참고자료

[공중보건] 가난, 낮은 교육수준이 흡연과 비만보다 더 건강 위협

가난 및 낮은 수준의 교육은 흡연이나 비만만큼 건강을 해치므로 대중들의 건강을 증진시키기 위해서는 비의료적 분야에 더 관심을 기울여야 한다는 내용의 “미국공중보건학회지” 2009년 12월호 연구결과입니다.

미국 컬럼비아대학 피터 뮤닝(Peter Muennig) 교수가 이끈 연구팀은 1997~2000년에 실시된 국립보건면접조사(National Health Interview Surveys) , 1996~2002년 이뤄진 의료비지출패널조사(Medical Expenditure Panel Surveys) 자료를 토대로 가난, 낮은 수준의 교육, 흡연, 비만 등과 건강한 생활 사이의 관계를 분석했습니다.

연구 결과 항상 소득이 낮은 가난한 사람은 그렇지 않은 사람보다 건강을 유지하는 기간이 평균 8.2년 감소하였습니다. 지속적인 흡연자는 6.6년, 고등학교도 졸업하지 못한 사람은 5.1년, 만성 비만자는 그렇지 않은 사람보다 4.2년이 줄었습니다. 연구진은 가난함의 기준을 최저생계비의 200% 이하가 소득인 가구로 정했습니다. 참고로  2010년 한국의 최저생계비는 4인 가족 기준 136만 3천원입니다.



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RESEARCH AND PRACTICE:
Peter Muennig, Kevin Fiscella, Daniel Tancredi, and Peter Franks

The Relative Health Burden of Selected Social and Behavioral Risk Factors in the United States: Implications for Policy

출처 : Am J Public Health(American Journal of Public Health), Dec 2009; doi:10.2105/AJPH.2009.165019
http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2009.165019v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Muennig&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&fdate=1/1/2009&resourcetype=HWCIT

Abstract



Objectives. We sought to quantify the potential health impact of selected medical and nonmedical policy changes within the United States.


Methods. Using data from the 1997–2000 National Health Interview Surveys (linked to mortality data through 2002) and the 1996–2002 Medical Expenditure Panel Surveys, we calculated age-specific health-related quality-of-life scores and mortality probabilities for 8 social and behavioral risk factors. We then used Markov models to estimate the quality-adjusted life years lost.


Results. Ranked quality-adjusted life years lost were income less than 200% of the poverty line versus 200% or greater (464 million; 95% confidence interval [CI]=368, 564); current-smoker versus never-smoker (329 million; 95% CI=226, 382); body mass index 30 or higher versus 20 to less than 25 (205 million; 95% CI=159, 269); non-Hispanic Black versus non-Hispanic White (120 million; 95% CI=83, 163); and less than 12 years of school relative to 12 or more (74 million; 95% CI=52, 101). Binge drinking, overweight, and health insurance have relatively less influence on population health.


Conclusions. Poverty, smoking, and high-school dropouts impose the greatest burden of disease in the United States.


Key Words: Epidemiology, Health Financing, Health Policy, Obesity, Overweight, Underweight, African Americans/Blacks, Socioeconomic Factors


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Poor Face Greater Health Burden Than Smokers or the Obese



ScienceDaily (Dec. 23, 2009) — The average low-income person loses 8.2 years of perfect health, the average high school dropout loses 5.1 years, and the obese lose 4.2 years, according to researchers at Columbia University’s Mailman School of Public Health. Tobacco control has long been one of the most important public health policies, and rightly so; the average smoker loses 6.6 years of perfect health to their habit. But the nation’s huge high school dropout rate and poverty rates are typically not seen as health problems.


This new study published in the December 2009 issue of the American Journal of Public Health, shows that poverty and dropout rates are at least as important a health problem as smoking in the United States.


These researchers define “low-income” as household earnings below 200% of the Federal Poverty Line, or roughly the bottom third of the U.S. population.


On average, poverty showed the greatest impact on health. Smoking was second, followed by being a high school dropout, non-Hispanic Black, obese, a binge drinker, and uninsured. The findings are based on data from various national datasets that are designed to measure both health and life expectancy. Healthy life lost combines both health and life expectancy into a single number, sometimes known as quality-adjusted life years.


“While public health policy needs to continue its focus on risky health behaviors and obesity, it should redouble its efforts on non-medical factors, such as high school graduation and poverty reduction programs,” according to Peter Muennig, MD, assistant professor of health policy and management at the Mailman School of Public Health and principal investigator of the study. Specific policies that have proven successful in the past include reduced class size in grades K-3 and earned income tax credit programs, according to Dr. Muennig.


To analyze the medical and non-medical policies that might affect population health, the researchers examined such policy goals as smoking prevention, increased access to medical care, poverty reduction, and early childhood education to provide policymakers with a sense of how different policy priorities might influence population health.


Building on prior research, the researchers examined health disparities resulting from an individual’s membership in a socially identifiable and disadvantaged group compared with membership in a non-disadvantaged counterpart. Although public health policy has always been directed at individual social and behavioral risks, until now there had been little systematic investigation of their relative contribution to U.S. population health. The researchers were not able to capture all population health risks. For instance, they did not include an analysis of transportation policy, which can affect health through reduced accidents, reduced pollution, and increased exercise.


“The smaller impact of schooling in our analyses probably had a lot to do with the fact that we are only measuring the health of people in the general population. We miss those in prisons and chronic care facilities, most of whom lack a high school diploma. If we captured these individuals, the numbers would be higher.


“As with other burden of disease studies, the policies we identify will not eliminate the risk factor in the population; our estimates can only serve as guideposts for policymakers,” says Dr. Muennig.

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