National Research Council (NRC) and Institute of Medicine (IOM) Health Report — Shows How Far the United States Lags Affluent Nations — in Longevity and Accepted Indicators of Health Quality — Tables and Graphs Dramatically Make the Point

© 2013 Peter Free

 

10 January 2013

 

 

Citation — to the “credible” quality of health report

 

Stephen H. Woolf and Laudan Aron (editors), U.S. Health in International Perspective — Shorter Lives, Poorer Health, National Research Council and Institute of Medicine (2013) (pre-publication copy)

 

Publisher’s recommended citation:

 

National Research Council and Institute of Medicine. (2013). U.S. Health in International Perspective: Shorter Lives, Poorer Health. Panel on Understanding Cross-National Health Differences Among High-Income Countries, Steven H. Woolf and Laudan Aron, Eds. Committee on Population, Division of Behavioral and Social Sciences and Education, and Board on Population Health and Public Health Practice, Institute of Medicine. Washington, DC: The National Academies Press.

 

[You can see why I am not partial to the recommended format.]

 

Note

 

You can download the entire report (or its chapters) at the above URL.

 

The electronic PDF is free of charge.  But the National Academies Press does require registration (email address and user name) to use its download service.

 

 

Why do we care what these “guys” say about health?

 

The National Research Council and the Institute of Medicine are components of the United States’ scientifically prestigious National Academies:

 

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare.

 

Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters.

 

© 2013 Stephen H. Woolf and Laudan Aron (editors), U.S. Health in International Perspective — Shorter Lives, Poorer Health, National Research Council and Institute of Medicine (2013) (at unpaginated introductory material in pre-publication copy)

 

 

 

None of these findings are new — but the United States’ comparative health performance is falling still further behind

 

The expert panel compared U.S. health performance to 16 other nations:

 

Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom.

 

Using decades of data, but concentrating on that 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:

 

For many years, Americans have had a shorter life expectancy than people in almost all of the peer countries. For example, as of 2007, U.S. males lived 3.7 fewer years than Swiss males and U.S. females lived 5.2 fewer years than Japanese females.

 

 

For the past three decades, this difference in life expectancy has been growing, especially among women.

 

 

The health disadvantage is pervasive—it affects all age groups up to age 75 and is observed for multiple diseases, biological and behavioral risk factors, and injuries.

 

 

© 2013 Stephen H. Woolf and Laudan Aron (editors), U.S. Health in International Perspective — Shorter Lives, Poorer Health, National Research Council and Institute of Medicine (2013) (pre-publication copy) (at page 2)

 

 

Nine categories in which U.S. health trails affluent nations

 

U.S. health does comparatively poorly in 9 major categories:

 

Adverse birth outcomes

Injuries and homicides

Adolescent pregnancy and sexually transmitted infections

HIV and AIDS

Drug related mortality

Obesity and diabetes

Heart disease

Chronic lung disease

Disability

 

Of these, the panel generalizes that:

 

Deaths that occur before age 50 are responsible for about two-thirds of the difference in life expectancy between males in the United States and peer countries,

and about one-third of the difference for females.

 

And the problem has been worsening over time; since 1980, the United States has had the first or second lowest probability of surviving to age 50 among the 17 peer countries.

 

Americans who do reach age 50 generally arrive at this age in poorer health than their counterparts in other high-income countries, and

as older adults they face greater morbidity and mortality from chronic diseases that arise from risk factors (e.g., smoking, obesity, diabetes) that are often established earlier in life.

 

The U.S. health disadvantage is more pronounced among socioeconomically disadvantaged groups,

but even advantaged Americans appear to fare worse than their counterparts in England and some other countries.

 

© 2013 Stephen H. Woolf and Laudan Aron (editors), U.S. Health in International Perspective — Shorter Lives, Poorer Health, National Research Council and Institute of Medicine (2013) (pre-publication copy) (at page 3) (sentences and paragraphs split)

 

 

Why is this?

 

The short answer is that no one knows.  But there are hints, ranging from systemic to sociological.

 

Below, I have rearranged some of what the panel wrote to make it more logically coherent.  Proceeding from (a) the institutionally systemic to (b) more individualized sociological causations:

 

 

[I]mportant antecedents of good health—such as the quality of health care and the prevalence of health-related behaviors—are also frequently problematic in the United States.

 

[T]he U.S. health system is highly fragmented, with limited public health and primary care resources and a large uninsured population.

 

Compared with people in other countries, Americans are more likely to find care inaccessible or unaffordable and to report lapses in the quality and safety of care outside of hospitals.

 

[T]he United States has higher rates of poverty and income inequality than most high-income countries.

 

Americans have less access to the kinds of “safety net” programs that help buffer the effects of adverse economic and social conditions in other countries.

 

U.S. children are more likely than children in peer countries to grow up in poverty, and the proportion of today’s children who will improve their socioeconomic position and earn more than their parents is smaller than in many other high-income countries.

 

In addition, although the United States was once the world leader in education, students in many countries now outperform U.S. students.

 

© 2013 Stephen H. Woolf and Laudan Aron (editors), U.S. Health in International Perspective — Shorter Lives, Poorer Health, National Research Council and Institute of Medicine (2013) (pre-publication copy) (at page 4)

 

From the sociological perspective, the panel noted that:

 

 

Americans are less likely to smoke and may drink less heavily than their counterparts in peer countries, but they[:]

 

consume the most calories per capita,

 

abuse more prescription and illicit drugs,

 

are less likely to fasten seatbelts,

 

have more traffic accidents involving alcohol,

 

and

 

own more firearms than their peers in other countries.

 

U.S. adolescents seem to become sexually active at an earlier age, have more sexual partners, and are less likely to practice safe sex than adolescents in other high-income countries.

 

© 2013 Stephen H. Woolf and Laudan Aron (editors), U.S. Health in International Perspective — Shorter Lives, Poorer Health, National Research Council and Institute of Medicine (2013) (pre-publication copy) (at page 4) (paragraph split and reformatted)

 

 

One surprising insight — even advantaged Americans may be in poorer health than their foreign peers

 

The following tidbit partially deflates some Americans’ favorite retort, namely that our health system gets better results for people who can afford it:

 

 

[S]everal recent studies have suggested that even Americans with high socioeconomic status may experience poorer health than their counterparts in peer countries.

 

Americans with healthy behaviors or those who are white, insured, college-educated, or in upper-income groups appear to be in worse health than similar groups in comparison countries.

 

© 2013 Stephen H. Woolf and Laudan Aron (editors), U.S. Health in International Perspective — Shorter Lives, Poorer Health, National Research Council and Institute of Medicine (2013) (pre-publication copy) (at page 4) (paragraph split and reformatted)

 

 

More subtle causes?

 

The authors wonder whether:

 

Agribusiness decisions distort a healthier food supply?

 

Stressful living conditions encourage unhealthy behaviors?

 

Easy availability of firearms results in gun violence?

 

Unhealthy housing and air pollution exacerbate asthma?

 

Pedestrian-unfriendly cities discourage physical exercise?

 

Lack of public transportation increases auto traffic and accidents?

 

Lax enforcement of driving laws encourages risky behavior?

 

Crumbling physical infrastructure contributes to more accidents?

 

 

Graphs and charts — very revealing

 

Generalizations are often easily disregarded.  Seeing comparative quantitative results in table and graph form can be more persuasive.

 

Here are some of the pre-publication copy’s more interesting charts:

 

page 27 (comparative mortality, by nation, chronic diseases)

 

page 27 (comparative mortality, by nation, infectious diseases)

 

pages 28-31 (Table 1-1, mortality rates by illness per nation)

 

page 32 (injury mortality, by nation)

 

page 38 (U.S. death rates compared to 16 nations, above and below categories)

 

page 39 (life expectancy at birth, 17 nations)

 

page 42 (U.S. male life expectancy at birth, yearly, 1980 to 2006, compared to 21 nations)

 

page 43 (U.S. female life expectancy at birth, yearly, 1980 to 2006, compared to 21 nations)

 

page 44 (probability that a 15-year old will die before age 50, U.S. versus 16 nations)

 

page 46 (probability survival for age 50 male, by year, 1980 to 2006, 21 nations)

 

page 47 (probability survival for age 50 female, by year, 1980 to 2006, 21 nations)

 

page 48 (U.S. mortality by age group, compared to 16 other nations)

 

page 49 (U.S. mortality by age group, non-Hispanic whites only, compared to 16 nations)

 

page 50 (years of life lost before age 50, males, 17 nations)

 

page 51 (years of life lost before age 50, females, 17 nations)

 

page 52 (years life lost before age 50, by cause, U.S. males versus mean of 16 nations)

 

page 53 (years life lost before age 50, by cause, U.S. females versus mean of 16 nations)

 

page 54 (pie chart, years U.S. life lost before age 50, by cause of increased mortality, males, versus 16 nations)

 

page 55 (pie chart, years U.S. life lost before age 50, by cause of increased mortality, females, versus 16 nations)

 

pages 61-63 (U.S. rank by age group, per health indicator, versus 16 nations)

 

page 65 (ranking, deaths per 1,000 live births, 17 nations)

 

page 66 (ranking, low birth weight, 17 nations)

 

page 67 (global map, color keyed by national prevalence of pre-term births)

 

page 68 (graph, U.S infant mortality versus average of 16 nations, by year, 1960 to 2009)

 

page 72 (graph, prevalence of overweight children, male versus female, 17 nations)

 

page 73 (ranking, adolescent birth rate, 17 nations)

 

page 76 (graph, transportation mortality, U.S. males, age 15-19, versus average 16 peer nations)

 

page 76 (graph, transportation mortality, U.S. males, age 20-24, versus average 16 peer nations)

 

page 77 (graph, violent mortality, U.S. males, age 15-19, versus mean 16 peer nations)

 

page 77 (graph, violent mortality, U.S. males, age 20-24, versus mean 16 peer nations)

 

page 79 (ranking, average body mass index, BMI, age 15-24, male versus female, 17 nations)

 

page 79 (ranking, average body mass index, BMI, age 25-34, male versus female, 17 nations)

 

page 80 (ranking, average body mass index, BMI, age 35-44, male versus female, 17 nations)

 

page 81 (ranking, self-reported diabetes, age 15-24, male versus female, 17 nations)

 

page 81 (ranking, self-reported diabetes, age 25-34, male versus female, 17 nations)

 

page 82 (ranking, self-reported diabetes, age 35-44, male versus female, 17 nations)

 

page 83 (Table 2-2, distribution of cardiovascular risk, by risk level, 11 nations)

 

page 116 (graph, percentage of primary care physicians among all medical doctors, 15 nations)

 

page 125 (graph, percentage of asthma hospital admissions, age 15 and up, 16 nations)

 

page 126 (graph, hospital admissions for uncontrolled diabetes, 14 nations)

 

page 142 (graph, prevalence of daily tobacco smoking, 17 nations)

 

page 143 (graph, lag time between increased U.S. smoking prevalence and increased deaths, males versus females)

 

page 146 (global map, color keyed by per capita calorie intake)

 

page 155 (percentages, auto seat belt and motorcycle helmet use, DUI deaths, 16 nations)

 

page 158 (graph, firearms per 100 people, 17 nations)

 

page 173 (graph, poverty rates by decade, 1980s to most recently available, 17 nations)

 

page 174 (graph, child poverty rates by decade, 1980s to 2008, 17 nations)

 

page 182 (2006 ranking, 15-year old student performances, reading-science-math, 17 nations)

 

 

From my perspective — an educated guess

 

I did not find the panel’s overall findings surprising because:

 

(1) The United States is among the most socioeconomically stratified of affluent nations.

 

(2) Our health care system is deliberately structured to allow cumulative profit-taking at multiple levels.

 

For example ObamaCare (Affordable Care Act) mandates citizens’ entry into the system, without simultaneously putting any meaningful brakes on escalating health care or insurance costs.

 

In other words, the President and his industry allies forced all Americans and their employers to actively enter an insurance system that directly benefits the avariciously sprawling health care industry.

 

(3) American voters frequently vote against their own economic and health self-interests based on poorly evaluated ideological leanings that make no practical sense.

 

 

The moral? — We are not doing especially well health-wise, and we’re probably not going to get any better in the foreseeable future

 

That said, I recommend the U.S. Health in International Perspective — Shorter Lives, Poorer Health to thoughtfully open-minded readers.

 

Glancing at its charts and tables conveys the most important bits of its message.