U.S. Health Worst Among Peer Nations

Amid discussions of health care, it needs to be noted that America’s health is the worst among comparable nations around the world. Furthermore, it’s the most expensive. And we’re not just last, we’re last by a mile. Americans need to know this, and to talk about it. Something needs to change. If you’ve been playing a losing hand all night, you look for a new strategy. It’s surely not a good idea to maintain the current failed health system.

There’s no doubt about our last-place status. The U.S. National Research Council, our most prestigious scientifi c organization, and the Institute of Medicine, the health wing of the National Academy of Sciences, recently issued a stunning description of the decline of the nation’s comparative health. The report’s title says it all: “U.S. Health in International Perspective: Shorter Lives, Poorer Health.” It’s available on the web. There’s a good summary in the journal Science dated Aug. 30.

The report ranks the United States last among 17 high-income democracies including all the larger western European nations plus Canada, U.S., Australia, and Japan. Americans’ healthcompares unfavorably with that of other nations at almost every stage of life.

This includes life expectancy, adverse birth outcomes, heart disease, injuries from motor vehicle accidents, injuries from violence, drug-related deaths, disability, sexually acquired diseases, lung disease, infant mortality, AIDS, child obesity, adult obesity and diabetes. It’s a list worth pondering, and an indictment of U.S. health care. The sorry state of U.S. health is all the more remarkable when one notes that we spend far more on health care than any other nation: $8,200 per person in 2010. The average among 33 other highly developed countries was $3,300 per person, with Norway, at $5,400 per person, spending the most.

We must be doing something terribly wrong.

We need to think honestly and non-ideologically about the reasons, because this problem, a problem that weneither understand nor even recognize, is killing us.

The report fi nds multiple explanations for poor U.S.

health. Here are the fi rst four:

First and foremost, unlike our 16 peer nations studied, we have large uninsured populations and more limited access to care. Americans are more likely to find health care inaccessible or unaff ordable. Uninsured people often forgo necessary or preventative care, driving up overall costs while driving down the nation’s health.

We have 44 million with no health insurance, plus 38 million with inadequate insurance. This is surely unacceptable and, in fact,outrageous.

Second is our unhealthy behaviors. Although Americans smoke less and drink less than people in our peer countries, we consume the most calories per person, abuse drugs the most, are less likely to use seat belts, are involved in more alcohol-related traft c accidents, and are more likely to resort to the violent use of guns.

Third, our peer nations provide better social and economic conditions. U.S.

average incomes are higher than that of most other nations, but our income inequality has jumped since about 1980 and we have higher levels of adult andchild poverty. For all our Horatio Alger mythology, we have lower social mobility than peer nations: Poor American kids fi nd themselves largely stuck, while kids in other nations receive the helping hand needed to escape poverty.

Because of the wellsubstantiated correlation between poverty and poor health, this aff ects America’s health outcomes. Other nations outpace us in the education of young people, which aff ects lifetime health. And American adults benefit less from safety nets that buffer the unhealthy effects of poverty.

Fourth, the report notes that U.S. infrastructure islargely constructed around automobiles, as opposed to walking, bicycling, buses, and trains. Sprawling cities, far-fl ung bedroom communities, and singleminded focus on cars as the primary transportation mode, discourages physical activity and contributes to obesity. As I’ve repeated frequently (nauseously, some of you will say) in these pages, over-dependence on cars causes the decline of our cities, resulting in a rise in poor health.

U.S. health care has trended downward during the past three decades, especially when viewed relative to other nations. Unless we change something, this trend will continue. We must hope President Obama’s Affordable Care Act improves these trends.

Nearly any change would be an improvement, because it’s hard to imagine a worse system than what we have. Our peer nations, all of whom have far better and far cheaper health care systems than ours, uniformly have systems that are more “socialized” than ours. It seems obvious that we need to take a tip from them.

ART HOBSON IS A PROFESSOR EMERITUS OF PHYSICS AT THE UNIVERSITY OF ARKANSAS.