Will seeing just how far we've fallen behind other countries, across almost all measures of health, finally motivate change?
We've known for years that Americans tend to be overweight and sedentary, and that our health care system, despite being the priciest in the world, produces some less-than-plum results. Health nerds who closely follow the news may even have known that we live shorter lives than people in other rich nations, and that infants in the U.S. die from various causes at far higher rates.
But a fresh report, out Wednesday, tapped vast stores of data to compare the health of affluent nations and delivered a worrisome new message: Americans' health is even worse than we thought, ranking below 16 other developed nations.
"The news is that this is across the lifespan, and regardless of income," said Georges Benjamin, executive director of the American Public Health Association, who was not an author of the study. "A lot of people thought it was underserved populations that were driving the statistics -- the poor, the uninsured. They still are a big part of our challenge, but the fact that even if you're fairly well-to-do you still have these problems shatters that myth."
The question is: Will it make a difference?
The report was prepared by a panel of doctors, epidemiologists, demographers, and other researchers charged by the National Research Council and the Institute of Medicine to better understand Americans' comparative health. They examined when and why people die in the U.S. and 16 other countries, including Australia, Japan, Canada, and nations in Western Europe. The data they pulled -- from such bodies as the World Health Organization and the Organization for Economic Cooperation and Development -- already existed, but no one had yet examined it this comprehensively.
The results surprised even the researchers. To their alarm, they said, they found a "strikingly consistent and pervasive" pattern of poorer health at all stages of life, from infancy to childhood to adolescence to young adulthood to middle and old age. Compared to people in other developed nations, Americans die far more often from injuries and homicides. We suffer more deaths from alcohol and other drugs, and endure some of the worst rates of heart disease, lung disease, obesity, and diabetes.
These disproportionate deaths especially affect young people. For three decades, Americans, particularly men, have had either the lowest or near the lowest likelihood of surviving to age 50. The most powerful reasons found for that were homicide, car accidents, other kinds of accidents, non-communicable diseases, and perinatal problems like low birth weight and premature birth, which contribute to high infant mortality.
Among the most striking of the report's findings are that, among the countries studied, the U.S. has:
- The highest rate of death by violence, by a stunning margin
- The highest rate of death by car accident, also dramatically so
- The highest chance that a child will die before age 5
- The second-highest rate of death by coronary heart disease
- The second-highest rate of death by lung disease
- The highest teen pregnancy rate
- The highest rate of women dying due to complications of pregnancy and childbirth
The report does reveal bright spots: Americans are more likely to survive cancer or stroke, and if we live to age 75 we're likely to keep on living longer than others. But these advances are dwarfed by the grave shortcomings.
The authors took pains to counteract the possible assumption that U.S. numbers must be negatively skewed by poor and underserved populations. In fact, the report cites data suggesting that even white, well-off Americans live sicker and die sooner than similarly situated people elsewhere.
In presenting their findings Wednesday, the authors seemed to be urging the U.S. to do some soul searching. Our culture "cherishes independence" and "wants to limit the intrusion of government in our personal lives," said Steven Woolf, director of the Center for Human Needs at Virginia Commonwealth University, the panel chairman. While those values serve us in some ways, he said, our resistance to regulation "may work against our ability to achieve optimal health outcomes."
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.
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