美国婴儿死亡率和肥胖人数呈上升趋势

根据美国公共卫生学会（the American Public Health Association, APHA）于2004年11月在华盛顿召开的第132次年会的最新报告指出：美国的卫生事业在经历多年的稳步上升之后，出现了下降趋势的迹象，这样不久之后也许会将美国的卫生事业引向错误的方向。

   根据该报告，“美国的卫生状况：各州的卫生排行榜”，揭示了三个重要不良趋势：四十年来婴儿死亡率首次升高，所有年龄组人群的肥胖流行率增加，在2003年～2004年有38个州的无保险人数增加。

   APHA执行主任Georges Benjamin医学博士告诉Medscape网站，那篇报告发现90年代卫生事业得到了改善，大约以每年1.5％的速度最终增加了17.5％，但最令人不安的是，这种趋势现在也许发生了逆转。从新世纪开始，卫生增长只有微不足道的0.2％，这个结果敲响了警钟。

  Benjamin医学博士评论：“尽管我们国家的健康状况在过去15年中取得了长足进步...，我们发现增长速度的戏剧性下降并不令人鼓舞。”他特别指出，婴儿死亡率从每千人6.9增加到7.0，这个统计数据将美国的婴儿死亡率置于世界第28位，同时还发现有14个州早产率超过13％。与这个具有警示作用的统计数据相关的是：1,260万美国处于生育年龄的妇女没有保险。

   Benjamin医学博士说：“显而易见，国家必须重视这种相关性。引起早产有多种因素，比如：贫穷、怀孕期间缺乏精心照顾、以及感染。但是对治疗这些妇女的临床医生而言，这【早产比例的增加】是医疗保健体系处于危险状态一个明证。”

   Benjamin医学博士号召临床医师参加到有组织的医学活动中，以敦促政策制订者意识到当前存在的问题，以及婴儿死亡率、早产率的增加在未来十年中可能给经济和卫生事业带来的负面作用。

   Benjamin医学博士说：“不用多久就可以知道你选举出的政府官员，也不需要很多时间来参与，但是我们知道医生的参与可以影响政策的走向。”由APHA、联合健康基金会（United Health Foundation)、预防互助协会（Partnership for Prevention）共同作出的报告敲响的另一个警钟是：在1990～2003年期间肥胖人数快速增加了97％。

   联合健康基金会的副会长Reed Tuckson医学博士说：“为了成功地战胜肥胖的流行，我们必须动员我们的社区资源，并制定有效的公共政策。”他还补充说肥胖者大约占美国人口的22.8％，仅过去一年肥胖率就上升了3.2％。

   但是报告也着重指出，去年有几项积极的发展可以促进卫生事业的发展。这包括每人花费在公共健康活动上的支出增加了17％，吸烟率下降了4％，心血管疾病的死亡率下降了2％。在绝大多数州传染性疾病的发病率也有所下降。

    高中毕业率出现微小的增加，从67.3％上升到了68.3％。Benjamin医学博士指出，考虑到教育与对健康问题认识之间的联系，这个发现是“令人鼓舞的”。年度报告权衡了18个与总体健康有关的指标，包括吸烟率、早产死亡、高中毕业率和人均公共卫生消费，从而描绘出各州健康状况的构成图。在各州排名中，路易斯安那州作为最不健康的州已长期居于榜首，紧随其后的是田纳西州和密西西比州。排名居健康榜首的是明尼苏达州、新罕布什尔州和佛蒙特州。

   Benjamin医学博士说各州之间总体健康的巨大差异，与贫困水平和未接受保险患者的数量密切相关，两者共同形成了对公共卫生工作人员和医疗提供者的一个持久挑战。例如，在美国俄勒冈州贫困儿童的数量在过去10年中由12.4％上升到20.1％，而同期在密西西比州则下降了13％。

   APHA第132次年会新闻发布会。

 Infant Mortality, Obesity Increasing in U.S.

 — After years of steady progress toward improved health in the U.S., there are signs of a
downturn that may soon translate into movement in the wrong direction, according to a new report

   released here at the 132nd annual meeting of the American Public Health Association (APHA).
The report, "America's Health State: State Health Rankings," uncovers three key troubling trends: the first rise in infant mortality rates in four decades, the rapidly increasing prevalence of obesity in all age groups, and the number of uninsured individuals, which increased in 38 states between 2003 and 2004.

   Most disturbing perhaps is the big-picture finding that the health improvements of the 1990s,
during which overall health improved at an annual rate of 1.5% for a total gain of 17.5%, is
headed for reversal. Since the start of the millennium, health improvement has been a negligible 0.2%, a finding that should set off alarms, APHA Executive Director Georges Benjamin, MD, told Medscape.

  "Despite the significant improvement in our nation's health over the last 15 years..., the trends we're seeing now — especially this dramatic slowdown in the rate of improvement — are not encouraging," Dr. Benjamin said.

   In particular, he cited the increase in infant mortality from 6.9 to 7.0 births per 1,000, a
statistic that puts the U.S. 28th internationally in infant mortality, as well as the finding
that 14 states have preterm birth rates that exceed 13%. That alarming statistic is likely
associated with the fact that 12.6 million American women of child-bearing age are uninsured.
"Clearly, there is a connection there that cannot be ignored, and this is something we must
address as a nation," Dr. Benjamin said. "Prematurity has many factors, from poverty to
inadequate prenatal care and infections, but for the clinicians who treat these women, this
[increasing prevalence of preterm births] is clear evidence of a healthcare system in crisis," he said.

   Dr. Benjamin urged physicians to get involved in organized medicine activities directed toward increasing policy-makers' awareness of both the current problems and the consequences that high infant mortality and poor preterm birth statistics herald — economically and in health status — for the decade ahead.

   "It really doesn't take long to get to know your elected officials, and it doesn't take a lot of time to get involved — and we know that physician involvement can make a difference" in how policy is shaped, Dr. Benjamin said.

   Another alarming finding of the report, jointly produced by the APHA, United Health Foundation, and Partnership for Prevention, was the meteoric rise in obesity, which increased by 97% between 1990 and 2003.

   "To successfully combat this [obesity] epidemic, we must mobilize our community resources and develop effective public policies," said Reed Tuckson, MD, vice president for United Health
Foundation, adding that an estimated 22.8% of the U.S. population is obese and that the obesity
rate rose 3.2% in the last year alone.

  However, the report highlights several positive developments in the last year that have the
potential to yield overall health improvement. These include the 17% increase in per-capita
spending on public health activities, a 4% decrease in smoking prevalence, and a 2% decrease in
deaths from cardiovascular disease. Incidence of infectious disease also declined in most states.

  There was also a slight upward tick in high school graduation rates, from 67.3% to 68.3%, a
finding that Dr. Benjamin called "somewhat encouraging," given the known association between
education and health issues awareness.

  The great disparities in overall health among the states, which correlates closely with poverty levels and the number of uninsured  patients, combines to present a persistent challenge for public health workers and physician providers, Dr. Benjamin said. In Oregon, for example, the percentage of children in poverty increased from 12.4% to 20.1% during the past decade compared with a 13% decrease in child poverty in Mississippi.

   APHA 132nd Annual Meeting: News conference. Presented Nov. 9, 2004.