If You’re an American, You’re Sicker Than You Should Be

Stories from New Scientist.
July 21 2013 7:00 AM

Why Is the United States So Sick?

The director of a massive new study says: “It’s almost everything.”

A member of Occupy DC smokes a cigarette after a march to mark the first anniversary of the movement.
Americans die younger and experience more illness than people in other rich nations

Photo by Alex Wong/Getty Images

In the wake of a startling report highlighting the United States’ poor health compared with other wealthy nations, the report’s director searches for answers.

Americans die younger and experience more injury and illness than people in other rich nations, despite spending almost twice as much per person on health care. That was the startling conclusion of a major report released earlier this year by the U.S. National Research Council and the Institute of Medicine.

It received widespread attention. The New York Times concluded: "It is now shockingly clear that poor health is a much broader and deeper problem than past studies have suggested."

What it revealed was the extent of the United States' large and growing "health disadvantage," which shows up as higher rates of disease and injury from birth to age 75 for men and women, rich and poor, across all races and ethnicities. The comparison countries—Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands and the United Kingdom—generally do much better, although the United Kingdom isn't far behind the United States.

The poorer outcomes in the United States are reflected in measures as varied as infant mortality, the rate of teen pregnancy, traffic fatalities, and heart disease. Even those with health insurance, high incomes, college educations, and healthy lifestyles appear to be sicker than their counterparts in other wealthy countries. The U.S. Council on Foreign Relations, a nonpartisan think tank, described the report as "a catalog of horrors."

Findings that prompted this reaction include the fact that the rate of premature births in the United States is the highest among the comparison countries and more closely resembles those of sub-Saharan Africa. Premature birth is the most frequent cause of infant death in the United States, and the cost to the health care system is estimated to top $26 billion a year.

As distressing as all this is, much less attention has been given to the obvious question: Why is the United States so unwell? The answer, it turns out, is simple and yet deceptively complex: It's almost everything.

Our health depends on much more than just medical care. Behaviors such as diet, physical activity, and even how fast we drive all have profound effects. So do the environments that expose us to health risks or discourage healthy living, as well as social determinants of health, such as education, income, and poverty.

The United States fares poorly in almost all of these. In addition to many millions of people lacking health insurance, financial barriers to care, and a lack of primary care providers compared with other rich countries, people in the United States consume more calories, are more sedentary, abuse more drugs, and shoot one another more often. The United States also lags behind on many measures of education, has higher child poverty and income inequality, and lower social mobility than most other advanced democracies.

The breadth of these causal factors, and the scope of the U.S. health disadvantage they produce, raises some fundamental questions about U.S. society. As the NRC/IOM report noted, solutions exist for many of these health problems, but there is "limited political support among both the public and policymakers to enact the policies and commit the necessary resources."

One major impediment is that the United States, which emphasizes self-reliance, individualism, and free markets, is resistant to anything that even appears to hint at socialism. Interestingly, as a group, classically liberal nations like the United States and the United Kingdom—free market-oriented with less regulation, tax, and government services—are the least healthy among wealthy democracies.

By contrast, social democratic countries such as Sweden—in which the state emphasizes full employment, income protection, housing, education, health and social insurance—enjoy better overall health, although health inequalities within these nations are not always the smallest.

Debates about the relative merits of "cut-throat" U.S. versus "cuddly" Swedish capitalism contend that there are important trade-offs between economic growth and innovation on the one hand and growing inequality, high poverty, and a weak social safety net on the other. Unfortunately, these debates often fail to factor in our health. That needs to change.

And, as it turns out, the United States spends plenty on social welfare. It may tax less and spend less on social programs than most rich democracies, but when you add in tax-based subsidies and private social spending, it ranks as the fifth highest in the world, just after Sweden. What distinguishes the United States is how that money is spent. More goes to healthcare—while still leaving many without health insurance or access to care—and less to children, families, and the disadvantaged.

Digging into the social determinants of health can be tricky. Social scientists and other researchers are rightly trained not to confuse correlation with causation. But the evidence on the biology of disadvantage—how social and economic conditions affect our health and survival—is rapidly building.

Following the World Health Organization's 2008 Commission on Social Determinants of Health, countries such as Finland, Australia, and Canada are taking a "health in all policies" approach that promotes health through public policies in areas as diverse as transportation, housing, and agriculture. In the United States, these ideas have yet to gain much traction.

Moving beyond the dismal headlines generated by the NRC/IOM report, we can hope that the evidence of a health disadvantage in the United States is now so compelling that the terms of the conversation and even the political calculus will begin to change. Then, perhaps, we can start addressing that disadvantage and stop paying for it with our lives.

This article originally appeared in New Scientist.

TODAY IN SLATE

Doublex

Crying Rape

False rape accusations exist, and they are a serious problem.

Scotland Is Just the Beginning. Expect More Political Earthquakes in Europe.

No, New York Times, Shonda Rhimes Is Not an “Angry Black Woman” 

Brow Beat
Sept. 19 2014 1:39 PM Shonda Rhimes Is Not an “Angry Black Woman,” New York Times. Neither Are Her Characters.

The Music Industry Is Ignoring Some of the Best Black Women Singing R&B

How Will You Carry Around Your Huge New iPhone? Apple Pants!

Medical Examiner

The Most Terrifying Thing About Ebola 

The disease threatens humanity by preying on humanity.

Television

The Other Huxtable Effect

Thirty years ago, The Cosby Show gave us one of TV’s great feminists.

There’s a Way to Keep Ex-Cons Out of Prison That Pays for Itself. Why Don’t More States Use It?

Why Men Can Never Remember Anything

The XX Factor
Sept. 19 2014 1:11 PM Why Men Can Never Remember Anything
Behold
Sept. 19 2014 11:33 AM An Up-Close Look at the U.S.–Mexico Border
  News & Politics
Foreigners
Sept. 19 2014 1:56 PM Scotland’s Attack on the Status Quo Expect more political earthquakes across Europe.
  Business
Moneybox
Sept. 19 2014 3:24 PM Why Innovators Hate MBAs
  Life
Inside Higher Ed
Sept. 19 2014 1:34 PM Empty Seats, Fewer Donors? College football isn’t attracting the audience it used to.
  Double X
The XX Factor
Sept. 19 2014 3:07 PM Everything Is a "Women's Issue"
  Slate Plus
Slate Picks
Sept. 19 2014 12:00 PM What Happened at Slate This Week? The Slatest editor tells us to read well-informed skepticism, media criticism, and more.
  Arts
Brow Beat
Sept. 19 2014 4:03 PM Kern Your Enthusiasm: The Ubiquity of Gotham
  Technology
Future Tense
Sept. 19 2014 12:38 PM Forward, March! Nine leading climate scientists urge you to attend the People’s Climate March.
  Health & Science
Medical Examiner
Sept. 19 2014 12:13 PM The Most Terrifying Thing About Ebola  The disease threatens humanity by preying on humanity.
  Sports
Sports Nut
Sept. 18 2014 11:42 AM Grandmaster Clash One of the most amazing feats in chess history just happened, and no one noticed.