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Health Justice CT Blog

Two competing visions of America: Are we a leader or laggard in health?

Good health poor health
Among the many issues over which liberals and conservatives in the U.S. disagree is how well the U.S. rates on certain key health indicators compared with other advanced industrial countries. That the U.S. is the greatest country in the world is a common meme propagated in conservative circles whereas among liberals, the fact that U.S. infant mortality rates and life expectancy are on par with many developing countries is yesterday’s news.

Though it may be yesterday’s news to some, a new report from the Institute of Medicine provides additional confirmation for the liberal perspective finding that there is a consistent and pervasive U.S. health disadvantage compared with its peer countries on up to 9 nine different health indicators.  Specifically, compared with 16 peer countries, the U.S. ranked among the lowest on the following 9 health indicators, which contribute to a persistent health disadvantage: 1) Birth outcomes; 2) injuries (including motor vehicle accidents) and violent crime; 3) Teen pregnancy and STDs; 4) HIV/AIDS; 5) Alcohol and drug related mortality; 6) Obesity and diabetes; 7) Heart disease; 8) Chronic lung disease; 9) Disability.

But what even liberals will find interesting about this report are the reasons for the US health disadvantage, which debunk some of the more obvious reasons that might come to mind for the U.S.’s moribund position. Here are a few facts from the report:

  •  A lack of universal health care in the US is not a primary reason for the US health disadvantage. For many it may come as a surprise that health care is not a major contributor to health outcomes.  First, most of the major causes of death and morbidity identified (such as violent crime or HIV/AIDS) are only marginally influenced by the health care system. Furthermore, each of the 16 peer countries that the US is compared with has a universal health care system of one stripe or another, and yet some also cluster at the bottom near the U.S. The UK for instance, with its completely publicly financed National Health Service ranks near the bottom on multiple indicators.
  •  It is not just minorities or extreme poverty that can account for the US health disadvantage. To be clear, this is not to say that low-income individuals and minorities in the US do not suffer a greater burden of disease since they do, but rather that this on its own cannot explain why the US performs worse on average.  The report comes to this conclusion by finding that even white, insured, college-educated, upper-income groups with healthy behaviors, appear to be in worse health than similar groups in comparison countries. Research has consistently found that not only does the US fare worse on certain health outcomes, we also have wider disparities and worse health at all income levels in absolute terms compared with other countries. Furthermore, even Americans with healthy behaviors, e.g., those who are not obese or do not smoke, appear to have higher disease rates than their peers in other countries.
  •  It is not only differences in rates of risk factors like smoking and obesity that matters. Current smoking rates are actually lower in the US than other places and although the US is the heaviest of the 16 countries, obesity can only help explain some of the health disadvantage related to chronic conditions like diabetes and heart disease.
  • The only major contributor to the U.S. health disadvantage that the report can definitively agree on is that high driving rates in the U.S. contributes to our higher mortality rates for automobile accidents. High rates of inequality and our minimalist welfare state are believed to be additional contributors, but the report only reviewed existing evidence and did not test explanations in a systematic way. As usual, the report concludes with a call for more research and is intentionally light on recommendations; since it is government-sponsored report , it cannot make recommendations that might be seen as endorsing a particular policy platform (e.g., that rapacious economic policies have led to vast social inequalities in the U.S. that have harmed health).

The story is not all negative though: the US health disadvantage actually disappears at older ages. The United States has higher survival after age 75 than do peer countries, and it has higher rates of cancer screening and survival, better control of blood pressure and cholesterol levels, lower stroke mortality, lower rates of current smoking, and higher average household income. Thus, our high-tech, treatment oriented system with end-of-life issues, which makes the U.S. health care system one of the most expensive in the world, does seem to pay off towards the end of life. In addition, U.S. suicide rates do not exceed the international average and other studies find Americans to be happier than average.

I guess, in the end, perhaps conservatives have the right attitude: ignorance IS bliss.

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About Ashley Fox

Ashley Fox, Ph.D., is an Assistant Professor at the Mount Sinai School of Medicine, Department of Health Evidence and Policy. Learn more about Ashley here.

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