U.S. Health in International Perspective: Shorter Lives, Poorer Health

From the summary at the Institute on Medicine

U.S. Health in International Perspective: Shorter Lives, Poorer Health

Released:

January 9, 2013

Type:

Consensus Report

Topics:

Public Health, Aging

Activity:

Understanding Cross-National Health Differences Among High-Income Countries

Boards:

Board on Population Health and Public Health Practice, Division of Behavioral and Social Sciences and Education

The United States is among the wealthiest nations in the world, but it is far from the healthiest. For many years, Americans have been dying at younger ages than people in almost all other high-income countries. This health disadvantage prevails even though the U.S. spends far more per person on health care than any other nation. To gain a better understanding of this problem, the NIH asked the National Research Council and the IOM to investigate potential reasons for the U.S. health disadvantage and to assess its larger implications. 

 

No single factor can fully explain the U.S. health disadvantage. It likely has multiple causes and involves some combination of inadequate health care, unhealthy behaviors, adverse economic and social conditions, and environmental factors, as well as public policies and social values that shape those conditions. Without action to reverse current trends, the health of Americans will probably continue to fall behind that of people in other high-income countries. The tragedy is not that the U.S. is losing a contest with other countries, but that Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary.

Related articles

• Why Is the United States So Sick? (slate.com)

  Excerpt

“The poorer outcomes in the United States are reflected in measures as varied as infant mortality, the rate of teen pregnancy, traffic fatalities, and heart disease. Even those with health insurance, high incomes, college educations, and healthy lifestyles appear to be sicker than their counterparts in other wealthy countries. The U.S. Council on Foreign Relations, a nonpartisan think tank, described the report as “a catalog of horrors.”

Findings that prompted this reaction include the fact that the rate of premature births in the United States is the highest among the comparison countries and more closely resembles those of sub-Saharan Africa. Premature birth is the most frequent cause of infant death in the United States, and the cost to the health care system is estimated to top $26 billion a year.

As distressing as all this is, much less attention has been given to the obvious question: Why is the United States so unwell? The answer, it turns out, is simple and yet deceptively complex: It’s almost everything.

Our health depends on much more than just medical care. Behaviors such as diet, physical activity, and even how fast we drive all have profound effects. So do the environments that expose us to health risks or discourage healthy living, as well as social determinants of health, such as education, income, and poverty.

The United States fares poorly in almost all of these. In addition to many millions of people lacking health insurance, financial barriers to care, and a lack of primary care providers compared with other rich countries, people in the United States consume more calories, are more sedentary, abuse more drugs, and shoot one another more often. The United States also lags behind on many measures of education, has higher child poverty and income inequality, and lower social mobility than most other advanced democracies.

The breadth of these causal factors, and the scope of the U.S. health disadvantage they produce, raises some fundamental questions about U.S. society. As the NRC/IOM report noted, solutions exist for many of these health problems, but there is “limited political support among both the public and policymakers to enact the policies and commit the necessary resources.”

One major impediment is that the United States, which emphasizes self-reliance, individualism, and free markets, is resistant to anything that even appears to hint at socialism. …”

• Charted: Female mortality trends in 21 high-income countries (projectmillennial.org)
• Yes, the Status of Health in the U.S. Is a Disaster. Why Do You Ask? (delong.typepad.com)
• Study: U.S. most expensive healthcare, mediocre outcomes (upi.com)
• U.S. Health Disadvantage is Not Inevitable (inequalitiesblog.wordpress.com)