Flu and Mortality

I am far from an expert on medicine but was interested in the difference in mortality in Mexico and the United States on this latest outbreak of swine flu. After reading many of the accounts I noted that many of the individuals in Mexico did not have access to health care and / or delayed going to the doctor and used home remedies or self-medicated until their situation was very bad.

The victims seem to be dying of what is basically pneumonia. Pneumonia is a serious condition, and if left untreated (or not treated until far into its course) it can be deadly, even here in the US. I know several individuals who have gotten some form of pneumonia (or their children) in recent months here in Chicago – and while they missed work and obviously had high concern for any youngsters with the symptoms, they all were treated and came back fine after being ill or out of work for a while.

What you likely are seeing in the difference in mortality is the difference between a broadly based, functioning health care system from a rich society and one for a semi-functioning health care system for a poorer society. Mexico is a pretty developed country – if this sort of flu broke out in Africa it probably wouldn’t even be noticed among the endemic diseases and preventable fatalities that happen every day, sadly enough. As I note in a recent post about Angola, one of the richer African countries (they have oil revenues), a significant portion of their total health care budget goes to sending the richest friends and family of their leader off for foreign doctors overseas, to show where their priorities lie.

The media won’t come out and say it directly because it may be perceived as offensive to Mexican sensibilities but the mortality rate seems to be almost solely due to the differences in the effectiveness of our overall health care systems.

12 thoughts on “Flu and Mortality”

  1. Oh Yeah… you can buy prescription medications over the counter in Mexico. And with their complete laws against private ownership of guns, you can walk down any street in Mexico and be perfectly safe. Man.. health and safety everywhere in our neighbor to the south.

    Although it truly is sad to have loss of life, we have to look at these things rationally. Rational thought is impeded in the United States now by an outbreak of ‘Obamaflu.’ Obamaflu impacts that part of the brain where emotionalisms are evaluated by logic and analysis. Obamaflu victims have lost the ability to reason through problems and react completely on an emotional level.

    To find out more and hopefully get a bit of a laugh, you might hit:

  2. I’d phrase what you are seeing a bit differently. I’d say you are seeing a state-sponsored national health care program in Mexico with the expected clinical service model, mediocre physicians unmotivated by competition, and long waits that eventually lead to a public avoidance of the entire program in favor of home remedies, etc.

    If we needed a side by side model for health-care demonstrating national vs free enterprise we’re probably looking at one. Similar side-by-side models for economic systems were offered in E and W Germany, where the lesson eventually was learned and in N and S Korea where the lesson continues.

    I’ll admit the modeling between Mexico medical and US isn’t a perfect pair-off, but it’s got a lot of the components.

  3. Carl:
    A lot of people are talking about the issue of higher mortality rate in swine flu victims in Mexico vs those in The United States but I do believe that people fail to see a few facts:
    There have been less than a couple of hundred people suspected of having the flu in the United States, and most cases are people who came to Mexico and returned during the days of the outbreak. The outbreak arrived to United States long after it was detected in Mexico. Another important factor is the first cases were discovered in the United States, the health authorities were already on alert and knew what it was all about.
    But there were already thousands of suspects in Mexico, where the flu had a lot of time to spread before it was even detected. I think this will probably explain the high mortality rate, I think it is a question of the timing of the outbreak mostly.
    Another important factor that may also explain the high mortality rate is the fact that the swine virus showed up at season of the year when common flu appears and people in Mexico, and around the world I think, normally self-prescribe, and even doctors in many small towns who are unaware of the outbreak would also prescribe the regularly available medicine, which in this case, did not work.
    I think Mexico has a very good health care system, though under a more socialist concept and though it is not entirely universal, it is accessible and cheap nevertheless; it has successfully eliminated very dangerous outbreaks that normally affect many Latin-American countries like Dengue and Cholera, and it has one of the most successful universal vaccination programs in the world for polio, measles and other diseases.

  4. Jose, I tend to agree. I know several practicing physicians from Mexico, and their take is that if you want it, medical care in Mexico is better than you’d expect from a country at their stage of development. But as in Taiwan and China, there is a certain segment of society that seeks out herbs and traditional therapists before escalating to the Western physician, and in this case, that kind of delay kills.

    The thing about socialized medicine is that int he developing world it provides a better overall standard of care than would be available to that society in a capitalist medical system, whereas in developed countries, socialized medicine retards the overall level. Socialized medicine tends to regress to a certain mid-to-low quality mean no matter what the affluence of the society it’s practiced in.

  5. Please remember that Jim Henson, of Muppet fame, died of pneumonia. He resisted going to the doctor until it was too late to save him. It doesn’t matter how wonderful your health care system is if people don’t go to the doctor. That is a behavioral thing that you cannot fix, either with socialized medicine or anything else.

    I’ll also point out the public health aspect of offering some kind of health care to illegal immigrants. Deport them, fine, but if you’re not going to, then for them to be here in large numbers possibly living on top of each other and let TB or something like it get loose w/o treatment would be a public health nightmare for all of us.

    I’ve read that one of the things that caused influenza to be hard to figure out and diagnose – and they were very motivated in 1918 – was that the actual cause of death differed in different regions. A lot of people died of secondary infections, such as pneumonia, and the specific pneumonia-causing bacteria didn’t necessarily spread hand-in-hand with the flu. It’s possible that the swine flu virus just got out of Mexico ahead of whatever pneumonia bug they’ve had killing people.

  6. The New York Times has an article that explains in large measure why there are (so far) deaths in Mexico but not nearly such serious reactions in the US. and it has nothing to do with Obama, socialized medicine, or other political perspectives.

  7. John, I agree with you this.

    Although a lot of people complain about the quality in the public health service in Mexico, it is not normally those who benefit from the public health services and those who are willing to wait in lines to get the service, they don’t normally complain for a free service. it is important to point out that this publicly funded health care system is not meant to be used by all Mexicans, the middle and upper classes in Mexico normally use private health care services, the public health care system in Mexico is a safety net for the poor, the unemployed and the low income workers of the country.
    Poor people, low income workers and unemployed people in Mexico are able to get treatment for cancer, diabetes, and all kinds of terrible diseases and even very expensive transplants that will turn a rich man poor anywhere in the world; they get all that for free, as a universal benefit and they don’t have to pay anything when they get out of the hospital, but they don’t get the nice and personal attention they’d get when they go to a private clinic and if their health problem is not an urgency, of course they have to wait for hours to get a doctor to see them when they come into a public hospital, there are public clinics in every city but resources are not unlimited. The centralization of the public health care system in poor or developing countries normally means a prioritization of the needs of the people, they administer limited resources and use them to treat the greatest health care problems in the population, so they try to maximize the impact of those resources by prioritizing cancer, diabetes, aids, etc.; these poor nations don’t have huge budgets for their health care systems and cannot have thousands of doctors immediately and timely seeing people with little problems like a regular cold. Doctors are very expensive to have everywhere in the world.
    But there are also private health care services for more affluent people in Mexico too and they are very good too and middle class and upper income people do not get to wait for hours to see a doctor.
    Interestingly, a lot of times Mexicans with higher income go to private clinics only to get diagnosed and then if the treatment is too expensive and their insurance plan does not cover or their deductible is too high, then they turn to the public health care system, which then doesn’t look that bad at all.
    So we do have both kinds of services in Mexico, private and publicly funded, and they both service different sectors of the population.

  8. According to what I’ve heard today on the radio from interviews with WHO officials, the death toll within the country of Mexico has been exaggerated: Deaths due to pneumonia were ascribed to H1N1 flu based upon symptoms, but have turned out not to be H1N1 when lab tests were completed.

  9. I think the Mexican government and health care services have acted with enormous responsibility. But one of the problems in the beginning of the outbreak was the fact that the Mexican laboratories did not have the capacity to identify the virus, so they were counting victims or suspects based solely on symptoms, which can create inaccurate figures, we have many high tech laboratories but we didn’t happen to have the tools to identify this particular influenza virus, and the Mexican authorities were getting help from laboratories in the United States and Canada. I understand that now they have put in place similar labs in Mexico and it is now possible to carry on without the foreign assistance.

    The mexican government called on a sanitary emergency, when there were less than a thousand hundred suspected cases and only a few dozens confirmed and less than 10 deaths confirmed from the flu.

    But check this out: http://online.wsj.com/article/SB124087003193660939.html, the argentinians are dealing with a Denge outbreak for months, the authorities lack any health infrastructure to deal with it, they need help from the world health organization and other nations, they have more than 18,000 people infected and the populist government of the Kichners refuse to declare an emergency, because elections are coming of course, and there have been already a few deaths.

  10. Jose, those are interesting comments about medicine in Mexico. What you are describing sounds reasonable to me, and it’s what some countries with socialized medicine would call a “two-tier” system, which they reject as being unfair.

  11. Laura,
    I think I probably described the public health care system in Mexico in the best terms, but it is not without flaws and shortcomings.
    The first major problem it has is the high centralization of the system; the best hospitals in the public systems are located in Mexico City, Guadalajara and Monterrey, although there are hospitals all over the country, in just about every city, small towns lack hospitals and clinics so a lot of times sick people have to travel for hours to get to a public clinic, many a times they have to go to a private hospital and end up paying a lot there.
    There’s medical negligence too, more than in the United States, and accountability is not one of the qualities of a burocratic and centralized system.
    Nepotism is another problem. High directors appoint family and friends in key positions.
    Another problem is that it is subjected to the party in power.
    The president appoints the director of the institution, but the tradition has been to appoint a renowned doctor as responsible for the institution.
    The IMSS provides just about any medical service, it is the only and ultimate public health care provider in Mexico and it also provides the medicine prescribed by the doctor. When a person is prescribed a certain medicine, he or she just walks to the pharmacy of the clinic to get the prescription filled.
    There’s corruption in the system that supplies the medicine and they don’t always provide the best medicines. So many people prefer to buy the medicines outside in regular pharmacies.
    Although many of the doctors are also very committed to public service, they know they will always have their position, there are also nurses and doctors who treat patients inhumanely, and they are rude and despotic.
    Nevertheless, there have been many efforts from this and past federal administrations to transparent all operations and transactions of the system and to end corruption and nepotism within the system. To a certain degree of success I might say.
    But perhaps one of the greatest problem in a socialized health care system is the lack of medical innovation, our public health care systems have no incentive to invest in medical research or medical best practices, they simply follow tendencies and apply technologies generated in privately funded health care systems like the ones in the United States, which are the ones that normally set the best practices and new cutting edge technologies in medicine.
    Would it be better for Mexico to privatize all medical services? I don’t think so, I think we got the best of both worlds, we got a privately funded, very professional and advanced health care system supported by a network of international and national insurance companies, and we also have a socialized system that provides the most needed services for the masses.

  12. Perhaps you have only hit on part of the problem.

    The April 27th issue of The Gaurdian contained an article detailing a town where 60% of the populace fell sick approx. a month ago with a disease very likely to be H1N1. Of the 1,800 who fell sick, only 2 died. That is a 0.2% mortality rate- a number consistent with the mortality figures for Swine Flu cases in the U.S.

    My explanation for the seemingly high Mexican rate of morality is simple: the number of actual cases of flu present is underrepresented and the number of fatal flue infections is overrepresented in the official numbers published by the Mexican government. In the United States, a combination of a frantic media attention and a slick health care apparatus means that mild cases of the flu were quickly identified. However, Mexico does not have a health care system efficient as that in the States, and the Mexican government and media did not give a large amount of attention to the flu until quite recently- when the bodies started to pile up. Likewise, I imagine that there are thousands of cases of flu that – like those cases presented in the article – were not ever reported, as they lacked the deadliness to warrant such.

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