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Summer 2013 Vol. 13 Number 1

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America's Health Disadvantage


Beginning at birth, Americans fall short when it comes to health. They die sooner, suffer from more disease and illness, and experience more injuries throughout life than people in other rich, industrialized nations. This is all despite the fact that the United States spends more per capita on health care than any other country in the world.

A joint panel of the National Research Council and Institute of Medicine investigated the health and health-related behaviors of people in the U.S. along with those in 16 comparable nations, including Canada, Japan, Australia, and much of Western Europe. They found that the U.S. lands at or near the bottom in nine key areas of health: infant mortality and low birth weight; injuries and homicides; teenage pregnancies and sexually transmitted infections; prevalence of HIV and AIDS; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability. What's more, the U.S. was found to have the second lowest female life expectancy among the countries in the study; for men, the U.S. ranked last.

Many of the conditions that ail Americans disproportionately affect infants, children, and adolescents, according to the panel's report. Infant mortality rates are higher in the U.S. than in any other high-income country, and have been for decades. Children in the U.S. are also more likely to die before the age of 5. Among teenagers, pregnancies, sexually transmitted infections, and deaths due to traffic accidents and homicide all occur at higher rates. Deaths before age 50 play a significant role in the overall life expectancy for both men and women.

But there are areas in which the U.S. outperforms many other nations. The study found that elderly adults in the U.S. who live to age 75 actually have longer life expectancies than their international peers. The U.S. also tops the rankings with lower rates of smoking, better control of blood pressure and cholesterol levels, and higher rates of recovery from stroke and cancer.

The broad spectrum of health outcomes makes it hard to pinpoint the root of the problem. Even a flawed health care system can't be held accountable for traffic accidents or homicides, and the considerable percentage of Americans who don't have health insurance can't explain the prevalence of drug use or sexually transmitted infections. Nor can the health disadvantage be blamed solely on the health of the poor or minority groups. The report notes that even when the numbers are adjusted to reflect only those who are insured, well-educated, and practice healthy behaviors, Americans still fall behind.

The panel dug deeper and explored whether America's poor health outcomes could be traced to social or economic factors. Although Americans have higher average incomes, the U.S. has higher levels of poverty and income inequality and lower rates of social mobility. Other countries have surpassed the U.S. in the education of young people. U.S. communities are built in ways that encourage automobile transportation or discourage physical activity. Many of these factors -- especially when present in childhood -- can shape health trajectories over the entire life course.

It's safe to say that there is no single cause of America's health disadvantage. Individual behaviors, deficiencies in the health care system, adverse social and economic conditions, physical environments, and the public policies that influence all of these factors combine in ways that contribute to overall worse health.

Similarly, individual, social, and political factors may combine in ways that contribute to good health in other nations. The report suggests taking a closer look at the policies and practices that lead to better health outcomes in other countries and how they could inform solutions for the U.S. -- Lauren Rugani

U.S. Health in International Perspective: Shorter Lives, Poorer Health. Panel on Understanding Cross-National Health Differences Among High-Income Countries; Committee on Population, Division of Behavioral and Social Sciences and Education; Board on Population Health and Public Health Practice, Institute of Medicine (2013, 420 pp.; ISBN 978-0-309-26414-6; available from National Academies Press, tel. 1-800-624-6242; $72.00 plus $5.00 shipping for single copies).

The panel was chaired by Steven H. Woolf, professor of family medicine at Virginia Commonwealth University in Richmond. The study was funded by the National Institutes of Health and the U.S. Department of Health and Human Services.

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Copyright 2013 by the National Academy of Sciences