Americans have worse health than people in other high-income countries, says new report

The United States spends more per capita on healthcare than any other nation, yet even its citizens with health insurance, a college education, higher income, or healthful habits are not protected, on average, from earlier death, disease, or injury as compared with citizens of other high-income countries, according to a new report from the National Research Council (NRC) and Institute of Medicine (IOM).

Solutions, according to the report, include an intensified effort to pursue established national health objectives, a comprehensive outreach campaign to share findings with citizens and stimulate a national discussion about its implications, and data collection and research to better understand the factors responsible for the U.S. disadvantage as well as potential solutions.

The report finds that this health disadvantage exists at all ages from birth to age 75 and that even advantaged Americans appear to be sicker than their peers in other rich nations.

"We were struck by the gravity of these findings," said Steven H. Woolf, MD, MPH, professor of family medicine at Virginia Commonwealth University in Richmond and chairman 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 United States 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 United States 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 of teenage pregnancy, and are more likely to acquire sexually transmitted infections. Nearly two-thirds of the difference in life expectancy between males in the United States, 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 United States die younger and have greater rates of illness and injury than youth in other countries."

The panel did find that the United States outperforms its peers in some areas of health and health-related behavior. People in the United States aged more than 75 years 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.

Root causes

This health disadvantage exists even though the United States spends more per capita on healthcare than any other nation. Although documented flaws in the healthcare 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 United States 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 United States has relatively high rates of poverty and income inequality and is lagging behind other countries in the education of young people.

The panel's research, however, suggests that the U.S. health disadvantage is not solely a reflection of the serious health disadvantages that are concentrated in the United States 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.

The study was sponsored by the National Institutes of Health and U.S. Department of Health and Human Services. The National Academy of Sciences (NAS), National Academy of Engineering (NAR), IOM, and NRC make up the National Academies. They are private, independent nonprofit institutions that provide science, technology, and health policy advice under a congressional charter granted to NAS in 1863. The NRC is the principal operating agency of the NAS and the NAR. For more information, visit http://national-academies.org.

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