There’s very little to love in a new analysis of death rates in America compared to other wealthy, industrialized countries. But there is a lot to be surprised by.
The 378-page study, overseen by the United States Institute of Medicine and the National Research Council, examines in painstaking detail how Americans die earlier and live in poorer health than people in almost all of the 16 other countries included. And it’s not just that older Americans are dying younger than global counterparts. Americans under 50 are also likely to die younger than young and middle-aged adults elsewhere — from all sorts of causes.
That’s what makes the results puzzling: There’s no easy explanation as to why. While many health disparities between America and elsewhere can be explained by our diets, or obesity rates, or fractured health care system, no one of those rationales (nor all three of them combined) explain why young Americans have far higher death rates from car accidents, drug overdoses, gun violence and suicide. Or why young Americans have the highest rates of sexually transmitted diseases, lose more years of life to alcohol abuse than people in any of the other countries, or still lose years of life to communicable diseases and nutritional deficiencies.
In “terms of sheer physical survival,” Americans fare worse except at the very oldest ages. According to report, deaths that occur before age 50 are responsible for about two- thirds of the difference in life expectancy between males in the United States and peer countries, and about one-third of the difference for females. And the problem has been worsening over time.
“Something fundamental is going wrong,” Steven Woolf, chairman of the Department of Family Medicine at Virginia Commonwealth University and leader of the panel, told the New York Times. “We expected to see some bad news and some good news. But the U.S. ranked near and at the bottom in almost every heath indicator. That stunned us.”
“This is not the product of a particular administration or political party,” he adds. “Something at the core is causing the U.S. to slip behind these other high-income countries. And it’s getting worse.”
In searching for possible explanations, the report’s authors note that “important antecedents of good health, such as the quality of health care and the prevalence of health-related behaviors,” are “frequently problematic” in America.
Compared with people in other countries, Americans are more likely to find care inaccessible or unaffordable and to report lapses in the quality and safety of care outside of hospitals.
In terms of individual behaviors, 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 involv- ing alcohol, and own more firearms than their peers in other countries. U.S. adolescents seem to become sexually active at an earlier age, have more sexual partners, and are less likely to practice safe sex than adolescents in other high-income countries.
Adverse social and economic conditions also matter greatly to health and affect a large segment of the U.S. population. Despite its large and powerful economy, the United States has higher rates of poverty and income inequality than most high-income countries. U.S. children are more likely than children in peer countries to grow up in poverty, and the proportion of today’s children who will improve their socioeconomic position and earn more than their parents is smaller than in many other high-income countries.
In addition, although the United States was once the world leader in education, students in many countries now outperform U.S. students. Finally, Americans have less access to the kinds of “safety net” programs that help buffer the effects of adverse economic and social conditions in other countries.”
Yet though “all of these differences are compelling and important, no single factor fully explains the U.S. health disadvantage,” they conclude.
Individual behaviors may contribute to the overall disadvantage, but studies show that even Americans with healthy behaviors, for example, those who are not obese or do not smoke, appear to have higher disease rates than their peers in other countries.”
And the problem isn’t confined to the socially or economically disadvantaged, either; Americans at all education and socioeconomic levels had poorer health outcomes and status.
Because choices about political governance structures, and the social and economic conditions they reflect and shape, matter to overall levels of health, the panel asked whether some of these underlying societal factors could be contributing to greater disease and injury rates and shorter lives in the United States. And might these choices also explain the inability of the United States to keep pace with peer countries in other important health- related domains, such as education and child poverty? These are important questions for which further research is needed. It will also be important for Americans to engage in a thoughtful discussion about what investments and compromises they are willing to make to keep pace with health advances other countries are achieving. Before this can occur, the public must first be informed about the country’s growing health disadvantage, a problem that may come as a surprise to many Americans.”
Other countries in the analysis included Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the U.K.