The U.S. spends more on health care than other high-income countries but Americans have shorter lifespans and worse health than comparable countries, a new report confirms.
Much can be attributed to high poverty rates and a large number of uninsured but it holds true even for those relatively well off and cuts across all ages and demographics, according to the National Research Council and the Institute of Medicine report released Wednesday.
“The American health-wealth paradox is a pervasive disadvantage that affects everyone, and it has not been improving,” the authors conclude.
Among the 17 high-income countries studied, the U.S. had the lowest life expectancy among men at 75.64 years, about four years younger than those in Switzerland, and was second to last among women at 80.78 years, more than five years younger than women in Japan. In particular, deaths before age 50 account for two-thirds of the difference in life expectancy for men in the U.S. and about one-third of the difference for women.
Much of that can be attributed to a higher death rate because of injuries and violence. Americans are seven times more likely to be victims of homicide and 20 times more likely to die in a shooting than peers in other high-income countries, said Dr. Steven Woolf, a professor of family medicine at Virginia Commonwealth University, who led the panel that authored the report.
“The size of the health disadvantage was pretty stunning,” he said.
There is a dramatic difference in gun ownership between the U.S. and some peer countries: There were 88.8 guns per 100 U.S. residents (mainly because of multiple gun ownership by many) compared with 0.6 per 100 in Japan.
But there were other factors, particularly among infants and children that “were equally disturbing,” Woolf said.
The U.S. has the worst infant mortality rate and American children are less likely to live to age 5 than in peer countries, the report found.
“Our rate of premature babies – 12 percent – is similar to sub-Saharan Africa,” Woolf said.
The life expectancy gap begins at birth and goes on to age 75 – even breaking it into five-year increments, at no age did the U.S. rank higher than 15th out of 17, he said.
The U.S., however, had much lower rates of smoking and alcohol consumption than many peer countries, but that appears to be wiped out by a higher prevalence of overeating and lack of physical activity. The U.S. has the highest rate of calorie consumption and obesity, the report found.
As to the causes, they were everywhere, Woolf said.
“We found clues to the U.S. health disadvantage in almost every category we examined: flaws in the health care system; a higher prevalence of unhealthy and risky behaviors; high levels of poverty and deficiencies in our education of young people; and a weak social safety net,” he said. “No single factor, but a combination is likely to blame for the U.S. health disadvantage.”
Some of the causes might not be obvious, said panel member Dr. Ana V. Diez-Roux, the director of the Center for Social Epidemiology and Population Health at University of Michigan School of Public Health. For instance, Americans’ heavy reliance on automobiles has shaped cities, determined how food is distributed and has “implications for physical activity behaviors,” she said.
“The report really highlights the importance of looking at a range of factors that people may not think of as health-related at first thought,” Diez-Roux said.
The panel also recognizes that many Americans “cherish personal autonomy” and want to limit government intrusion in their lives, Woolf said.
The aim of the report was to help educate the public on the serious nature of the health gap and “to stimulate a national discussion about what trade-offs we’re willing to make to achieve the health gains that other high-income countries are now enjoying,” he said.