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Health & Medicine for Senior Citizens

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’

Jan. 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 smoking.

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 behind."

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 European countries. 

 

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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
    9.  disability.

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. 

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 age 50. 

"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 countries."

The panel did find that the U.S. outperforms its peers in some areas of health and health-related behavior. 

Why Are Americans So Unhealthy?

The panel’s inquiry found multiple likely explanations for the U.S. 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 health care 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. And Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages.

Physical environments. 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 Medical Association

"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. Read more...

Root Causes

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. 

Americans still 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 obese. 

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 Engineering. 

For more information, visit http://national-academies.org.

Project website

Causes of Death, U.S. Women Before Age 50,

Compared with Average of Peer Countries 2006-2008

Causes of Death, U.S. Men Before Age 50,

Compared with Average of Peer Countries 2006-2008

More charts and graphs.

 

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