The panelists' subtext: There's no turning a blind eye anymore, guys. We have to care.
Co-author Paula Braveman, who directs the Center on Social Disparities in Health at University of California, San Francisco, said the panel grappled with this question as
it searched for explanations for our poor health: "Is it Americans' rugged individualism and the sense that the most important thing is the individual's
freedom, and that's so much more important than doing what's right for society?"
Might our national M.O., in other words, be summed up as "Live free and die"?
Not that one factor is likely to be able to explain everything. The panelists identified a host of factors: More than other countries, our health care
system is fragmented, unaffordable for many people, and short on primary care. Of the countries studied, we have the highest rate of children living in
poverty. More of our communities are built around cars, which may discourage exercise.
As individuals, the study found, "Americans are less likely to smoke and may drink less heavily than their counterparts in peer countries, but they consume
the most calories per capita, abuse more prescription and illicit drugs, are less likely to fasten seatbelts, have more traffic accidents involving
alcohol, and own more firearms." Yet even fit, nonsmoking Americans have higher disease rates than those elsewhere, the report said.
The panelists' research uncovered no single cause, no rallying point for action, that accounts for the totality of our unhealthiness -- a complexity which
makes the message harder to deliver and the solutions harder to achieve.
Alternatively, Woolf said, it's conceivable that "we are on the leading edge of a trend." As other countries catch up to our obesity, and their legions of
young smokers age, they could save us from last place.
What do we do about all this? Yes, lots more research, to ferret out the effects of our current policies and what alternatives might work better, the
panelists said. Meanwhile, they concluded that we already have enough evidence to act.
Here's the rub. Reading through the panel's suggested solutions, it's impossible not to notice that a number of these involve public money and policy, and
so would have to get through Congress. Many of the core recommendations read like the House Republicans' hit list: affordable health insurance for
everyone, programs to encourage healthier behavior (read: nanny state), a stronger public safety net for people in poverty. There's even a hint of gun
control.
By late Wednesday, neither Congress nor the White House appeared to be springing into action over the report's revelations. Senator Tom Harkin, chairman of
the Committee on Health, Education, Labor, and Pensions, said via a spokesperson that the existing Affordable Care Act "addresses many of these primary
causes" of our health gap. New support for primary care, free cancer screenings, improved women's care, and other features of the law "will all help
address these disadvantages," he said. (The office of Rep. Jack Kingston, the new chairman of the House Appropriations subcommittee that covers health,
didn't reply to my inquiry.)
Braveman believes the best hope for the report is a wakeup call. "The political obstacles are the huge ones," she said. "My biggest hope is that this will
shake people up and open people up to the evidence that's there from other countries."
This much, at least, could help: We don't like to lose to Europe.
