American medicine is a critical element with modern society. Statistics show that the overall population of the developed world is aging. When extrapolated to the world, the healthcare statistics are exacerbated. According to research, by 2030, one in five individuals within the world will be over 60 years old. This trend is attributable to falling fertility rates, higher left expectancy rates, and overall improvement in medicine. Each of these trends coalesce to form a much more dynamic healthcare system that increase the over life expectancy of individuals throughout the world. This trend of medicine shows now signs of abating. Currently the United States spends roughly 17% of GDP on healthcare related expenditures. This amounts to roughly $11,500 per person or $1.8 Trillion in 2020 alone. By 2030, this figure is projected to be roughly 20% of GDP indicating the rapid rise in healthcare relates cost, expenditures and investments. This trend is also occurring throughout the world, as the world continues to witness a seismic shift in the demographics of the world. Figure 1 below is aging statistics from the United Nations Population Fund depicting this trend on a much more statistical basis. Here, you can see that Asian countries are propelling this demographic shift in aging throughout the world (Adler,2008).
Figure 1 Aging Population
Medicine therefore is a paramount concern within these populations. As a result, it is my argument that more investment must be made into medicine to further expand and improve on the benefits that have been derived to date.
The history of medicine has a very long, contentious, and often heart-breaking history. Here, the historical context of medicine involves heavy use of slaves, and experimenting on then in inhumane conditions. It also involves a lack of involvement by women who where often deemed as inferior. As a result, for the better part of the worlds history, only 50% of its output was being adequately used within the field of medicine. The lack of investment historically form women and minority practitioners should now be a catalyst for the profession going forward. Historically, the world essentially used half of its intellectual capacity. Going forward, medical breakthroughs should occur at a much more rapid pace as more the world intellectual capital is being used within the medical field.
To begin, the reverend Thomas Thatcher published what is assumed to be the very first purely medical publication within the United States called, A Brief Rule to Guide the Common People of New-England . How to Order Themselves and Theirs in the Small Pocks or Measles. The publication began dissemination in 1678. Likewise the first medical journal was started in 1797 and was called the The Medical Repository. Here, the overall quality of information of the articles was suspect resulting in the creation of the American Journal of Medical Sciences, which was a much more fact based and academic source on medicine. Over the next decades the overall quality of medical literature would improve, helping to improve the overall potency of medicine throughout the world. Here the quality improved due to many physicians moving to Austria and Germany, which where considered the most advanced schools for medical training in the world. Many of the most prominent physicians at the time leveraged these teaching to improve their overall practice throughout the world. By 1896, medical journals where now becoming more specialized. The first known journal is that of the Journal of Experimental Medicine which looked to established a academic source for emerging applications of medicine. This was a very important milestone for medicine as it allowed for the widespread dissemination of innovative technologies to solve many of the worlds more pressing healthcare needs. During this period of the worlds healthcare development, there were many highly damaging diseases that impacted many individuals. In 1896, when the first issue of the Journal of Experimental Medicine was published, the world was just beginning to recognize the retrocessions of poor hygiene and sanitation on the lives of others. For example, typhoid fever was a result of poor sanitation and had very troubling side effects that eventually would result in death. Pellagra an d goiter where complications that resulted from poor nutrition, which also lead to a large amount of worldwide deaths due to poor treatment. Many discoveries and breakthroughs depicted in the journal helped to mitigate these diseases helping to save lives and reduced overall deaths throughout the world.
By the 20th century, these texts where translated into more foreign languages allowing other nations to benefit for the technological breakthroughs of the past. For example, according to medical historians the number of biomedical journals translated into foreign languages increased from 50 to more than 700 throughout the 20th century. This is attributed to the growth in specializations, expansion of research, and the need for investment due to the worlds aging population.
Along with the rise of information throughout the 20th century , came the rise of epidemiology. Epidemiology, or the study of disease was not utilized heavily until this time period. Here, the widespread consequences of worldwide disease required a much more disciplined approach to studying disease and its transfer around the world. Unlike other medical disciplines, epidemiology concerns itself with groups of people rather than individual patients and is frequently retrospective, or historical, in nature. Here, the history of medicine was changed due to the shifting trends of medicine on an individual base to medicine as a means to helping a specific high-risk population. As noted above, the high death rates due to low sanitation, hygiene, and eating habits. This ultimately required a shift in medical technology, research and though. During the period, the medical field shifted to making disease prevention a much more paramount attribute to medical research. Likewise, studied where used to help prevent many diseases, identify high risk populations, and fund research to prevent transitions within these population. During this period, governments also became much more intertwined with the history of medical development. This support primarily consisted of grants to medical schools. For example medical funding in the United States increased from $27 million in 1947 to $1.4 billion in 1966. In 1968 69 approximately one third of faculty salaries were paid from federal sources. Today, nearly 76% of faculty salaries are paid from federal sources indicated the growth in government investment within the healthcare industry overall (Anderson, 2010).
The history of medicine also includes aid from non-profit organizations as well during the 20th century. In 1916, with the support of the Rockefeller Foundation, the Johns Hopkins School of Hygiene and Public Health was started. The Rockefeller foundation also contributed to the development of the Hookworm eradication project. Here, this program was known as one of the earliest instances of voluntary efforts to remove a specific disease from the planet. By the 1920s the foundation also looked to provide grands to overall healthcare reform, which included the founding of the National Tuberculosis Association along with organizations designed to help review infant health. By 1922, Columbia, Harvard, and Yale universities had established schools of public health to further the dissemination of medical research and aid to developing countries. By 1969, the number of schools of public health had increased to 12. By 1999, 29 accredited schools of public health enrolled approximately 15,000 students (Acemoglu, 2007)
The above paragraphs illustrate the changes of many centuries of the public health system throughout the world. Here, the history of American medicine has been predicated on developing the infrastructure in a manner that allows for a much robust and efficient exchange of information. As noted abov, the late 1700s where related to the establishment of medical journals and other publications designed to educate the public on health issues. Soon after, these publications started to grow in number, the overall quality began to deteriorate. Here, many publications became much more of a branding initiative as oppose to actual medical research. In response by 1896, journals based on academic and accredited research began to emerge helping to establish a much more robust field of medicine predicated on real world results. This soon transitioned into the field of epidemiology in the early 20th century. Likewise, by the early 1900s the medical field was becoming much more widespread and utilized. Governments began heavily funding research while also paying a large portion of research salaries. Universities, began to heavily emphasize medicine within its own curriculum, increasing enrollment and investment with the industry. Likewise, non-profit organizations began to emerge leveraging the research conducted over the prior generations to help eradicate diseases and other illnesses from American society. Public companies also emerged looking to use investor capital to engage in the research and develop of medicines that could cure or eradicate certain ailments and diseases throughout the United States. All of these elements coalesced to form the modern medical and healthcare system we have today. Each of these elements provided a unique and well-researched approach to helping prevent and ultimately cure large ailments.
Although the history of American medicine has a history of improvement and advancement as indicated above, more funds are needed to help expand the overall infrastructure. The recent COVID-19 pandemic has been an illustration of the overall weaknesses of the current healthcare infrastructure in America. For one, the pandemic has shown that the advancements in medicine are still not enough to keep up with the rapidly changing healthcare environment. In many instances, nations, governments, and healthcare institutions are becoming much more reactive in nature as oppose to being proactive in the case of the last few centuries. Likewise, healthcare infrastructure was overwhelming creating an adverse circumstance for those in the medical field. For one, the virus has shown the world that mutations and viruses are constantly changing requiring the infrastructure to properly combat them. Likewise, the need for investment is exacerbated by the need to invest in future preventative measures.
Here, the need for future investment in the medical profession is paramount to the health, safety and well-being of American society. Over 1 million people have died as a result of COVID-19. As indicated in the history of medicine section, this pandemic is not unique to the world. There have been many pandemics that have occurred over the last few centuries, each requiring unique preventative measures that where not readily available as the time of their occurrence. The most notable of which is the black plagues which resulted in the death of roughly 25 million people between 1347 and 1351. Although uncommon these pandemics due occur and often result in large and excessive amount of damage
In order to prevent this occurrence more resources should be devoted to first expanding the overall healthcare infrastructure throughout the United States. This includes increase capacity to help benefit those who have complications and other surgeries that are not related specifically to the pandemic. With COVID-19, capacity was so overwhelmed that individuals where forced to defer and even completely cancel important surgeries and operations. By investing in capacity, when a pandemic does occur, it is much more easily addressed as capacity constraints will not occur.
Next investments must be made in preventative research and care. As noted in the history section above, governments have been a large proponent of this. However, public-private partnerships should occur to better facilitates further discoveries and overall improvements in medicine. Through these partnerships, investment is encouraged as citizens can earn an adequate rate of return on their investment. This ultimately creates a win-win situation in which society is better able to mitigate the next pandemic while investors earn an adequate rate of return on their overall investment. Likewise funds can be used to help reduce the overall costs of medicines and drugs requires to prevent disease. In this instance is benefits all parties involved by increasing overall investment.
1. Acemoglu D, Johnson S. Disease and development: The effect of life expectancy on economic growth.Journal of Political Economy.2007;115(6):925985
2. Adler NE, Rehkopf DH. U.S. disparities in health: Descriptions, causes, and mechanisms.Annual Review of Public Health.2008;29:235252
3. Anderson G, Squires D.Measuring the US health care system: A cross-national comparison.New York: Commonwealth Fund; 2010.
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