医療アクセスの悪化がタバコより大きながん死亡の原因に/米国医療事情 無保険

がん学会が無保険問題のキャンペーン/米国医療事情
 英国同様に、医療アクセスの悪化がガン死亡率の改善の劣化を招いている。
 米国がん学会が従来の方法と決別し、禁煙や直腸がん検診ではなく、健康保険の重要性についてのキャンペーンを 1500万$の費用をかけて行う。がんの死亡率が期待したほど低下せず、健康保険がないことががんの発見を遅らせているという最近の研究により業を煮やしたグループが提案した。すでに民主共和両党の大統領候補に相当関心を持たれている政治的な問題を強調する意味を込めている。
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 しかし、米国心臓協会、糖尿病協会、アルツハイマー協会のような組織のリーダーは、国が医療保健システムを整えるまでは慢性疾患に対する進歩が止まってしまうだろうというキャンペーンメッセージを称讃すると言ってきた。
 かつてのように心臓病協会はもっと強力に運動と健康食を推進するための宣伝費用を使っている。一番最近のがん学会のキャンペーンは大腸がん検診の勧めだった。
 しかし結局、検診と治療が受けられなければ、予防と研究の進歩にはあまり意味がなくなってしまうという結論に達した。医療システムを整備しなければ、アクセスの不足がタバコより大きながん死亡の原因になる。究極のがん制圧が医学的科学的問題と同じく公衆衛生行政(公序良俗?)問題である。60秒のTVコマーシャルはまさにこの点がみそになっている。うつろで心配そうな無保険のがん患者のイメージに、「こうした医療危機こそが米国がん学会の直面する問題であり、医学を進歩させても、人々の命が救われるような医療アクセスが得られなければ十分ではありません」。別のコマーシャルは、若い母親が自分の保険ではがん治療ができないために家族が借金を背負ってしまう設定で、「自分の治療と家族のケアはどちらか選択するもの?」
 米国では、健康保険に入っていない人が、4700万人、15.8% になる。2003年、がん患者10人に1人は無保険だった
 1990年から2015年までに、がん死亡率を50%、発生率を25%低下させるという学会で掲げた目標の達成は、現在の傾向でみると良くても半分しか達成できないだろう。このことがキャンペーン始動のきっかけである。
 がん死亡率は低下はしているが、早期発見されていればもっと低下しただろう。最新の研究で、早期に発見できるかどうかがしばしば健康保険の有無と関連すると確認された。今年発表された論文で無保険の乳ガン患者が既に進行した状態で診断される確率は有保険者の2倍である。同様な結果は喉頭や口腔のがんでも確認されている。われわれが対策を立てなければ、ガンについて起きているこの事実から、否応なく、これが世界中で主要な死因となってくることだろう。
(書きかけ)

英国のガン5年生存率/英国医療事情
http://kurie.at.webry.info/200708/article_34.html
米上院で児童健康保険制度改正案(SCHIP)成立
http://kurie.at.webry.info/200708/article_6.html
児童健康保険制度充実案可決/米上院予算委員会
http://kurie.at.webry.info/200707/article_44.html

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Cancer Society Focuses Its Ads on the Uninsured
By KEVIN SACK
Published: August 31, 2007
http://www.nytimes.com/2007/08/31/us/31cancer.html?pagewanted=2&_r=1&ref=health

A scene in a commercial on Americans and health insurance.
American Cancer Society

ATLANTA, Aug. 30 ― In a stark departure from past practice, the American Cancer Society plans to devote its entire $15 million advertising budget this year not to smoking cessation or colorectal screening but to the consequences of inadequate health coverage.

The campaign was born of the group’s frustration that cancer rates are not dropping as rapidly as hoped, and of recent research linking a lack of insurance to delays in detecting malignancies.

Though the advertisements are nonpartisan and pointedly avoid specific prescriptions, they are intended to intensify the political focus on an issue that is already receiving considerable attention from presidential candidates in both parties.

The society’s advertisements are unique, say experts in both philanthropy and advertising, in that disease-fighting charities traditionally limit their public appeals to narrower aspects of prevention or education.

But the leaders of several such organizations, including the American Heart Association, the American Diabetes Association and the Alzheimers Association, said they applauded the campaign’s message that progress against chronic disease would be halting until the country fixed its health care system.

As in the past, the heart association is using its advertising dollars these days to promote more rigorous exercise and healthier diets. The most recent cancer society campaign encouraged screening for colon cancer, including a memorable commercial in which a diner plucked ― and then ate ― a lima bean polyp from the intestinal tract he had carved in his mashed potatoes.

But John R. Seffrin, the chief executive of the cancer society, which is based here, said his organization had concluded that advances in prevention and research would have little lasting impact if Americans could not afford cancer screening and treatment.

“I believe, if we don’t fix the health care system, that lack of access will be a bigger cancer killer than tobacco,” Mr. Seffrin said in an interview. “The ultimate control of cancer is as much a public policy issue as it is a medical and scientific issue.”

The two 60-second television commercials that form the spine of the campaign make that point.

One features images of uninsured cancer patients, appearing hollow and fearful. “This is what a health care crisis looks like to the American Cancer Society,” the narrator begins. “We’re making progress, but it’s not enough if people don’t have access to the care that could save their lives.”

The other commercial depicts a young mother whose family has gone into debt because her insurance did not fully cover her cancer treatment. “Is the choice between caring for yourself and caring for your family really a choice?” the narrator asks.

Census figures released this week show that the number and percentage of people in the United States without health insurance rose last year, to 47 million and 15.8 percent. A 2003 study estimated that one of every 10 cancer patients was uninsured.

Other surveys have found that one of every four families afflicted by cancer, which is projected to kill 560,000 Americans this year, is effectively impoverished by the fight, including one of every five with insurance.

The cancer society plans to buy time on network and cable channels from Sept. 17 to Thanksgiving, said Greg Donaldson, the group’s vice president for corporate communications. There will also be advertisements in magazines and on Web sites.

With nearly $1 billion in revenues, the cancer society is the wealthiest of its peers and has spent about $15 million annually on advertising since 1999. By comparison, Geico, the automobile insurer with the “Caveman” advertisements, spent about $14 million on network advertising in the first quarter of 2007, according to TNS Media Intelligence, a tracking firm.

Advertising about the health insurance crisis is not uncommon among more broadly based medical organizations and other interest groups.

Last week, the American Medical Association kicked off a three-year campaign called “Voice for the Uninsured” that will begin with $5 million in advertising in early primary states. AARP, in conjunction with the Business Roundtable and the Service Employees International Union, recently began a similar effort called “Divided We Fail.”

This year, the cancer society formed a collaborative with the heart, diabetes and Alzheimers associations, as well as AARP, to promote awareness of the health access problem. The group adopted as common principles that all Americans deserve quality, affordable health care with transparent costs.

But the cancer society is the only disease-focused group ever to have dedicated advertising resources to the topic, said officials with other charities and with trade groups.“I’ve never seen anything like it before,” said Bill Novelli, chief executive of AARP and, in a previous career, a co-founder of the Porter Novelli public relations firm. “It’s taking a different tack for them.”

That a charity like the cancer society felt compelled to join the access debate reflects both the urgency and the resonance of the issue. Nonetheless, Mr. Donaldson said it was “risky business” for the tax-exempt group.

It steered away, he said, from promoting solutions that could be viewed as partisan, like mandatory insurance or single-payer government coverage. Rather, he said, the commercials are intended to urge action by the next administration, and to drive viewers to a Web site linked to the group’s advocacy and lobbying arm.

“We very much see a moral imperative to raising the discussion,” Mr. Donaldson said, “but we understand there’s a need to be appropriate.”

Cancer society executives said they had heard little dissent from volunteers and donors, and several regional officials said they supported the new approach.

But others called the campaign misguided. Valerie C. Robinson, a longtime board member of the Jacksonville, Fla., chapter, said expanded access to insurance coverage was “not our fight.”

“To me, it’s throwing away money that we could have put into providing free mammograms or free PSA tests or free colonoscopies,” she said.

Mr. Seffrin initiated the advertising campaign after being pushed by the society’s board to make faster progress toward its goals of reducing cancer death rates by 50 percent and incidence rates by 25 percent from 1990 to 2015. If trends continue, the actual reductions are projected to fall well short, perhaps by as much as half.

While the decline in death rates is accelerating, studies have shown that if cancer was diagnosed more in its early stages, the rates would fall faster. And new research is confirming that insurance status often determines whether a person’s cancer is diagnosed early or late.

One study published this year found that uninsured breast cancer patients were more than twice as likely to have their cancer diagnosed in late stages as those with private insurance. Other studies have found similar results with cancers of the larynx and mouth.

“The truth is we know what’s going to happen with cancer if we don’t intervene,” Mr. Seffrin said. “It will become the leading cause of death in the world, needlessly.”

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