Americans are in poorer health and die younger than people in other high-income countries, according to a report from the National Research Council and Institute of Medicine. Perhaps the most unsettling thing to come out of the report is that this is true for all Americans — including those with health insurance, high incomes, college educations, and a healthy lifestyle — and despite the fact that the U.S. spends more per capita on health care than any other nation.
“Americans are dying and suffering at rates that we know are unnecessary because people in other high-income countries are living longer lives and enjoying better health. What concerns our panel is why, for decades, we have been slipping behind,” said Steven H. Woolf, professor of family medicine at Virginia Commonwealth University in Richmond and chair of the panel that wrote the report.
Where the U.S. is Failing
The report compared the United States with 16 affluent democracies, including Australia, Canada, Japan, and many western European countries. The U.S. ranks 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
The Generation Gap
Sadly, children and teenagers are disproportionately affected. The U.S. has the highest infant mortality rate of any high-income country, and it also ranks poorly on premature birth and the proportion of children who live to age five.
- American teens fare worse due to:
- higher rates of death from traffic accidents and homicide
- highest rates of teenage pregnancy
- higher likelihood of acquiring sexually transmitted infections
Almost two-thirds of the difference in life expectancy between males in the U.S. and these other countries is due to death before age 50.
The growing mortality rate for Americans under age 50 has resulted in a serious generation gap. “I don’t think most parents know that, on average, infants, children, and adolescents in the U.S. die younger and have greater rates of illness and injury than youth in other countries,” Woolf said.
Where the U.S. is Succeeding
There are few areas where the U.S. does well, including:
- people in the U.S. over age 75 live longer
- lower death rates from stroke and cancer
- better control of blood pressure and cholesterol levels
- lower rates of smoking
The Question of Why
The panel concluded that there are many factors involved in our health disparity, including:
- higher caloric intake
- higher rates of drug abuse
- higher rate of accidents involving alcohol
- lower likelihood of using seat belts
- higher likelihood of using guns in an act of violence
Although behavior plays an important role, the panel is unable to explain why Americans who don’t smoke and are not overweight also have higher rates of disease than those groups in peer countries.
- large population of uninsured
- limited access to primary care
- unaffordable or inaccessible health care
- lapses in quality and safety of care outside of hospitals
The Physical Environment
- communities designed around cars, discouraging walking and possibly contributing to obesity
Society and the Economy
- relatively high rates of poverty (especially child poverty) and income inequality
- low rate of social mobility
- lagging behind other countries in education of young people
- inadequate safety net programs
The panel suggests that the U.S. may be able to learn from other countries.
“Something fundamental is going wrong,” said Woolf. “This is not the product of a particular administration or political party. Something at the core is causing the U.S. to slip behind these other high-income countries. And it’s getting worse.”
The study was sponsored by the National Institutes of Health and U.S. Department of Health and Human Services. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. They are private, independent nonprofit institutions that provide science, technology, and health policy advice under a congressional charter. The Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering. Read the Report Brief
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