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This Article Extract Full Text (PDF) All Versions of this Article: AJPH.2004.060350v1 95/8/1306-a    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Muennig, P. Search for Related Content PubMed Articles by Muennig, P.

Peter Muennig, MD, MPH

Correspondence: Requests for reprints should be sent to Peter Muennig, MD, MPH, Mailman School of Public Health, Columbia University, 600 W 168th St, 6th Floor, New York, NY 10032 (e-mail: pm124{at}columbia.edu).

In their evocative thought experiment, Woolf et al. demonstrate that reducing racial disparities might result in greater gains in life expectancy than would investments in medical technology.¹ In calculating reductions in mortality attributable to medical technology, the authors conservatively assumed that medical technology was responsible for 100% of the observed reduction in mortality over the study period. Unfortunately, there is a catch to this assumption that renders it less conservative. Over the 1991–2000 study frame the authors used, increases in the Gini coefficient occurred.² This suggests that socioeconomic disparities for the overall population (not just African Americans) worsened. If disparities are causing declines in health, they will hide a portion of the observed gains in life expectancy owing to medical technology.

For instance, suppose that increasing disparities resulted in a loss of 1 year of life expectancy for the overall US population over the 1991–2000 study frame. The actual improvement in life expectancy was 1.5 years.³ Therefore, if improvements in medical technology were responsible for all gains in life expectancy, the actual gains from medical technology would have been 2.5 years rather than the observed 1.5 years. Nonetheless, the study points to a critical issue that requires further examination by policymakers. Most educational interventions produce dollar returns.⁴ Therefore, shifting societal resources toward improving the educational attainment of African Americans makes sense from a public policy standpoint, regardless of the relative gains in health.

References

1. Woolf SH, Johnson RE, Fryer GE, Rust G, Satcher D. The health impact of resolving racial disparities: an analysis of US mortality data. Am J Public Health.2004;94(12):2078–2081.[Abstract/Free Full Text]

2. US Census Bureau. Historical Income Tables—Income Equality. Available at: http://www.census.gov/hhes/income/histinc/ie1.html. Accessed December 6, 2004.

3. Arias E, Anderson R, Kung H, Murphy S, Kochanek K. Deaths: final data for 2001. Natl Vital Stat Rep.2003;52(3):1–115.[Medline]

4. Muennig P, Fahs M. The cost-effectiveness of public postsecondary education subsidies. Prev Med.2001; 32(2):156–162.[CrossRef][ISI][Medline]

This Article Extract Full Text (PDF) All Versions of this Article: AJPH.2004.060350v1 95/8/1306-a    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Muennig, P. Search for Related Content PubMed Articles by Muennig, P.