news: fewer teenagers in the US are giving birth: from 2009 to 2010, the rate fell to 34 per 1,000 teens aged 15-19, the lowest ever, a 41% drop from 1991. The drop varied by state: Mississippi had the highest rate (55 births per 1,000 teens); New Hampshire, the lowest (15.7 per 1000).
For the nation, this is wonderful: fewer infants will grow up in poverty, with its attendant miseries. More teenagers will graduate from school, get jobs, bear children when they are mature enough to take care of them. Delaying child-rearing does not guarantee a better life, but it ups the odds.
What happened? Teenagers didnt suddenly embrace abstinence. Indeed, there is no correlation between the enthusiasm for abstinence-only sex education and abstinence. Teenagers continue to have sex.
Another CDC survey found the not-surprising key: contraception. Although the worsening economy may have propelled teenagers to delay parenthood, a range of contraceptives, including the hormonal ones, has made that possible. Thanks to publicly funded clinics and public health insurance, teenagers have access to those contraceptives. Cheer the plunging rate of teenage pregnancy, but thank government.
Tuberculosis remains contagious, often fatal. The good news: The Centers for Disease Control and Prevention, which monitors cases (reporting is mandatory), recently reported the lowest level since 1952, when the government started collecting tuberculosis data: 3.4 cases per 100,000. The disease hasnt vanished. In parts of the globe it is endemic. American residents born in other countries have much higher rates: for those born in Asia, the rate is 25% higher than for native-born Americans. Control depends on testing. Most foreign-born residents who have tuberculosis develop it at least two years after they enter the United States; they enter with latent tuberculosis. If physicians identify latent cases, a short regimen of treatment will often suffice.
Active cases require more extensive, more expensive treatment. And public health physicians work to get everybody treated. Regardless of health insurance or income, the authorities treat people who are infected, as well as people who are exposed.
If a person does not cooperate with the regimen, the public health department can opt for directly observed treatment, where a nurse will go to the persons home to administer the medication. Without the vigilance of authorities in special enclaves (half of all cases are in Florida, Texas, New York, and California), tuberculosis would spread. Tea-partiers might be willing to let uninsured poor people, especially immigrants, suffer from diabetes, heart disease, and cancer, but most would demur at tuberculosis. If Uncle Sam didnt morph into a medical Big Brother, wed have far more cases. More good news from the CDC: childrens accidental deaths, mostly from car accidents, fell 30% from 2000 to 2009 or 11,000 children saved. The plunge varied by state: Massachusetts had the lowest fatality rate; Mississippi, the highest.
The reason lies in better drivers. But the reason for better drivers lies with laws: mandatory seat belts, child safety seats, booster seats, bars on texting, restrictions on teenage drivers, testing of bus drivers.
Thanks to these laws and their aggressive enforcement, more people drive more cautiously than they used to. Admittedly, the restrictions infringe on a citizens liberty to drive however s/he wants. But the result of this infringement: fewer deaths. The government deserves both blame for the restrictions, and credit for the plunge.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email firstname.lastname@example.org.
From The Progressive Populist, June 1, 2012
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