This is Healthcare Marketplace Specialization, Healthcare Marketplace Overview. And this is module 5.1.5 Health Bads and their Consequences. So what types of Bads are we really talking about? Smoking is pleasurable to many people, but it does create some damage. It is probably, of the diseases out there today, at least what it can lead to as disease, will be responsible, at least in 2000, for nearly half a million deaths mostly from lung cancer. It's associated with tremendous amount of vision and hearing problems. Actually, it's the largest source of cataracts in the United States today. It is the leading cause of lung cancer, 90% of deaths. From lung cancer, causes smoking, and also chronic bronchitis, emphysema. And COPD are major issues. There are additional cancers that are all complicated by cancer as well. Obesity, lots of links to hypertension, high cholesterol, coronary heart disease. In the year 2000, 400 thousand deaths, in the year 2015, closer to the 600 thousand deaths actually, potentially eclipsing obesity, as you'll be smoking. And as far as the cost, $75 billion in 2003, nearly triple that in 2015. Excessive alcohol consumption, this is not just a drink every week, this is basically two to three shots of whiskey on a daily basis if not half a dozen. Associated loss of productivity, disability, early death, crime, neglect of family responsibilities, lots of motor vehicle accidents, 100,000 deaths just in 2000 alone from alcohol abuse. When we look at some of these trends over time, there's actually some good news. What we actually do see is the consumption of cigarettes over a period of time, let say 1980 through 2000, has been going down steadily. This is associated almost, I think almost with relative prices of cigarettes going up over at the same period of time. The good news is that with the reduction of smoking prevalence, and how many people are smoking at any given point and time, we're actually seeing lung cancer death rates going down, particularly since the mid 1990s. And that's probably one of, as an educational campaign, probably one of the most successful stories in terms of the U.S., for public health. This isn't necessarily the case going on in other parts of the world, by the way. Smoking is much higher in many of the developing countries, and China in particular. Russia is very high. And those trends aren't reversing that quickly. Now, in terms of smoking prevalence over time, we go even further back. What we find is that smoking was obviously much more common for folks who, say, were born in 1900, and in terms of percentage of smokers. And then that sort of drops off as they get older. What we are finding as we get to the 1960 cohort or '70 or '80 cohort, that the percent of smokers in terms of the max never really exceeds, if you were born in 1980, at any particular point, 40% of time in your life. And that's dropping off, and again, that will lead to less deaths and less problems from smoking. When we look at alcohol, we have these BRFSS's, provided by the US public health service. This is looking at binge drinkers that are there, in the state that I'm located in. Turns out Minnesota is a high binge drinking state. Maybe it keeps us warm. Not quite sure. But when we actually look at some other places, interestingly, Utah is pretty low, which actually given some of the religious preferences there makes sense. Also kind of surprising, I have to say when I first saw this I was kind of surprised. That a lot of the south actually is a lot less in consumption than I might have expected. And in any case this shows that there is great variation in drinking in terms of what goes on and there could be also differences also with motor vehicle accidents that go along with this as well. Now one of the other things that's trended, through what we call the BRFSS survey is this issue of obesity. And so this is actually one of the more fascinating things that this group has started to attract, starting in 1985. Where, what they identified was the BMI, that is body mass index, of greater than equal, defining that as an obese person, and the thought is this is 30 lbs overweight for any person say 5'4" in size. So BMI is a calculation of this based on your height and your weight to come up with some sort of ratio. And the thought was as they were tracking, let's just see if there's really a trend over time. Because people have said, well you know, this is not really a major problem with all the stuff going on with obesity. And it's just something that all societies go through. So, let's see. We see that some states here have, say, 10 to 14% of their population, I mean, South Carolina, Georgia, Indiana, Ohio, North Dakota. Some states less, though in lots of states it wasn't reporting data when it first came out. And so color coding will show us where we go. So this is in 1985. So let's go to 1986. We see a little more variation in the trends, looking forward, and then we're going to go to 1987. So here we are in 1987. A little more blue occurring here, showing that more states are getting obese. 1988, a few more states. In 1989, now we have California coming online as being obese. Minnesota has gone obese as well. 1990 even more states. We're becoming a bluer nation. And here we are in 1991, we have a new color. Louisiana, Mississippi, and Michigan, as well as West Virginia, leading the way different category, 15% to 19% overweight. Now at 1992, even more states involved, Wisconsin now I guess is the cheese and then as well as Kentucky. 1993, even more states, they're now involved with North Carolina, South Carolina and Pennsylvania. 1994, the great state of Texas, now Missouri engaged as well. In 1995, now we have Alaska, North Dakota, some of the Midwest and then most of the mid-Atlantic region. 1996, we have made it over to the west coast with Oregon, and Idaho, and Nevada. 1997, new color. Now greater than 20% of the population leading the way here with Mississippi, Kentucky, and Indiana. 1998 contagion, now Michigan, West Virginia, Kentucky is sort of veering out of there, South Carolina and Louisiana as well, plus Alaska. 1999, a big state here, so North Dakota coming online with Texas and a good part of the South, except for Florida. 2000, now we're at the west coast and moving on, Pennsylvania as well. 2001, new color again, Mississippi leads the nation of the country's of color, state's evolve as well. Colorado, they're looking actually fairly healthy 2002, again, more expansion of this one particular color, and then we have West Virginia as well. It is now 25% greater of that population that's overweight. 2003, even more of that trend, greater than 25% overweight. We get to 2004, even greater. Now with Michigan, Texas, and a good chunk of the central south coming online as well. In 2005 guess what? New color, again Mississippi leads the way along with Louisiana as well as West Virginia, now 25 to 29% overweight of this category in the population. And then finally, going up to 2010, just to speed up things again, we actually have now, even a further new color in 2010, greater than 30% of the population, with a good chunk of the South, as well as Michigan and in West Virginia there. The takeaway message here is this didn't happen by accident. It's definitely a real trend and measured pretty scientifically and lots of different complex reasons why, but cheap food and other pieces, but it's definitely a major issue for the U.S. health economy with cost consequences as well as major health consequences. And it's a global trend, too. If you did this actually across the globe, in Europe, one would see the same phenomenon. This concludes this module on healthcare behaviors and BADS in the healthcare marketplace.
