People in US have poorer health and die younger than those in other rich countries

BMJ 2013; 346 doi: (Published 11 January 2013) Cite this as: BMJ 2013;346:f215
  1. Michael McCarthy
  1. 1Seattle

People in the United States are less healthy, have more chronic disease and disability, and die at a younger age than people living in other wealthy nations, concludes a new report by a panel convened by the US National Research Council and the Institute of Medicine.1

The panel found that the US fell short in health outcomes at every age from birth to 75 years and that the deficiencies were found at all levels of society. Even high income, college educated, white Americans tended to be sicker and die younger than their peers in other rich countries.

So many problems were identified in so many areas that it indicated that “something is fundamentally going wrong,” said Stephen Woolf, professor of family medicine at Virginia Commonwealth University in Richmond, Virginia, and chairman of the panel.

In the report, released on 9 January, the panel compared health outcomes in the US with those in 16 high income “peer” countries: Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom.

The panel found that US men had the lowest life expectancy, at 75.64 years, of the nations studied, living 3.7 fewer years than men in top ranking Switzerland, and that US women had a life expectancy of 80.78, a bit better than women in bottom ranking Denmark, but 5.2 years fewer than women in top ranking Japan.

When US health outcomes were compared with the average of the peer countries, Americans fared the worst in nine areas: infant mortality and low birth weight; injuries and homicide; adolescent pregnancy and sexually transmitted infections; HIV and AIDS; drug related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability.

Several of these areas, such as high infant mortality and homicides and accidents, affect young people in particular and so have a significant effect on life expectancy, the report notes. In fact, two thirds of the difference in life expectancy in men between the US and the other countries could be attributed to deaths before 50.

Those Americans who do reach age 50, however, tend to “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 (eg, smoking, obesity, diabetes) that are often established earlier in life,” the panel said.

Shortcomings of the US health system may contribute to many of these poor outcomes, but the problems are too “pervasive” to be explained by failures in the health system alone, the report concludes.

In fact, by some measures the US health system outperformed systems in the other nations, achieving higher rates of cancer screening and survival, better control of blood pressure and cholesterol levels, and lower stroke mortality, for example.

Indeed Americans aged over 75 live longer than their peers in the comparison nations and have lower death rates from stroke and cancer.

Nevertheless, the US’s fragmented healthcare system and shortage of primary care and public health services have likely affected the nation’s health outcomes, the panel said.

But larger social, environmental, and policy factors play a substantial role as well, the panel said. These included higher rates of poverty and income inequality, declining educational achievement, an unhealthy food culture, communities designed for cars that discourage walking and other physical activity, and high risk behaviors involving drug use, reckless driving, and firearms.

The panel closed with a call for a “strengthened national commitment” to tackle the problems identified in the report, a “robust outreach effort” to inform the public and “stimulate a national discussion” about these problems, and an “examination of the policies and approaches that countries with better health outcomes have found useful and that may have application, with adaptations, in the United States.”


Cite this as: BMJ 2013;346:f215