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'U.S. health disadvantage' strikes all Americans, major study finds

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REUTERS/Mike Blake
Even Americans with healthy behaviors or those who are white, insured, college-educated, or in upper-income groups appear to be in worse health than similar groups in comparison countries.

Americans — including those who are “highly advantaged” — die at earlier ages and have more illnesses than their counterparts in other developed countries, according to a report published earlier this week by a panel of experts brought together by the Institute of Medicine and National Research Council.

The 378-page report, which was 18 months in the making, found that the U.S. ranked at or near the bottom for almost every health indicator when compared to 16 other wealthy countries, a finding that the panelists said surprised them.

As the report also notes, the U.S. spends more money per capita on health than any other nation.

Here is the panel’s summary of its overall findings:

  • For many years, Americans have had a shorter life expectancy than people in almost all of the peer countries. For example, as of 2007, U.S. males lived 3.7 fewer years than Swiss males and U.S. females lived 5.2 fewer years than Japanese females.
  • For the past three decades, this difference in life expectancy has been growing, especially among women.
  • The health disadvantage is pervasive — it affects all age groups up to age 75 and is observed for multiple diseases, biological and behavioral risk factors, and injuries.

And here are the panel’s more specific findings, by topic:

  1. Adverse birth outcomes: For decades, the United States has experienced the highest infant mortality rate of high-income countries and also ranks poorly on other birth outcomes, such as low birth weight. American children are less likely to live to age 5 than children in other high-income countries.
  2. Injuries and homicides: Deaths from motor vehicle crashes, non- transportation-related injuries, and violence occur at much higher rates in the United States than in other countries and are a leading cause of death in children, adolescents, and young adults. Since the 1950s, U.S. adolescents and young adults have died at higher rates from traffic accidents and homicide than their counterparts in other countries.
  3. Adolescent pregnancy and sexually transmitted infections: Since the 1990s, among high-income countries, U.S. adolescents have had the highest rate of pregnancies and are more likely to acquire sexually transmitted infections.
  4. HIV and AIDS: The United States has the second highest prevalence of HIV infection among the 17 peer countries and the highest incidence of AIDS.
  5. Drug-related mortality: Americans lose more years of life to alcohol and other drugs than people in peer countries, even when deaths from drunk driving are excluded.
  6. Obesity and diabetes: For decades, the United States has had the highest obesity rate among high-income countries. High prevalence rates for obesity are seen in U.S. children and in every age group thereafter. From age 20 onward, U.S. adults have among the highest prevalence rates of diabetes (and high plasma glucose levels) among peer countries.
  7. Heart disease: The U.S. death rate from ischemic heart disease is the second highest among the 17 peer countries. Americans reach age 50 with a less favorable cardiovascular risk profile than their peers in Europe, and adults over age 50 are more likely to develop and die from cardiovascular disease than are older adults in other high-income countries.
  8. Chronic lung disease: Lung disease is more prevalent and associated with higher mortality in the United States than in the United Kingdom and other European countries.
  9. Disability: Older U.S. adults report a higher prevalence of arthritis and activity limitations than their counterparts in the United Kingdom, other European countries, and Japan.

All groups disadvantaged

As the report’s authors point out, almost all demographic groups in the U.S. experience poorer health than their peers in other countries. The “U.S. health disadvantage is more pronounced among socioeconomically disadvantaged groups, but even advantaged Americans appear to fare worse than their counterparts in England and some other countries,” the report states. “That is, Americans with healthy behaviors or those who are white, insured, college-educated, or in upper-income groups appear to be in worse health than similar groups in comparison countries.”

The only exception appears to be people past the age of 75. Only when Americans live to that age does their life expectancy exceed that of their peers in other developed countries.

A variety of causes

What are the causes of the “U.S. health disadvantage”? The report cites many.

To begin with, there is our fragmented health care system and our high number of uninsured individuals and families. We also have higher poverty rates and greater income inequality than other developed countries.

Individual behavior also plays a role. Americans do smoke and drink less than the residents of some of the other developed countries, but we consume more calories per capita, abuse more prescription and illicit drugs, and own more firearms. We’re also less likely to wear seat belts — and more likely to have alcohol-related traffic accidents. In addition, our young people become sexually active an earlier age and are less likely to practice safe sex.

Needed: research and action

“No single factor fully explains the U.S. health disadvantage,” the authors of the report note. For that reason, they call for a comprehensive approach to further research — including studying the strategies and policies that are working in other developed countries.

But, we shouldn’t simply wait for more data before addressing our health disadvantage, they stress, because “evidence is already available to begin tackling this important problem and the lead conditions responsible for it.”

You can download and read the report in full from the National Academies of Science website. The site also offers several interactive charts that will help you see at a glance how the U.S. compares with the other 16 developed countries on some of the major health indicators.

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Comments (1)

Wow

We are really screwed up. That being said, what does "addressing our health disadvantage" mean? If it means spending taxpayer money (because clearly individual money isn't enough--even the rich are sicker), it probably won't happen any time soon. America and Americans are too busy being concerned with what is "mine" and what is "not yours." We're "laser focused" on the economy and gun control, it seems, and ignoring that there must be other factors that come into play in all facets of American life, that are likely shared. Why do people become sexually active earlier and get pregnant as teens more often? Other countries are much more open about sexuality than the US, and having sex and getting pregnant aren't things that you can't prevent from the standpoint of those that are affected. Why do we eat more calories, leading to obesity, heart disease, and diabetes? It's not like the entire country has so much excess income that we can simply afford more food (the article notes higher rates of poverty, in fact). Why are there more accidents, more often fatal, than in other countries? Why are our violence rates higher (let's stop blaming it on guns and start treating our population like adults rather than children who shouldn't touch dangerous things)? Why do we die more of alcohol-related injuries when we actually drink LESS, and similarly why are we sicker and die more frequently of pulmonary disease if we smoke LESS?

On a different note, and probably disturbing one, but still important: What would be the consequences of a population that lives longer? The greatest medical expenses occur at the end of life where interventions are likely to have little impact (or negative impact) on quality of life. While we're having a conversation on how to extend our lives, we also need to have an adult conversation on quality of life and end-of-life decisions/care.