Friday, December 19, 2014

We're a lot sicker than we realize

Should the wealthiest country in the world also be the healthiest? It seems logical that it should be, but, alas for us, that is not the case.

We’re a lot sicker than we realize

Should the wealthiest country in the world also be the healthiest? It seems logical that it should be, but, alas for us, that is not the case.

Americans enjoy more material wealth than any other major developed nation, but when it comes to health, we lag far behind. Our money can buy many things, but physical wellbeing is apparently not one of them.

The grim details emerged in a report published this week by the Institute of Medicine, a component of the National Academy of Sciences. Americans have shorter life expectancies, higher rates of disease, and higher rates of injuries than citizens of other high-income countries. American males have the shortest life expectancy of 17 nations studied, and females have the second to worst. (Click here for a summary of the Report.)

Our health disadvantage is evident at all ages up to 75. It persists even for those with high incomes and high levels of education, and for those who engage in healthy behaviors. Living in America puts almost everyone at greater risk of poor health.

The United States did particularly poorly compared with other affluent nations in nine key health areas. These are infant mortality and low birth weight, injuries and homicides, teen pregnancies and sexually transmitted infections, prevalence of HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease, and disability.

Even more disturbing is a finding that the gap is especially large for American infants and children. Their mortality rates are higher than their age-mates in the other countries studied, and they are more likely to become sick or injured. One result is that Americans are also less likely to survive to age 50.

The only bright spot was for the elderly, those above age 75. Americans in that age group are likely to live longer than those of a similar age in other wealthy nations.

It’s not as though Americans don’t spend enough on health care. In fact, we spend more than any other country – by a wide margin. We now devote close to 18% of our entire economy to health care, which is almost 50% more than the next highest spender, France. It spends just under 12%. In Japan, where women live longer than anywhere else in the world, the figure is even lower at 9.5%.

To risk a gross understatement, we are getting a terrible deal for what we pay.

What’s going on? Why aren’t Americans healthier?

The Report identified several possible culprits, but none of them explains it all. Shortcomings in our health system could be part of the problem, but that wouldn’t explain the greater incidence of injuries. More unhealthy behavior could explain a portion, but Americans who lead healthy lifestyles still do worse than their counterparts elsewhere. More widespread poverty could also be a cause, but higher-income Americans are still sicker than wealthy citizens of other countries.

However, one aspect of our health care system clearly deserves a large piece of the blame. We are the only country in the developed world that fails to guarantee health care coverage to all citizens. Almost 50 million Americans currently lack health insurance. Their access to primary care is limited largely to emergency rooms and public clinics, and they have almost no access to advanced care.

Of course, their numbers will fall significantly when Obamacare fully kicks in next year. It will guarantee coverage to everyone who wants it. However, experts predict that 20 million people will still be left without health insurance.

Thanks to the Report, we now know the real cost of excluding millions of people from access to health care. It is measured in more than just money. We pay it with our health and our lives.

Could there be a more compelling reason for health reform than that?

- By Robert I. Field, Ph.D., J.D., M.P.H.

Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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