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Who needs health care—the well or the sick?
Apr 25, 2005, 19:54, Reviewed by: Dr.
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In a study of people living in Bihar (the poorest state in India) and the United States, rates of self reported illness were disturbingly low in Bihar and enormously high in the United States. It seems that the more people are exposed to contemporary health care, the sicker they feel, writes the author.
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By BMJ,
Shifting drug spending from the worried well in rich countries to those with treatable disease in poorer nations will benefit the health of everyone, argues a doctor in this week's BMJ.
Seventy per cent of the UK population is taking medicines to treat or prevent ill health or to enhance wellbeing. How can this level of medicine taking be appropriate in a population which, by all objective measures, is healthier than ever before? asks Dr Iona Heath.
In a study of people living in Bihar (the poorest state in India) and the United States, rates of self reported illness were disturbingly low in Bihar and enormously high in the United States. It seems that the more people are exposed to contemporary health care, the sicker they feel, writes the author.
And as the overall health of a population increases, more money can be made from selling healthcare interventions for the healthy majority than for the sick minority, she adds. For instance, weigh the huge amount invested in the vast bureaucracy of health promotion in the UK against the waiting times for interventions of proved effectiveness and the neglect of care of frail elderly people.
Are we sure that the balance sheet of preventive activity really offers more good than harm?
A tax on preventive drugs sold in rich countries could be used to fund drugs in poor countries, she suggests. This would benefit people in both rich and poor countries. 
- Iona Heath, General Practitioner, London, UK
d full text at http://bmj.com/cgi/content/full/330/7497/954
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