For four decades, the health of Americans has declined compared to 16 other high-income countries. A comprehensive report sponsored by the National Research Council and the Institute of Medicine, “U.S. Health in International Perspective: Shorter Lives, Poorer Health” (www.iom.edu/Reports/2013) analyzes wide-ranging data gathered from the 1990s to 2008 to determine causes for this decline. Canada, Japan, France, Germany, Italy, the United Kingdom and Australia are among the nations with whom we are contrasted.
Compared to our wealthy peers, Americans have shorter lifespans and worse health. The U.S. fares badly in nine areas:
• Adverse birth outcomes. We have a high infant mortality rate, low average birth weight and a lower likelihood that a child will reach age 5.
• Injuries and homicides. Both transportation and non-transportation accidents are increased along with homicide. Adolescents and young adults die at a higher rate than similar-aged residents of other nations.
• Adolescent pregnancy and sexually-transmitted diseases. We have higher rates in both categories.
• HIV/AIDS. The U.S. incidence for AIDS is the highest.
• Drug and alcohol related mortality. This includes both prescription and illicit drugs.
• Obesity and diabetes. The incidence of childhood obesity is especially prominent, far above that of our peer nations. More than one-third of Americans age 5 to 17 are overweight. Obesity in childhood usually leads to obesity in adult years, and obesity is a powerful risk factor for diabetes.
• Heart disease. Despite advances in controlling high blood pressure and elevated cholesterol, Americans over age 50 are more likely to develop and die from cardiovascular disease.
• Chronic lung disease. We have a higher incidence of emphysema and chronic bronchitis than wealthy European countries.
• Disability. Our incidence of chronic arthritis and other movement-limiting disorders is higher than our peers.
The nine conditions are more prevalent among socially and economically disadvantaged Americans. Even wealthier Americans, however, are less healthy than their overseas counterparts. Women fare worse than men.
This information indicates that we should smoke less and drink less heavily. We consume many more calories and use more prescription narcotics and illicit drugs. Americans are less likely to use seatbelts. We are less physically active.
Even with enactment of the Affordable Care Act, we have many more residents who lack access to health care, especially primary care and preventive services. Among wealthy nations, we have a higher rate of poverty and wider income disparity.
The report analyses various determinants of health. Individual behavior is paramount. Multiple, unhealthy behaviors may coexist. An individual may smoke, drink to excess, be overweight and prone to violent behavior. Excess drinking or abuse of prescription opiates may contribute to reckless driving or carelessness in the workplace.
Our health care system remains fragmented. This is particularly evident in the management of chronic illness. Emergency rooms, which serve as the primary care provider for many, are not equipped to provide long-term care.
Neighborhoods play a role if there is no access to playgrounds, sound schools and stores with affordable, healthy foods.
Violence and sexually charged content are increasingly part of popular entertainment, whether in movies, televised programs, or video games.
The report is almost overwhelming in its content and analyses. Where does an individual, a family or a community begin corrective action to regain better health for nation?
Contact Clif Cleaveland at cleaveland1000@comcast.net.