Americans Have Worse Health Than People in
Other Prosperous Countries Until They Pass Age 75
‘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’
25, 2013 – Senior citizens are probably more likely than most
Americans to consider the U.S. health system as the best in the
world for living a long healthy life. They are, however, wrong.
Americans die sooner and experience higher rates of disease and
injury than people in other high-income countries and this
disadvantage extends to age 75, says a shocking new report. There is
good news for seniors, however - people over age 75 in U.S. live
longer, have lower death rates from stroke and cancer, better
control of blood pressure and cholesterol levels, and lower rates of
This news from
the National Research Council and Institute of Medicine concludes
that even Americans with health insurance, college education, higher
incomes and even healthy behaviors appear to be sicker than people
in other rich countries.
"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
The report is the first comprehensive look at
multiple diseases, injuries, and behaviors across the entire life
span, comparing the United States with 16 peer nations - affluent
democracies that include Australia, Canada, Japan, and many western
Among these countries, the U.S. is at or near
the bottom in nine key areas of health:
1. infant mortality and low birth weight;
2. injuries and homicides;
3. teenage pregnancies and sexually transmitted infections;
4. prevalence of HIV and AIDS;
5. drug-related deaths;
6. obesity and diabetes;
7. heart disease;
8. chronic lung disease; and
Many of these health conditions
disproportionately affect children and adolescents, the report
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
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
Nearly two-thirds of the difference in life
expectancy between males in the U.S. and these other countries can
be attributed to deaths before age 50.
These findings build on a 2011 Research Council
report that documented a growing mortality gap among Americans over
"It's a tragedy. Our report found that an
equally large, if not larger, disadvantage exists among younger
Americans," Woolf said.
"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
The panel did find that the U.S. outperforms
its peers in some areas of health and health-related behavior.
Why Are Americans
panel’s inquiry found multiple likely explanations for
the U.S. health disadvantage:
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 health care inaccessible or unaffordable and
to report lapses in the quality and safety of care
outside of hospitals.
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.
And Americans benefit less from safety net programs that
can buffer the negative health effects of poverty and
other social disadvantages.
U.S. 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.
Journal of American
"The United States
spends more on health care than does any other country,
but its health outcomes are generally worse than those
of other wealthy nations. People in the United States
experience higher rates of disease and injury and die
earlier than people in other high-income countries.
Although this health disadvantage has been increasing
for decades, its scale is only now becoming more
apparent," says an opinion piece in JAMA.
This health disadvantage exists even though the
U.S. spends more per capita on health care than any other nation.
Although documented flaws in the health care system may contribute
to poorer health, the panel concluded that many factors are
responsible for the nation's health disadvantage.
The report examines the role of underlying
social values and public policies in understanding why the U.S. is
outranked by other nations on both health outcomes and the
conditions that affect health.
For example, Americans are more
likely to engage in certain unhealthy behaviors, from heavy caloric
intake to behaviors that increase the risk of fatal injuries, the
report says. The U.S. has relatively high rates of poverty and
income inequality and is lagging behind other countries in the
education of young people.
However, the panel's research suggests that the
U.S. health disadvantage is not solely a reflection of the serious
health disadvantages that are concentrated in the U.S. among poor or
uninsured people or ethnic and racial minorities.
fare worse than people in other countries even when the analysis is
limited to non-Hispanic whites and people with relatively high
incomes and health insurance, nonsmokers, or people who are not
The report recommends an intensified effort to
pursue established national health objectives. It calls for a
comprehensive outreach campaign to alert the American public about
the U.S. health disadvantage and to stimulate a national discussion
about its implications.
In parallel, it recommends data collection
and research to better understand the factors responsible for the
U.S. disadvantage and potential solutions, including lessons that
can be learned from other countries.
"Research is important, but we should not wait
for more data before taking action, because we already know what to
do. 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," Woolf said.
The study was sponsored by the National
Institutes of Health and U.S. Department of Health and Human
Services. The National Academy of Sciences, National Academy of
Engineering, Institute of Medicine, and National Research Council
make up the National Academies. They are private, independent
nonprofit institutions that provide science, technology, and health
policy advice under a congressional charter granted to NAS in 1863.
The Research Council is the principal operating agency of the
National Academy of Sciences and the National Academy of