America may be one of the richest countries in the world, but its people are less healthy and more likely to die early from disease or accidents than those in any other affluent country, a damning official US report has found.
Even the best-off Americans – those who have health insurance, a college education, a high income and healthy behaviour – are sicker than their peers in comparable countries, says the report by the US National Research Council and the Institute of Medicine.
"We were struck by the gravity of these findings," said Steven H Woolf, professor of family medicine at Virginia Commonwealth University in Richmond and chair of the panel that wrote the report. "Americans are dying and suffering at rates that we know are unnecessary because people in other high-income countries are living longer lives and enjoying better health. What really concerns our panel is why, for decades, we have been slipping behind." The report, US Health in International Perspective: Shorter Lives, Poorer Health, was commissioned by the National Institutes of Health. It compares the US with 16 affluent democracies, including Australia, Canada and Japan and many in Europe including Britain. There have been similar findings from the Commonwealth Fund over some years, but they have compared the US with only a handful of nations.
The new report looked in detail at data from the late 1990s to 2008. "Over this time period, we uncovered a strikingly consistent and pervasive pattern of higher mortality and inferior health in the United States, beginning at birth," it said.
For many years, Americans have had a shorter life expectancy than people in almost all the comparator countries and for the past three decades the gap has been widening, particularly for women.
The US does badly in nine specific areas. It has the highest infant mortality rate of any wealthy country and also does poorly on other birth outcomes, such as low weight babies.
Deaths from injuries and homicides are far higher than elsewhere and a leading cause of death in children, adolescents and young adults. US adolescents have had the highest rate of pregnancies of affluent countries since the 1990s and are more likely to acquire sexually transmitted infections. The US has the second highest HIV rate and the highest incidence of Aids among the 17 countries.
Even taking out drunk driving, Americans lose more years of life to alcohol and other drugs than people in other affluent countries. The US has the highest obesity rate and, from age 20, one of the highest levels of type 2 diabetes. The death rate from heart disease is the second highest in the 17 countries. There is more lung disease and more deaths from it than in Europe and older people report more arthritis and other limitations on their activity than in Europe or Japan.
The US is, however, good at looking after the health of the most elderly. People who reach 75 are more likely to live longer, have lower death rates from stroke and cancer, better-controlled blood pressure and cholesterol levels and lower rates of smoking than elsewhere.
But death and disease take a huge toll on the younger American population, even though the US spends more on healthcare per capita than almost any other country in the world. Poverty, inequality, racial and ethnic differences and lack of health insurance are part of the story but not all. Even non-Hispanic white people with money and insurance who are not smokers or obese do less well than those in other countries.
Unless action is taken, the report says, the health of Americans will probably continue to fall behind. "The tragedy is not that the United States is losing a contest with other countries but that Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary. Superior health outcomes in other nations show that Americans also can enjoy better health," says the report.
The US public is unaware of the issues, says the report. "I don't think most parents know, on average, infants, children, and adolescents in the US die younger and have greater rates of illness and injury than youth in other countries," said Woolf.
The report says the situation will not improve unless Americans wake up to the truth about their health and a public debate begins.
