"Americans are sicker and die younger than people in other wealthy nations."
That stark sentence appears in the January 2013 issue of the Journal of the American Medical Association, and it comes from the authors of a landmark report -- "Shorter Lives, Poorer Health" -- on differences among high-income countries.
You probably already know that America spends more on health care than any other country. That was one of the few facts to survive the political food fight pretending to be a serious national debate about the Affordable Care Act.
But the airwaves also thrummed with so many sound bites from so many jingoistic know-nothings claiming that America has the best health care system in the world that today, most people don't realize how shockingly damaging it is to your wellness and longevity to be born in the U.S.A.
This is made achingly clear in the study of the "U.S. health disadvantage" recently issued by the National Research Council and the Institute of Medicine, which was conducted over 18 months by experts in medicine and public health, demography, social science, political science, economics, behavioral science and epidemiology.
Compare the health of the American people with our peer nations -- with Britain, Canada and Australia; with Japan; with the Scandinavian countries; with France, Germany, Italy, Spain, Portugal, Austria, Switzerland and the Netherlands. Side by side with the world's wealthy democracies, America comes in last, and over the past several decades, it's only gotten worse.
With few exceptions -- like death rates from breast cancer -- we suck. Our newborns are less likely to reach their first birthday, or their fifth birthday. Our adolescents die at higher rates from car crashes and homicides, and they have the highest rates of sexually transmitted infections. Americans have the highest incidence of AIDS, the highest obesity rates, the highest diabetes rates among adults 20 and older, the highest rates of chronic lung disease and heart disease and drug-related deaths.
There is one bright spot. Americans who live past their 75th birthday have the longest life expectancy. But for everyone else -- from babies to baby boomers and beyond -- your chances of living a long life are the butt-ugly worst among all the 17 rich nations in our peer group.
In case you're tempted to blow off these bleak statistics about American longevity by deciding that they don't apply to someone like you -- before you attribute them to, how shall we put it, the special burdens that our racially and economically diverse and culturally heterogeneous nation has nobly chosen to bear -- chew on this: "Even non-Hispanic white adults or those with health insurance, a college education, high incomes, or healthy behaviors appear to be in worse health (e.g., higher infant mortality, higher rates of chronic diseases, lower life expectancy) in the United States than in other high-income countries." And by the way, "the nation's large population of recent immigrants is generally in better health than native-born Americans."
Why are we trailing so badly? Some of the causes catalogued by the report:
The U.S. public health and medical care systems: Our employer -- and private insurance-- based health care system has long set us apart from our peer nations, who provide universal access. The right loves to rail against "socialized medicine," but on health outcomes, the other guys win.
Individual behavior: Tobacco, diet, physical inactivity, alcohol and other drug use and sexual practices play a part, but there's not a whole lot of evidence that uniquely nails Americans' behavior. The big exception is injurious behavior. We loves us our firearms, and we don't much like wearing seat belts or motorcycle helmets.
Social factors: Stark income inequality and poverty separate us from other wealthy nations, who also have more generous safety nets and demonstrate greater social mobility than we do. In America, the best predictor of good or bad health is the income level of your zip code.
Physical and social environmental factors: Toxins harm us, but our pollution isn't notably worse than in other rich nations. The culprit may be our "built environment": less public transportation, walking and cycling; more cars and car accidents; less access to fresh produce; more marketing and bigger portions of bad food.
Policies and social values: To me, this is the richest, and riskiest, ground broken by the report, which asks whether there's a common denominator -- upstream, root causes -- that help explain why the United States has been losing ground in so many health domains since the 1970s:
Certain character attributes of the quintessential American (e.g. dynamism, rugged individualism) are often invoked to explain the nation's great achievements and perseverance. Might these same characteristics also be associated with risk-taking and potentially unhealthy behaviors? Are there health implications to Americans' dislike of outside (e.g., government) interference in personal lives and in business and marketing practices?
My answer is yes, but I'd plant the problem in recent history and politics, not in timeless quintessentials. Since the 1980s, in the sunny name of "free enterprise," there's been a ferocious, ideologically driven effort to demonize government, roll back regulations, privatize the safety net, stigmatize public assistance, gut public investment, weaken consumer protection, consolidate corporate power, delegitimize science, condemn anti-poverty efforts as "class warfare" and entrust public health to the tender mercies of the marketplace.
The epidemic of gun violence has been fueled by anti-government paranoia stoked by the gun manufacturers' lobby, the NRA. The spike in consumption of high-fructose corn syrup has been driven by the food industry's business decisions and its political (i.e., financial) clout. In the name of fiscal conservatism, plutocrats push for cuts in discretionary expenditures on maternal health, early childhood education, social services and public transportation. The same tactic that once prolonged tobacco's death grip -- the confection of a phony scientific "controversy" -- now undermines efforts to combat climate change, which is as big a danger to public health as any disease.
More accidents may be shortening our lifespans. But we're not getting sicker by accident.
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