Photographs by September Dawn Bottoms. Article from the NYT
Mr. Kristof is an Opinion columnist reporting from Greenwood, Miss. Ms. Bottoms is a photographer from Oklahoma whose work focuses on mental illness, family and poverty.
This is the third in the series “How America Heals” in which Nicholas Kristof is examining the interwoven crises devastating parts of America and exploring paths to recovery.
It’s not just that life expectancy in Mississippi (71.9) now appears to be a hair shorter than in Bangladesh (72.4). Nor that an infant is some 70 percent more likely to die in the United States than in other wealthy countries.
Nor even that for the first time in probably a century, the likelihood that an American child will live to the age of 20 has dropped.
All that is tragic and infuriating, but to me the most heart-rending symbol of America’s failure in health care is the avoidable amputations that result from poorly managed diabetes.
A medical setting cannot hide the violence of a saw cutting through a leg or muffle the grating noise it makes as it hacks through the tibia or disguise the distinctive charred odor of cauterized blood vessels. That noise of a saw on bone is a rebuke to an American health care system that, as Walter Cronkite reportedly observed, is neither healthy, caring nor a system.
Dr. Raymond Girnys, a surgeon who has amputated countless limbs here in the Mississippi Delta, one of the poorest and least healthy parts of America, told me that he has nightmares of “being chased by amputated legs and toes.”
“It starts from the bottom up,” Dr. Girnys said, explaining how patients arrive with diabetic wounds on the foot that refuse to heal in part because of diminished circulation when blood sugar is not meticulously managed in a person with diabetes. Dr. Girnys initially tries to clean and treat the lesions, but they grow deeper, until he has to remove a toe.
When more wounds develop, he takes off the foot in the hope of saving the rest of the leg. New wounds can force him to amputate the leg below the knee and perhaps, finally, above the knee. After that, Dr. Girnys said, the patient is likely to die within five years.
A toe, foot or leg is cut off by a doctor about 150,000 times a year in America, making the United States a world leader of these amputations.
I’ll be blunt: America’s dismal health care outcomes are a disgrace. They shame us. Partly because of diabetes and other preventable conditions, Americans suffer unnecessarily and often die young. It is unconscionable that newborns in India, Rwanda and Venezuela have a longer life expectancy than Native Americans newborns (65) in the United States. And Native American males have a life expectancy of just 61.5 years — shorter than the overall life expectancy in Haiti.
Sources: National Center for Health Statistics, United Nations Note: Life expectancies are for those born in 2020 for the United States and 2021 internationally. Countries with fewer than 20 million people or where data quality was questionable were excluded.
But there are fixes, and three in particular would make a huge difference: expanding access to medical care; more aggressively addressing behaviors like smoking, overeating and drug abuse; and making larger society-wide steps to boost education and reduce child poverty. One reason to believe that we can do better on health care outcomes is that much of the rest of the world already does.
Step 1: get the USDA out of the conflicting role of promoting grain and defining “healthy diets”. The average american does not benefit by carb-loading. I’ve been consuming 20-50g of carbs daily for over a decade, and my bloodwork is textbook.