Why Aren't Americans Healthier?

Examining why American health lags behind other affluent nations.

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Last week, a new catch phrase punctuated media reports: the so-called "U.S. health disadvantage." The term summarizes a report released Thursday by the Institute of Medicine and National Research Council, which, as suggested by its title, "U.S. Health in International Perspective: Shorter Lives, Poorer Health," found America lagging far behind the global health curve.

This is not, of course, a zero-sum game. Health for all is the ideal, if not a moral imperative. But the dismal U.S. ranking raises some soul-searching questions about flagging health in America.

Why, for example, do American men rank dead last in life expectancy among 17 nations? While their Swedish counterparts lead the longevity pack with an average life span of 79.3 years, American men can look forward to nearly four fewer years. Much of the disparity is due to deaths before the age of 50, according to the report, which underscores another issue—that American youth are especially subject to hardships in health due to high rates of teen pregnancy, sexually transmitted diseases, and death from traffic accidents and violence, as well as obesity and its consequent diseases.

[See Top 10 Hotspots for Human Longevity.]

"We expected that we would find some possible disadvantages in certain age groups," said Steven Woolf, a professor of family medicine at Virginia Commonwealth University and chair of the panel that authored the report. "We were not prepared for what we found, which was there was a profound health disadvantage across all age groups beginning with infancy, all the way up to age 75," and across so many measures, even when controlling for income, education, and healthy behaviors. "It's a problem that all classes of our society need to be concerned about ... we're all in this and potentially affected by it."

It's not news that Americans suffer poorer health than their peers in high-income countries—such patterns emerged in the 1980s. What is? The broad extent to which the gap has widened in the last 30 years. This, in spite of the fact that Americans spend $2.8 trillion per capita on health care each year—far more than any other country spends on health care.

"If we live sicker and die younger in almost every way, shape, or form, and we pay more, it's a damning indictment of how we've done," says James Marks, senior vice president and director of the New Jersey-based Robert Wood Johnson Foundation Health Group and retired assistant surgeon general. The scope of the problem requires multiple solutions to realize what Marks is calling for: "a culture of health." Indeed, the report ascribes the sobering data to numerous issues, including social and economic disparities, high rates of obesity, risky behaviors, and the substantial uninsured population. To a large extent, those concerns fall outside the realm of traditional medicine, he says, suggesting, for example, that how and what we eat involves everything from agricultural policies to the built environment.

[See Can 'New Urbanism' Bring Health to Your Neighborhood?]

That's a point Woolf makes as well, noting where U.S. dollars are and aren't spent. America is an "outlier from the other high-income countries," spending more on health care and less on social programs that provide various safety nets.

In a 2011 study of 30 industrialized countries, researchers at Yale University's Global Health Leadership Institute found that for every dollar America spends on health care, it puts 90 cents toward social services. But among peer countries, twice as much is invested in social services as health care. The study further found that countries putting more money into health care than social services have lower life expectancies and higher infant mortality rates than those with the reverse strategy, according to a December 2011 New York Times op-ed piece by Elizabeth Bradley and Lauren Taylor, professor of public health and program manager, respectively, at Yale's Global Health Leadership Institute.