In the wake of a startling report highlighting the US’s poor health compared with other wealthy nations, its study director searches for answers
July 16, 2013
AMERICANS die younger and experience more injury and illness than people in other rich nations, despite spending almost twice as much per person on healthcare. That was the startling conclusion of a major report released earlier this year by the US National Research Council (NRC) and the Institute of Medicine (IOM).
It received widespread attention. The New York Times concluded: “It is now shockingly clear that poor health is a much broader and deeper problem than past studies have suggested.”
What it revealed was the extent of the US’s large and growing “health disadvantage”, which shows up as higher rates of disease and injury from birth to age 75 for men and women, rich and poor across all races and ethnicities. The comparison countries – Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands and the UK – generally do much better, although the UK isn’t far behind the US.
The poorer outcomes in the US 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 US Council on Foreign Relations, a non-partisan 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 US 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 US, and the cost to the healthcare 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 US 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. Behaviours 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 US 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 US consume more calories, are more sedentary, abuse more drugs and shoot one another more often. The US 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 US health disadvantage they produce, raises some fundamental questions about US 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 US, which emphasises self-reliance, individualism and free markets, is resistant to anything that even appears to hint at socialism. Interestingly, as a group, classically liberal nations like the US and the UK – free market-oriented with less regulation, tax and government services – are the least healthy among wealthy democracies.
By contrast, social democratic countries such as Sweden – in which the state emphasises full employment, income protection, housing, education, health and social insurance – enjoy better overall health, although health inequalities within these nations are not always the smallest.