Why Is America The Sick Man Of Rich Nations?

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Main Category: Public Health
Article Date: 10 Jan 2013 - 10:00 PST


Americans have shorter lifespans and higher rates of injury and disease than their counterparts in other rich countries, researchers from the Institute of Medicine and the National Research Council wrote in a new report this week.

The authors added that not only are disadvantaged Americans way behind their equivalents in other industrialized nations, but also Americans with higher incomes, college educations, healthy behaviors and people with health insurance.

The chair of the panel that wrote the report, Steven H. Woolf, a professor of family medicine at Virginia Commonwealth University in Richmond, said:

"We were struck by the gravity of these findings. 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."

This is not the first time alarm bells have sounded regarding America's health compared to other equivalent nations. In June, 2011, researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and Imperial College London reported that while the leading industrial nations reported significant increases in life expectancy each year, most US counties had fallen further behind.

A report in 2011 explained that although life expectancy in the USA rose to 78 years, on a world scale the country only ranked number 50.

This is the first report to take a comprehensive look at several diseases, injuries and behaviors across all age groups, comparing Americans with citizens from 16 rich nations, which the authors describe as "affluent societies", including Canada, the United Kingdom, Germany, Australia, France, Japan and some other western European countries.

In the majority of health issues, including infant mortality, teenage pregnancies, STIs (sexually transmitted diseases), heart disease, chronic lung disease, disability, obesity, diabetes, drug-related deaths, homicides, injuries, and HIV/AIDS, the USA is either at the bottom or very near the bottom of the table when compared to the other countries.

Children and adolescent health are affected disproportionately, the report explains. For over twenty years the USA has had the highest infant mortality rate of high-income nations. America also ranks poorly on the proportion of children who survive to the age of 5, as well as premature births.

The USA fared much worse than its rival rich nations in the following health areas:

• American adults (aged 20+ years) have the highest diabetes rates
• For over thirty years, obesity rates have been higher in America than anywhere else
• HIV infection rates among 15 to 49 year-olds are higher in the USA than in any of the other countries
• More years of life have been lost to alcohol and other drugs in America than anywhere else
• Over the last twenty years, American adolescents have had the highest rates of STIs (sexually transmitted infections)
• Since the early 1990s, American teenagers have had the highest pregnancy rates
• Most of the difference in life expectancy among males in the USA compared to other countries is attributed to deaths before age 50

There is a growing mortality gap among people over 50 in the USA. Woolf said:

"It's a tragedy. Our report found that an equally large, if not larger, disadvantage exists among younger Americans. 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."

However, in the following health areas, the USA fared well compared to the majority of the other rich nations:

• Americans aged over 75 live longer
• There are lower death rates from stroke in the USA
• There are lower death rates from cancer in the USA
• A lower percentage of American adults smoke
• Americans have better cholesterol and blood pressure control

The USA spends more per capita on health care than any other nation in the world, and does not get good value for its health care money.

America's health disadvantage is due to many factors

The authors examined the role of underlying social values and public policies. They found that Americans tend to acquire unhealthy behaviors, such as consuming too many calories each day; they also engage in behaviors that raise the risk of fatal injuries.

Woolf believes that the American culture of personal autonomy, self-reliance and minimal government intrusion contributes towards unsafe and unhealthy behaviors.

Poverty - compared to the other rival nations, the USA has higher rates of poverty and income disparities. America also lags behind other nations in the education of children and young people.

However, even when certain "well-off" sectors of the US population are compared to those of other rich nations, Americans still fare worse.

Transport and food - Americans rely much more on their private cars to get around, compared to the western Europeans and Japanese. Food is generally prepared in a less healthy way in the USA.

The number of primary care providers - there are proportionally fewer primary care providers in the America compared to, for example the United Kingdom, Canada and other western European countries. There are greater problems coordinating care in the USA. Primary care refers to general practice - a primary care physician is a GP (general practitioner, family doctor).

Woolf explained that when Americans are in a hospital they do well. The problems start when they are discharged and go out into the community; then their quality of life drops faster.

"This study suggests we need to think about how we spend our money," Woolf said.

More needs to be done to push forward established national health aims. The report calls for a comprehensive outreach campaign to make Americans aware of the US health disadvantage and to better understand which factors cause the disadvantage, and which possible solutions should be put into practice. Perhaps, by observing how other countries manage to do much better with less money, this could be a first step.

Woolf said, "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."

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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