Wall Street Journal
Americans die younger and have more illnesses and accidents on average than people in other high-income countries—even wealthier, insured, college-educated Americans, a report said Wednesday.
The study by the federally sponsored National Research Council and Institute of Medicine found the U.S. near the bottom of 17 affluent 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 [U.S.] health disadvantage is pervasive—it affects all age groups up to age 75 and is observed for multiple diseases, biological and behavioral risk factors, and injuries," said the report's authors, who are public-health and medicine academics recruited by the government panels.
The shorter life expectancy for Americans largely was attributed to high mortality for men under age 50, from car crashes, accidents and violence. But the report also said U.S. women's gains in life expectancy had been lagging behind other well-off countries.
The authors offered a range of possible explanations for Americans' worse health and mortality, including social inequality. They also described criticisms including limited availability of contraception for teenagers, community designs that discourage physical activity such as walking, air pollution and access to firearms, as well as individual behaviors such as high calorie consumption.
The U.S. health-care system wasn't spared criticism, with authors describing it as fragmented, lacking sufficient primary-care physicians and posing financial barriers to millions of Americans who lack insurance or are unable to afford out-of-pocket medical costs.
But the chairman of the panel of authors, Steven Woolf, a professor of family medicine at Virginia Commonwealth University, said the report showed that health outcomes were determined "by much more than health care."
"Our health as Americans is only partly aided by having a very good health-care system," he said. "Much of our health disadvantage comes from factors outside of the clinical system and outside of what doctors and hospitals can do."
The Obama administration has aimed to improve Americans' health by expanding insurance coverage through the 2010 Affordable Care Act, while Republicans have pushed for giving the private sector a greater role in managing health care through changes to such programs as Medicare.
Public health has received relatively little attention from lawmakers, despite campaigns by high-profile figures such as first lady Michelle Obama on childhood obesity and New York City Mayor Michael Bloomberg on smoking, gun control and the sale of high-calorie beverages.
"The political environment on health is so wrapped up right now around implementation of health reform that we need to have the space to have this larger conversation and for people to understand that having health insurance is necessary but not sufficient to close this gap," said Jeff Levi, head of the Trust for America's Health, a public health advocacy group. He wasn't involved in the study.
The new report noted that average life expectancy for American men, at 75.6 years, was the lowest among the 17 countries and almost four years shorter than for Switzerland, the best-performing nation.
American women's average life expectancy, 80.8 years, was second-lowest among the countries and five years shorter than Japan's, which had the highest expectancy.
The report's authors were particularly critical of the availability of guns, writing: "One behavior that probably explains the excess lethality of violence and unintentional injuries in the United States is the widespread possession of firearms and the common practice of storing them [often unlocked] at home."
The authors noted that Americans who lived past age 75 had higher survival rates compared with similar countries, and Americans overall had better rates of surviving cancer and strokes. They also said the U.S. better controls high blood pressure, cholesterol, smoking rates and use of alcohol than many other nations.
The report didn't directly consider U.S. health in the context of spending on care, but noted that America's low outcomes were striking given that U.S. per capita health spending exceeds that of other countries.