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Government study explains why Americans have shorter lives, poorer health

Robin Wulffson MD's picture
longevity, poverty, lifestyle choices, traffic accidents, physical activity

Despite the fact that the United States spends far more per person on healthcare than any other nation, Americans die younger and have more illnesses and accidents on average than people in other developed nations. These sad statistics include wealthier, insured, college-educated Americans. The study, which was released on January 9, was prepared by the Committee on Population and was sponsored by the National Research Council and Institute of Medicine.

The report examined the nature and strength of the research evidence on life expectancy and health in the US; it compared US data with statistics from 16 peer countries: other high income democracies in Western Europe, as well as Canada, Australia, and Japan. The panel reviewed the most current data, and it also examined historical trend data beginning in the 1970s; most statistics in the report were obtained from the late 1990s through 2008. The panel members note that they were shocked by the findings. For many years, Americans have been dying at younger ages than individuals in almost all other high income countries. Furthermore, the situation has been getting worse for three decades, especially among women. Not only are their lives shorter, but Americans also have a longstanding pattern of poorer health that is strikingly consistent and pervasive over the life course: at birth, during childhood and adolescence, for young and middle-aged adults, and for older adults.

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The study found the US near the bottom of the peer countries for life expectancy, with high rates of obesity and diabetes, heart disease, chronic lung disease and arthritis, as well as infant mortality, injuries, homicides, teen pregnancy, drug deaths and sexually transmitted diseases. The shorter life expectancy for Americans largely was attributed to high mortality for men under age 50, from car crashes, accidents and violence. The investigators note that many of these conditions have a particularly profound effect on young people, reducing the odds that Americans will live to age 50. In addition, for those who reach age 50, these conditions contribute to poorer health and greater illness later in life.

The panel found multiple likely explanations for the US health disadvantage:

  • Health systems: Unlike its peer countries, the United States has a relatively large uninsured population and more limited access to primary care. Americans are more likely to find
  • their healthcare inaccessible or unaffordable and to report lapses in the quality and safety of care outside of hospitals.
  • Health behaviors: Although Americans are currently less likely to smoke and may drink alcohol less heavily than people in peer countries, they consume the most calories per person, have higher rates of drug abuse, are less likely to use seat belts, are involved in more traffic accidents that involve alcohol, and are more likely to use firearms in acts of violence.
  • Social and economic conditions: Although the income of Americans is higher on average than in other countries, the United States also has higher levels of poverty (especially child
  • poverty) and income inequality and lower rates of social mobility. Other countries are outpacing the United States in the education of young people, which also affects health. In addition, Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages.
  • Physical environments: US communities and the built environment are more likely than those in peer countries to be designed around automobiles, and this may discourage physical activity and contribute to obesity.

Reference: Committee on Population

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