According to a recent report from the US National Research Council and Insitute of Medicine, U.S. Health in International Perspective: Shorter Lives, Poorer Health, when compared with 16 high-income "peer" countries, we fare worse in 9 health domains:
- higher infant mortality rate, low birth weight and other adverse birth outcomes
- higher deaths from motor vehicle crashes, non-transportation-related injuries and violence
- highest rate of adolescent pregnancy and STIs
- second highest prevalence of HIV infection and highest incidence of AIDS
- more deaths from alcohol and drug-related mortality compared to others
- highest obesity rate
- second highest death rate from ischemic heart disease
- lung disease is more prevalent and associated with higher mortality
- higher prevalence of arthritis and activity limitations
What are in our favor:
- The US has higher survival after age 75 than peer countries, higher rates of cancer screening and survival, better control of BP, cholesterol levels, lower stroke mortality, lower rates of current smoking, and higher average household income.
What could be possible explanations for the US health disadvantage?
MULTIFACTORIAL!!! the logical answer (ended up to be my conclusion for a number of clinical challenging cases over the years). Remember that even highly advantaged Americans may be in worse health than their counterparts in other countries! here are 4 groups of factors:
- US health care and public health system: costliest health care system (you heard repeatedly); fragmented, quality, safety issues
- social factors: poverty, income inequality, education/employment, racism
- individual behaviors: we consume calorie-dense, low-nutrient food, are less physically active, love prescription drugs and illicit drugs, less likely to wear seatbelts and helmets and own more firearms...One could argue that individual behaviors/lifestyle are heavily influenced by social factors and the built environment.
- built environment: (physical and social environments) car culture, neighborhood factors, work stress, pollution, etc.
Where do we go from here? (and not just alert the public and more research studies) We have underinvested in public health, education and community environments in this country and have not achieved many critical national health objectives. Local and national conversations on important social and health topics are often shadowed by political divisions, claims of American exceptionalism, individualism and belief in limited government. It is also time that our claim as a big heterogeneous country with a vibrant immigrant population (and in generally better health according to the report) should NOT hamper us from achieving consesus and policy and implementation. We should be able to come up with diverse solutions for various communities--there may be a few things we could learn from the localist movement?
"I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful"