Are you tired of international health care comparisons? I sure am. I’ve traveled the world, working on most continents and in more countries than I care to count.
Cleaning out files yesterday, I happened upon an Environmental Health Perspectives report saying the health benefits of cycling in an urban environment outweigh the risks. Huh?
Where I live, far too many cyclists are a menace, to themselves and to others. They ride on sidewalks and the wrong side of roads. They weave between traffic lanes. heir ears are plugged up with iPods and they don’t brake for red lights. In fact, some bikes don’t have brakes.
I’ve been nearly hit twice by cyclists running red lights and was run down on a walking path. I was lucky. Two pedestrians in my neighborhood have been killed by cyclists.
Read the details and you’ll see deep in the article and you’ll see that this was data from another country. Only in the fine print does it become clear that the report involved cycling in – wait for it – the Netherlands. The Netherlands is a country I’ve worked in. Cycling practices there are quite different from those here in the US.
Therein is a problem that stalks far too many health policy debates. Yes, we can compare our system with some other for costs and outcomes, but we’d better account for key cultural differences. Let’s get back to the bikes. In Amsterdam, cyclists have:
- Sturdy, upright bikes with brakes, lights and reflectors,
- Specially dedicated lanes that are wide, well paved and separate from pedestrians or cars,
- Separate, highly visible traffic signals,
- Signal systems to show who has priority — bikes or cars — for roads, roundabouts, tunnels and bridges, and
- Whole neighborhoods restricted to bikes.
This might seem a silly cycling story, but it’s not. Far too many stories like this one catalyze ill-informed international comparisons and risk good health policy here. Comparisons must take into account the bigger picture or they will be very feeble comparisons indeed. To get better at this, I’ll invite you to:
- Stop taking international numbers at face value and comparisons for granted. Require authors to prove that the comparisons are directly relevant to the US.
- Dig deeper into the relevant differences between the US and other countries when comparisons are made. For example, young children in Italy will probably not get routine annual flu shots. Pediatricians don’t think they need them. Why? Here’s why: In Italy, from the time a child is six months old and attending day care, they receive twice-daily nasal washes. By the time a child is four years old, they can do their own. Honest. I’d hazard a guess that the majority of adult Americans would not know how to do a nasal wash on themselves and trying to do one on a six month old would make for a great Saturday Night Live sketch.
- Refer to this anecdote when other comparisons appear (and they will). It’s not just about biking. It’s about biking in a community that is structured to make the biking safe for cyclists and pedestrians. It’s also about being a responsible cyclist and following a few basic rules. It’s not just about the necessity of flu shots, but about other, associated practices that prevent illness.