Health Care

Americans are more likely to engage in certain unhealthy behaviors, from heavy caloric intake to behaviors that increase the risk of fatal injuries, than people in other affluent countries.  In addition, the U.S. has relatively high rates of poverty and income inequality and is lagging behind other countries in the education of its young people.

Despite all this, people in the U.S. still have lower death rates from stroke and cancer, better control of blood pressure and cholesterol levels, and lower rates of smoking than people in most other affluent countries according to a January 2013 report from the National Research Council and Institute of Medicine.

That's the good news.  On average, however, Americans can expect to die sooner and experience higher rates of disease and injury.  Even Americans who have health insurance, college educations, higher incomes, and healthy behaviors appear to be sicker than their peers in other rich nations.

The report compares the United States with 16 peer nations - affluent democracies that include Australia, Canada, Japan, and many western European countries. Among these countries, the U.S. is at or near the bottom in nine key areas of health: infant mortality and low birth weight; injuries and homicides; teenage pregnancies and sexually transmitted infections; prevalence of HIV and AIDS; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability.

This health disadvantage exists even though the U.S. spends more per capita on health care than any other nation.

"We were struck by the gravity of these findings," said Steven H. Woolf, professor of family medicine at Virginia Commonwealth University in Richmond and chair of the panel that wrote the report. "Americans are dying and suffering at rates that we know are unnecessary because people in other high-income countries are living longer lives and enjoying better health. What concerns our panel is why, for decades, we have been slipping behind."

Many of these health conditions disproportionately affect children and adolescents, the report says. For decades, the U.S. has had the highest infant mortality rate of any high-income country, and it also ranks poorly on premature birth and the proportion of children who live to age 5. U.S. adolescents have higher rates of death from traffic accidents and homicide, the highest rates of teenage pregnancy, and are more likely to acquire sexually transmitted infections. 

"I don't think most parents know that, on average, infants, children, and adolescents in the U.S. die younger and have greater rates of illness and injury than youth in other countries," Woolf said.  "If we fail to act, the disadvantage will continue to worsen and our children will face shorter lives and greater rates of illness than their peers in other rich nations."

The research suggests that the U.S. health disadvantage is not solely due to the disadvantages concentrated among poor or uninsured people, or ethnic and racial minorities. Americans still fare worse than people in other countries even when the analysis is limited to nonsmokers, people who are not obese, or people with relatively high incomes and health insurance.

This suggests that even the overhaul of the American health insurance industry provided by the Affordable Care Act (aka Obamacare) may not make up the difference in life expectancy and mortality unless other factors are also changed.