High prices at the pump complicate health choices

Ben Brewer, MD, a family physician in Forrest, Ill., has noticed that some patients are missing more appointments than usual. Others seem to forgo the office visit altogether, instead waiting until they're sick enough to call a local free ambulance to take them to a hospital.

With record-breaking gas prices and no public transportation in this rural area about two hours south of Chicago, some of his patients have admitted they can't afford the drive to the office. If they do, they say, filling their gas tanks cuts into the money they otherwise would use to cover the co-pays for medical services.

"They've been squeezed by these prices, and it's been more noticeable since it hit four bucks a gallon," he said.

Dr. Brewer and other physicians increasingly are concerned that high prices for gas and other essentials may leave patients unable to access health care.

Data from the National Poll on Children's Health released last year by the University of Michigan C.S. Mott Children's Hospital in Ann Arbor found that 6% of parents postponed a medical visit or the purchase of medication for their kids in response to the cost of fuel.

Early indications also suggest that high gas prices are affecting the ability of some parts of the health system to provide care. The National Assn. for Home Care & Hospice issued a statement in June warning that fuel costs were jeopardizing the capability of nurses and other health care workers to visit patients, particularly in rural areas.

Also in June, the National Assn. of Area Agencies on Aging released the results of a survey reporting that 74% of its member organizations found it more difficult to recruit volunteers, and 53% decreased the number of weekly scheduled visits because of fuel-related expenses.

"Older adults served by these programs live on fixed incomes, have limited mobility and face challenging health conditions that complicate their ability to live independently even in the best of economic times," said Sandy Markwood, CEO of the agencies on aging group.

But although high gas prices clearly have a downside, researchers are examining potential health benefits that could result from the pinch.

Scrutiny of data from the Fatality Analysis Reporting System covering 1985-2006 and presented at the June American Society of Health Economists Second Biennial Meeting in Durham, N.C., found that a 10% increase in gas prices decreased motor vehicle fatalities by 3.2% among drivers ages 18 to 20. That decrease was 6.2% for drivers ages 15 to 17.

"It is remarkable to think that percent change in gas prices can equal lives saved," said Michael Morrisey, PhD, the piece's lead author. He also is the director of the Lister Hill Center for Health Policy at the University of Alabama at Birmingham.

The effect of a 10% price jump appears to be similar, although less pronounced, for adults. Previous studies by Morrisey and his co-author David Grabowski, PhD, associate professor of health care policy at Harvard Medical School in Boston, found the reduction in fatalities for those 21 or older to be 2.3%. The gas price effect also may be more dramatic lately, since costs have escalated nearly 32% in the past year.

"It almost certainly will decrease the amount of driving, and, therefore, it will decrease the number of accidents that occur," said Fred Rivara, MD, MPH, professor of pediatrics at the University of Washington, Seattle, who researches aspects of pedestrian injury.

The possibility that high gas prices could be healthy for us is supported by an analysis of a simulation in the March Journal of Occupational and Environmental Medicine. Researchers found that a 20% increase in gas prices sustained for at least a year would translate to about 1,994 fewer car crash deaths, and 600 fewer fatalities from air pollution per annum.

Fuel costs could trim obesity

Experts suggest that record gas prices also may impact the obesity epidemic, because people seem to be turning to alternative modes of transport requiring human power -- walking, running and cycling.

"We see this in other situations in public health. Increases in the cigarette tax mean the number of people smoking goes down, and deaths due to tobacco go down.

"If you increase prices, a certain percentage will decide to forgo using the product or, in this case, an activity such as travel," said Gary Smith, MD, DrPH, director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio. "It's simple economics." He is the immediate past chair of the American Academy of Pediatrics' Committee on Injury, Violence and Poison Prevention.

But the chance that these benefits will be countered by other transportation trends, such as increases in bicycle or pedestrian mishaps or in motorcycle ridership, cannot be dismissed. The economics of other healthy lifestyle choices must be considered.

"On the downside, higher gasoline prices certainly could have a very negative effect on health, because people may have less money for healthy food or medicines," said Eliot Nelson, MD, professor of pediatrics at the University of Vermont College of Medicine in Burlington.

"I would have to be very cautious about guessing whether this was overall a plus or a minus for public health," he said.