From Our 2013 Archives
Americans Sicker Compared to Other Wealthy Nations
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By Denise Mann
Reviewed by Laura J. Martin, MD
Jan. 9, 2013 -- Americans die younger and have higher rates of many types of diseases and injuries than people in other high-income countries, a new report shows.
"The health of Americans is far worse than the health of people in other countries despite the fact that we spend more money on health care," says report author Steven H. Woolf, MD, MPH, during a news conference. He is a professor of family medicine at Virginia Commonwealth University in Richmond. "This has been going on since 1980 and getting progressively worse. I am struck by the gravity of our findings."
This health disadvantage exists at all ages from birth to age 75 and in all socioeconomic groups. "Even those who are insured and college educated and have high incomes seem to be in worse health than people in other nations," he says.
The report, put out by the National Research Council and Institute of Medicine, looked at multiple diseases, injuries, and behaviors across the entire life-span among 17 nations, including the U.S., Australia, Canada, Japan, and Western European countries.
Overall, American men live four years less than men in certain other high-income countries, and women live five years less than women in certain other countries, the report shows.
According to the report, the U.S. is at or near the bottom in nine key health areas, including:
Specifically, children born in the U.S. are less likely to reach their fifth birthday than kids from certain other countries. The U.S. also has the highest infant death rate of any high-income country.
What's more, U.S. teens have higher rates of death from traffic accidents and murders, the highest rates of teenage pregnancy, and are more likely to catch sexually transmitted infections. "I was stunned by how pervasive the disadvantage was across so many different topic areas," Woolf says.
The playing field changes after age 75, the report shows. If an American lives to 75, they have a higher life expectancy than people in the other high-income countries.
Do Americans Take Worse Care of Themselves?
So why are we faring so poorly up until 75? There are many possibilities, Woolf says.
Americans are more likely to take part in certain unhealthy behaviors, such as eating high-fat, high-caloric diets and not wearing seatbelts.
When looking for causes and solutions, we have to think outside of the box, says panel member Ana V. Diez-Roux, MD, PhD, MPH. She is a professor and chair of epidemiology, and director of the Center for Social Epidemiology and Population Health, at the University of Michigan in Ann Arbor.
"One example is the high dependence that many of us have on automobiles ... which may affect our level of physical activity," she says. "There are a range of factors that people may not think of as health-related at first thought."
Another example: Easy access to guns may result in high gun violence and murder rates, she says.
It's not hopeless, Woolf says. "There is action that can be taken at the individual, family, community, and national levels that can address the various conditions." For example, there are recommendations about the importance of healthy food choices and weight management that can help prevent obesity and diabetes.
Prevention Should Trump Treatment
Many people think of America as the place to be or go for cutting-edge medical care and treatments such as robotic surgery. But there is more to health care than technology, says Jacqueline Moline, MD. She is the vice president of population health at the North Shore-Long Island Jewish Health System in Great Neck, N.Y. Moline reviewed the new report for WebMD.
"These numbers are stark and should serve as a wake-up call," she says. "Some of these things that we are dying from were self-inflicted, including obesity, alcohol use, and seatbelt use."
The solution lies in shifting our emphasis toward preventing illnesses and injury -- not treating it once it happens.
Access to health care is also restricted in the U.S. "Other countries have greater access to health care and services," Moline says.
Alison Norris, MD, PhD, is an assistant professor in epidemiology at Ohio State University's College of Public Health in Columbus. She also reviewed the report for WebMD.
"This report shows where the differences and disparities exist and who bears the greatest burden, but they don't tell us why these differences exist," she says.
SOURCES: National Research Council and Institute of Medicine report: "U.S. Health in International Perspective: Shorter Lives, Poorer Health." Jacqueline Moline, MD, vice president, population health, North Shore/Long Island Jewish Health System, Great Neck, N.Y. Steven H. Woolf, MD, MPH, professor, family medicine, Virginia Commonwealth University, Richmond, Va. Ana V. Diez-Roux, MD, PhD, MPH, professor and chair, epidemiology; director, Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor. Alison Norris, MD, PhD, assistant professor, epidemiology, Ohio State University's College of Public Health, Columbus.