Institute for Health and Aging

The elderly population in America is growing in size owing to declining death rates, increasing life expectancy, and the aging of the baby boomers. Although the prevalence of chronic illness and disability increases with age, successful aging in the elderly population is widespread, and the elderly are generally healthy. Indeed, the prevalence of disability among the elderly is declining, and expenditures for their care are increasingly concentrated at the end of life rather than during extra years of relatively healthy life. Nevertheless, health care costs will undoubtedly increase during the next 30 years as a result of the baby boomers entering late life. The economic and social impact of future growing health care expenditures for the elderly will be significant. Important policy issues will include the continued viability of the Medicare and Social Security programs, future needs for long-term care, improvement of the health status of the elderly, technological advances, the need for a geriatric work force, and development of viable strategies to pay for escalating medical care costs.

Alcohol abuse is known to cause illness, disability, and premature death. It is also a contributing factor in many instances to criminal activity, motor vehicle crashes, and other injuries. Substantial costs resulting from alcohol abuse are incurred in the United States and in California, including the cost of providing medical care for people with alcohol-related illness, treatment and prevention costs, costs to the law enforcement system, costs resulting from alcohol-related motor vehicle crashes and other injuries, and the indirect costs associated with disability, diminished capacity, and premature death from alcohol-related causes.

The purpose of this briefing paper is to review the research that has been done in this area, and to present preliminary estimates of the costs of alcohol abuse in California and its impact on the state. These estimates are based on research that has been conducted by experts at the national level over the years coupled with some specific analyses conducted for California. We also suggest how one could conduct a thorough study to develop more detailed and refined estimates for the state.

THE COST OF ALCOHOL ABUSE IN CALIFORNIA: HIGHLIGHTS

1) The cost of alcohol abuse in California in 2001 totaled $17.8 billion for health service, substance abuse treatment/prevention, lost productivity from premature deaths, and justice system costs (See Appendix Table 11).

2) Nearly 84,000 hospital discharges resulted from alcohol abuse, including 11,388 discharges with alcohol dependence syndrome, 9,314 with alcoholic psychoses, and 8,115 with cirrhosis of the liver. Almost 16,000 Californians were hospitalized for injuries that resulted from alcohol use (Table 3 and page 3).

3) Hospitalization costs amounted to $1.3 billion (Table 6). The mean length of hospitalization in non-federal hospitals was 6.5 days and the mean cost per hospitalization was over $12,000 (Table 5 and page 3).

4) Public programs paid for 64% of hospitalization costs, including 38% paid by Medicare, and 19% paid by MediCal (Table 5 and page 4).

5) Costs of other medical services, including outpatient care, nursing homes, pharmaceuticals, and other health professionals, totaled $1.11 billion (Table 6 and page 4).

6) Health insurance administration costs in California attributed to alcohol abuse amounted to $122 million for 2001 (Table 6 and page 5).

7) More than 13,000 Californians died as a result of alcohol abuse, including 3,600 who died of primary alcohol-caused diagnoses, over 5,100 who died of an alcohol –related diagnosis, and 4,400 who died of an injury attributed to alcohol. These deaths represented lost productivity of nearly $8 billion and over 358,000 life years (Tables 7,8 and page 6).

8) Criminal justice system costs attributed to alcohol were as high as $6.7 billion including $2.1 billion for police protection, $2.1 billion for judicial and legal services, and $2.4 billion for corrections (Table 9 and page 6).

9) In California’s justice system, 25% of total police arrests are for alcohol-specific offenses; approximately 43% of total arrests have been observed to be alcohol-involved (Table 10 and page 6). An estimated 36 percent of state prison and jail inmates were under the influence of alcohol at the time of their convicted offense (Table 9 and page 7).

10) The alcoholic beverage industry paid excise taxes, license fees, and fines totaling $350 million in 2001. In addition to $41 million in license fees and fines, this included $130 million excise taxes on beer sales, $19 million on wine sales, and $138 million on the sale of spirits (Page 8).

11)Seen as an additional cost for the price of a drink, health care and justice system costs add 18 cents not paid by the drinker. Offsetting beverage industry payments (through excise taxes, license fees, and fines) are less than one cent (Page 13).

Objective: Empirically examine medicine and public health partnership factors that are associated with partnership success.

Methods: 329 medicine and public health partnership informants were interviewed to assess factors associated with success in achieving partnership goals.

Results: Partnership formation; partner recruitment; barriers to collaboration; and leadership/governance variables were not predictive of partnership success. Partnership duration was significant in predicting success in achieving outcomes.

Conclusions: Factors identified in the literature are not as salient as believed in insuring the success of medicine and public health partnerships. The longer a partnership can remain intact (i.e., minimally longer than one year), irrespective of the particularities of the formation and structure of the partnership, the greater the probability that the partnership will achieve its desired outcomes.

Over two hundred years of anecdotal, epidemiological, and experimental evidence indicate that poverty breeds disease. This holds true for type 2 diabetes, which both in the United States and other developed nations disproportionately occurs, cripples, and kills among the poor. In this article we examine rhetorical strategies used in 30 journal articles indexed under type 2 diabetes and poverty. As we show, poverty is rarely highlighted in this literature as a causal factor. Instead, explanations for diabetes among poor people overwhelmingly emphasize features of patients—their biology, behaviors, psychology, culture, or other “risk factors”—while ignoring, reframing or neglecting the links between poverty and disease. By so doing, these discursive strategies naturalize higher rates of diabetes among poor persons, legitimize relations of domination in the larger society, and encourage only research projects, treatment practices and health and social policies that do not challenge existing social relations. We discuss the implications of these discursive practices for medical research and care, and for social and public health policies.