In a call to action on the sorry comparative state of U.S. health, researchers at Columbia University’s Mailman School of Public Health are urging President Obama to “remove the public veil of ignorance” and confront a pressing question: Why is America at the bottom? The report, published in the journalScience, appeals to the President to mobilize government to create a National Commission on the Health of Americans. The researchers underscore the importance of this effort in order for the country to begin reversing the decline in the comparative status of U.S. health, which has been four decades in the making.
This is not a challenge that can be left to private groups, no matter how well meaning. Drs. Ronald Bayer and Amy Fairchild, both Professors of Sociomedical Sciences, argue, “The health status of Americans is a social problem that demands social solutions.” More is at stake than the U.S. healthcare system, which fails to provide needed care to millions of Americans. “There is a need for bold public policies that move beyond individual behavior to address the fundamental causes of disease,” Bayer and Fairchild conclude.
A January 2013 report by the U.S. National Research Council (NRC) and Institute of Medicine (IOM) ranks the United States last among peer nations in health status and compares it unfavorably to 17 peer countries at almost every stage of the life course. The report, titled “U.S. Health in International Perspective: Shorter Lives, Poorer Health,” emphasizes that socioeconomic causes are the drivers of these outcomes and details the categories in which the U.S. has the worst or next-to-worst results:
- The U.S. has higher rates of adverse birth outcomes, heart disease, injuries from motor vehicle accidents and violence, sexually acquired diseases, andchronic lung disease.
- Americans lose more years of life to alcohol and other drugs.
- The U.S. has the highest rate of infant mortality among high-income countries.
- The U.S. has the second highest incidence of AIDS and ischemic heart disease,
- For decades, the U.S. has experienced the highest rates of obesity in children and adults as well as diabetes from age 20 and up.
In an interview, Drs. Bayer and Fairchild said, “Too many studies, too many reports documenting the grave health inequalities within the U.S. have been published.” Now, they noted, “not only are social inequalities greater than they have been in a century, but we see that the U.S. does more poorly than other nations. Echoing the sense of urgency expressed in the report, they concluded, “We fear that like earlier studies this most recent analysis will be consigned to the dustbin of history. Only determined action by the President can prevent such an outcome.”
On average, Americans die sooner and experience higher rates of disease and injury than people in other high-income countries, says a new report from the National Research Council and Institute of Medicine. The report finds that this health disadvantage exists at all ages from birth to age 75 and that even advantaged Americans—those who have health insurance, college educations, higher incomes, and healthy behaviors—appear to be sicker than their peers in other rich nations.
“We were struck by the gravity of these findings,” said Steven H. Woolf, professor of family medicine at Virginia Commonwealth University in Richmond and chair of the panel that wrote the report. “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.”
The report is the first comprehensive look at multiple diseases, injuries, and behaviors across the entire life span, comparing the United States with 16 peer nations—affluent democracies that include Australia, Canada, Japan, and many western European countries. Among these countries, the U.S. is 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.
Many of these health conditions disproportionately affect children and adolescents, the report says. For decades, the U.S. has had 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 5. U.S. adolescents have higher rates of death from traffic accidents and homicide, the highest rates ofteenage pregnancy, and are more likely to acquire sexually transmitted infections. Nearly two-thirds of the difference in life expectancy between males in the U.S. and these other countries can be attributed to deaths before age 50.
These findings build on a 2011 Research Council report that documented a growing mortality gap among Americans over age 50. “It’s a tragedy. Our report found that an equally large, if not larger, disadvantage exists among younger Americans,” Woolf said. “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.”
The panel did find that the U.S. outperforms its peers in some areas of health and health-related behavior. People in the U.S. over age 75 live longer, and Americans have lower death rates from stroke and cancer, better control of blood pressure and cholesterol levels, and lower rates of smoking.
This health disadvantage exists even though the U.S. spends more per capita on health care than any other nation. Although documented flaws in the health care system may contribute to poorer health, the panel concluded that many factors are responsible for the nation’s health disadvantage.
The report examines the role of underlying social values and public policies in understanding why the U.S. is outranked by other nations on both health outcomes and the conditions that affect health. For example, Americans are more likely to engage in certain unhealthy behaviors, from heavy caloric intake to behaviors that increase the risk of fatal injuries, the report says. The U.S. has relatively high rates of poverty and income inequality and is lagging behind other countries in the education of young people.
However, the panel’s research suggests that the U.S. health disadvantage is not solely a reflection of the serious health disadvantages that are concentrated in the U.S. among poor or uninsured people or ethnic and racial minorities. Americans still fare worse than people in other countries even when the analysis is limited to non-Hispanic whites and people with relatively high incomes and health insurance, nonsmokers, or people who are not obese.
The report recommends an intensified effort to pursue established national health objectives. It calls for a comprehensive outreach campaign to alert the American public about the U.S. health disadvantage and to stimulate a national discussion about its implications. In parallel, it recommends data collection and research to better understand the factors responsible for the U.S. disadvantage and potential solutions, including lessons that can be learned from other countries.
“Research is important, but we should not wait for more data before taking action, because we already know what to do. If we fail to act, the disadvantage will continue to worsen and our children will face shorter lives and greater rates of illness than their peers in other rich nations,” Woolf said.
Although the English are generally healthier than Americans, both countries grapple with large health inequalities. A new study suggests that in both countries, health and wealth are tightly linked.
The study, published online Sept. 20 in the American Journal of Public Health, links income level with obesity, diabetes, cardiovascular disease, asthma and other health conditions.
The results surprised author Melissa Martinson, an assistant professor at the UW’s School of Social Work, who expected income to have less of an effect on the health of English residents due to their access to publicly funded health care.
Instead, she found a similar connection between income and health in Americans and the English from childhood through later adulthood, and the link persisted regardless of other factors commonly associated with poor health, including ethnicity, body mass index, access to health insurance, smoking andalcohol consumption.
“It’s not just that those with low income don’t have access to health care,” Martinson said. “The results suggest that reducing health disparities requires attention to broader social conditions associated with income inequality, such as extra stressors and unhealthy living environments.”
Martinson used data from national health surveys that included 36,360 American and 55,783 English people, up to age 80 and with about an even mix of men and women. She calculated prevalence rates and risk ratios of obesity, hypertension, diabetes, cholesterol levels, heart attack or angina, stroke and asthma.
In a previous study, Martinson found that Americans had poorer health than the English. Yet her new study demonstrates that the magnitude of health inequalities between low- and high-income people were the same in both countries. “This suggests that despite differences in health care systems, high income inequality translates directly into large health inequalities,” Martinson said.
She cautioned that while income disparities in health are similar in the U.S. and England, low-income Americans are less healthy than low-income English residents according to nearly all of the health measures she used.
Martinson suspects that this is because the British health care system improves health for the entire population. In her study, all low-income English residents—like the rest of the English population —received health care through the government, compared with about one-third of low-income Americans going without health insurance.
Martinson says that equal access to health care is an important first step in improving health in the U.S., but there is more work to be done. “We need a better understanding of why low income coincides with poor health so that we can develop policies and interventions that even out these inequalities,” Martinson said.