How long can you expect to keep blowing out the candles on your birthday cake? American men and women enjoy a life expectancy at birth of almost 76
and 81 years, respectively. That’s not bad, globally speaking, but
not as impressive as the life expectancy for Swiss men, at more
than 79 years, or Japanese women, at almost 86.
In fact, U.S. life expectancy ranks 16th for women and
dead last for men among the 17 “peer countries” evaluated in
a National Academies report released this year by the National
Research Council and the Institute of Medicine, called U.S.
Health in International Perspective: Shorter Lives, Poorer Health.
Americans not only die sooner, but also suffer higher rates
of injury and disease than their peers in other high-income
countries, the report found.
The reasons for America’s grim prognosis are many and
complex, experts say. It’s clear, though, that social and economic
inequality is an important factor. And all Americans, rich and
poor, are suffering the consequences.
“We knew that Americans had poorer health than people
in other countries, but the surprise for us was how bad the
problem is,” says Steven H. Woolf, MD, a professor of family
medicine at Virginia Commonwealth University and chair of
the panel that produced the report. “The problem has been
going on for many years and has been getting worse.”
Richer, poorer
The United States is among the richest nations in the world.
That prosperity doesn’t translate to better health, however.
Where the U.S. health disadvantage is concerned, few segments
of the population are spared. The Shorter Lives, Poorer Health
report found that just about all Americans — from birth to
age 75, with low incomes and high, with or without health
insurance, with or without college educations — are worse off
than people in other wealthy countries, including Australia,
Canada, Japan and most of Western Europe.
Specifically, Woolf and his colleagues on the report panel
found that U.S. health falls short in nine broad areas: adverse
birth outcomes (including infant mortality and low birth
weight); injuries and homicides (including deaths from car
crashes); sexually transmitted diseases; HIV and AIDS; drug-and alcohol-related deaths; obesity and diabetes; heart
disease; lung disease; and disability from arthritis and other
physical limitations.
“While some [Americans] might be aware
that our health-care system has some issues,
they probably think their health is still very
good. Our findings are the exact opposite,”
says Woolf. He and his co-authors note
that compared with other high-income
countries, the U.S. health-care system is
more fragmented, and more Americans
are uninsured, often finding health
care to be inaccessible or unaffordable.
But health care is only one piece of the puzzle. “Health care
is estimated to account for about 10 percent of premature
mortality,” says Nancy Adler, PhD, director of the Center for
Health and Community at the University of California, San
Francisco. “Health care matters, but it’s a very small part of
what’s going on.”
Individual behaviors are also a cause of concern, the report
notes. Compared with our peers elsewhere in the world,
Americans consume more calories, experience more violent
deaths, misuse more prescription and illicit drugs, and have
more alcohol-related traffic accidents.
We also have higher rates of poverty and income
inequality than most other wealthy countries, which
undermines our health in a multitude of ways. Among the
17 countries evaluated in the Shorter Lives, Poorer Health
report, the United States had the highest rates of poverty and
child poverty, according to the Organisation for Economic
Co-operation and Development (OECD). More than one in
five American children live below the federal poverty level,
making them more likely to suffer from asthma and obesity
and have poorer nutrition, less access to health care and lower
vaccination rates.
Adults with lower socioeconomic status are more likely to
experience high blood pressure, obesity, heart disease, infectious
diseases and mental illness, according to a report by Adler
and colleagues for the John D. and Catherine T. MacArthur
Foundation Research
Network on
Socioeconomic
Status and Health.
For people just
scraping by
with paying
the rent
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