Who is the most responsible for our good health today? Some experts credit the medical profession while others credit the health-insurance industry. They all are wrong.

What our medical establishment and the insurance industry have done for our health is bring us the most costly health-care system in the world. And after spending more than anybody else, we get expensive, but second-rate health care.

According to the CIA World Fact Book, the U.S. ranks No. 42 in the world and dead last among industrialized nations in life expectancy. Current American life expectancy is about what it was for farmers living 2,000 years ago in the Roman Empire. In infant mortality, another good indicator of the quality of health care, America ranks No. 38.

U.S. health care is bested by nations such as Singapore, Hong Kong (even with SARS), Greece and Montserrat, a nation which, despite being poor and devastated by a volcano for most of the past decade, nevertheless manages to provide better health care than America. U.S. health care is in fact only marginally better than in Cuba.

Even so, we’re not succumbing to cholera, tuberculosis and the plague in the U.S. too often any more. But this is the product of Darwin, sewers, the water company and the janitor — not medical care.

More than anything, evolution made us healthy. The plague killed 25 to 40 percent of the population of Europe, leaving behind a plague-resistant population.Consequently, although the germ has not been wiped out, plague is no more than a minor nuisance today. The plague is just one example of how evolution brought humanity into a fairly stable relationship with pathogens. In the long run, it does the microorganisms no good to kill their hosts, so evolution balances things out.

Save lives by taking out the trash
The historic analysis of life expectancy shows how important cleaning up garbage is to good health. At the height of the Roman Empire, rural Romans had a life expectancy a bit over 70 years, about the same as 21st-century Americans. As for the residents of the city of Rome, they were lucky to live past age 30. The progression of human health for the past three millennia is from making cities as healthy as Roman farms. The janitor, the trash collector and the sewer worker have kept us healthy where evolution isn’t enough.

The blessings of sewers, clean water and trash collection are obvious and they are, along with evolution, responsible for advancing the health of city dwellers to the standards of the farms of ancient Rome. Cleaning up the cities doubled life expectancy.

For instance, take cholera, the most deadly disease in history. We are not bothered by cholera today because we have sewers, clean drinking water and trash removal, not because of any medical miracle drugs. Cholera is just one prominent example of the many diseases the janitor keeps at bay.

Now, let’s compare some contributions of modern medicine to our health. Modern medicine tried to cure tuberculosis, but lost the war to evolution, succeeding only in breeding drug-resistant TB germs. On the other hand, all that is needed to defeat a TB bug is fresh air and sunshine. Low population density also helps a lot.

Civilization is ahead in the TB battle because economic prosperity reduced population density, cleaned up polluted, sun-obscuring air, and brought fresh air to city dwellers by building bigger, less crowded rooms with lots of windows — not because of expensive drugs or technology.

Simple solutions succeed
The medical establishment, for all of its research and expense, historically has turned its back on simple solutions, including hygiene.

An Austrian doctor named Semmelweis began birthing babies in hospital in the 1840s. The new-mother death rate was more than 30 percent, far higher than the death rate for mothers who delivered at home by midwives. Semmelweis reduced the death rate of mothers giving birth in hospitals from 30 percent to 3 percent. How? He simply insisted that the hospital staff wash their hands after seeing each patient.

The medical profession reacted to Dr. Semmelweis’ discovery by ignoring it. They branded Semmelweis a quack, drove him out of the country and refused to read his books on how infection spreads.

Dr. Semmelweis’ cleaning program has saved more lives than the all the antibiotics ever developed, despite the best efforts of the medical establishment to silence him.

Do not think that because Dr. Semmelweis was shunned by the medical establishment some 150 years ago that it couldn’t happen today. It is in fact happening again right now — just ask most proponents of alternative medicine.

If you want to credit somebody with bringing you good health, thank the janitors and the folks down at the water works. For all these professionals do for our health, the medical community and all its science and technology should give them some more credit.

Can you figure out why our physicians and surgeons are paid 10 to 20 times more than the people who actually keep us good health? And why aren’t the services of a cleaning company more valued?

John Walker is a regular Contracting Profits columnist. He is a veteran building service contractor; owner of ManageMen consulting services, Salt Lake City; and founder of Janitor University, a hands-on cleaning management training program.




POSTED ON: 9/1/2003