From Our 2006 Archives

Americans Less Healthy Than the British

By E.J. Mundell
HealthDay Reporter

TUESDAY, May 2 (HealthDay News) -- Americans may have won the Revolutionary War, but 230 years later they're losing the battle for good health to the British.

An extensive new study comparing the health of middle-aged, white residents of both countries finds that "we get sicker, sooner," according to American co-researcher James Smith, a senior economist at Rand Corp.

The gap between the two countries is significant, despite the fact that people in the United States have a standard of living that is 25 percent higher than their counterparts across the Atlantic, and that they spend more than double on health care than the British -- $5,274 per capita vs. $2,164, respectively.

The health gap between the two nations "persists even after you take out things such as the large role of African-Americans with very poor health in the United States, or that people may be reporting health differences differently in the two countries," Smith said. "We also looked at biological markers of disease -- you take away the fact that there may be risk-factor differences in obesity, smoking and drinking."

Even with those factors taken into account, "you are basically back where you started," Smith said. "You find enormous differences in health between the two countries among non-Hispanic whites."

How big a difference? Using well-respected national survey data on the health and lifestyles of more than 6,400 Americans and 9,300 English people aged 40 to 70, the researchers found that U.S. citizens aged 55 to 64 are twice as likely as their peers in England to be diabetic (12.5 percent of Americans surveyed vs. 6.1 percent of British); 10 percentage points more likely to have high blood pressure (42.4 percent vs. 33.8 percent); 6 percentage points more likely to suffer from heart disease (15.1 percent vs. 9.6 percent); and at nearly double the risk for cancer (9.5 percent vs. 5.5 percent). Americans also had higher rates for heart attack, stroke and lung disease when compared to the British.

The findings appear in the May 3 issue of the Journal of the American Medical Association.

Smith said his team assumed that one possible explanation for the disparity might lie in differences in access to care: The United States relies on a patchwork system of private and public health care, whereas England offers universal, socialized medicine to its citizens. To account for the difference, the researchers factored out health-care access by limiting their analysis to financially well-off, non-Hispanic whites -- the vast majority of whom have access to care in both countries. The result: The gap persisted.

At this point, Smith said, he and his British colleagues who helped conduct the study are left scratching their heads.

"We have some plausible hypotheses for the difference in health outcomes," Smith said. A leading theory is that "it may matter how long you've been in an epidemic, and the big epidemic that separates the two countries right now is the obesity epidemic," he said. "We started first, and the English are catching up with us. It may really matter that we have had [rising obesity rates] 20 years longer than they have."

According to a Rand statement, the overall incidence of obesity in the United Kingdom rose steadily from 7 percent of the population in 1980 to 23 percent in 2003. However, in 1980, 16 percent of Americans were already obese, and that number climbed to 31 percent by 2003.

Furthermore, despite spending billions more on health care than the British, Americans "are not treating obesity," said Lona Sandon, an assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center in Dalla. "We're treating the symptoms -- the heart disease, the diabetes, the hypertension, everything else. We're not addressing the underlying problem."

Sandon also noted that the English and their European counterparts are much less reliant on cars for transport than people in the United States. "When you go to England, Europe, you'll still see many people walking or using bicycles," she said. "In the United States, we've moved away from that and lessened our physical activity to a bare minimum."

Then there's the ever-expanding American dinner plate. According to Sandon, "our portion sizes are triple or four times what they should be, or what they were 20 to 30 years ago."

Smith stressed, however, that obesity may not be the only reason explaining the health gap. "It may also trace back to childhood health differences between the two countries," he said. And because stress is known to negatively affect health, it's possible that "we may live in a more stressful country than the English do."

Smith noted that the English don't live any longer than Americans do -- they just develop chronic or acute illnesses much later. The real challenge is to prevent or postpone these conditions in the first place, he said.

"The mortality rates among people around age 60 is about the same in both countries," Smith said. This means the U.S. health-care system may do a better job of keeping individuals alive after they develop diabetes, health disease or other illnesses. "But we don't do a better job at preventing people from getting sick in the first place."

However, with obesity rates rising in England, the British may not have much cause to be complacent. "We've had a few more years to get obese and develop chronic illnesses, whereas they are just beginning," Sandon said. "So, if they can look at these comparisons and say, 'We need to stop this now,' they might be better off in the long run."

The study has a different message for policymakers back in the former colonies.

"We have a 25 percent higher standard of living here in the U.S. than the English do," Smith said, "so achieving the level of health of the English should not be outside our reach."

SOURCES: James Smith, Ph.D., senior economist, Rand Corp., Santa Monica, Calif.; Lona Sandon, R.D., assistant professor, clinical nutrition, University of Texas Southwestern Medical Center, Dallas, and spokeswoman, American Dietetic Association; May 3, 2006, Journal of the American Medical Association

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