Last week, American people, health-care workers, and policy makers received shocking news. Despite spending more on health care per person than other high-income countries, Americans die sooner, are least likely to reach the age of 50 years, and have higher rates of disease or injury. When judged by health alone, Americans are less healthy from birth to 75 years of age than people in 16 other economically wealthy countries, and this health disadvantage has been getting worse for 30 years, especially among women.
In a report released on Jan 9 from the US National Research Council and Institute of Medicine, U.S. Health in International Perspective: Shorter Lives, Poorer Health, comprehensive mortality and morbidity data are presented, comparing the USA with affluent democratic countries including Australia, Canada, France, Italy, most of the Nordic countries, Spain, and the UK. Life expectancy is shorter at birth for American men than for men in any of the other 16 countries, and American women fare little better—Denmark is the only country that has a lower life expectancy for women at birth. In nine key areas of health, Americans fare least well, or are near the bottom of the tables. These areas are: infant mortality and low birthweight; injuries and homicides; teenage pregnancies and sexually transmitted infections; HIV/AIDS prevalence; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability. This health disadvantage applies to those with health insurance, a college education, higher incomes, and healthy behaviours as well as to those without.
US health spending was US$2·7 trillion in 2011, which is $8700 for every person in the country, and represents 17·9% of the economy—far greater than any other economically advanced country. But spending on health care bears little relation to good health.
To promote and inform continuing debate, health in the USA will be the theme of a Series in a special issue of The Lancet in 2014. In conjunction with Tom Frieden and Harold Jaffe at the Centers for Disease Control and Prevention, we will publish papers reviewing new opportunities to substantially improve health in the era of the Affordable Care Act. Planned topics include more on premature mortality in the USA, the impact of violence and injury, the challenges of non-communicable diseases and infections, public health and biosecurity, and the role of the USA in global health.
The USA is one of the world's wealthiest countries; it should be one of the world's healthiest.
For the report on US health disadvantage see http://www.nap.edu/catalog.php?record_id=13497
For the US prevention strategy see http://www.healthcare.gov/prevention/nphpphc/strategy/report.pdf