U.S. Health in International Perspective (original) (raw)

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Shorter Lives, Poorer Health

Authors: ; Institute of Medicine (US). Editors: Steven H Woolf and Laudan Aron.

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Copyright © 2013, National Academy of Sciences.

Excerpt

The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. A growing body of research is calling attention to this problem, with a 2011 report by the National Research Council confirming a large and rising international “mortality gap” among adults age 50 and older. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people, because recent studies suggest that even highly advantaged Americans may be in worse health than their counterparts in other countries.

As a follow-up to the 2011 National Research Council report and in light of this new evidence, the National Institutes of Health asked the National Research Council (NRC) and the Institute of Medicine (IOM) to convene a panel of experts to study this issue. The Panel on Understanding Cross-National Health Differences Among High-Income Countries was charged with examining whether the U.S. health disadvantage exists across the life span, exploring potential explanations, and assessing the larger implications of the findings.

Contents

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• THE NATIONAL ACADEMIES

• PANEL ON UNDERSTANDING CROSS-NATIONAL HEALTH DIFFERENCES AMONG HIGH-INCOME COUNTRIES

• COMMITTEE ON POPULATION 2012

• BOARD ON POPULATION HEALTH AND PUBLIC HEALTH PRACTICE 2012

• Foreword

• Preface

• Summary

  • THE INFERIOR HEALTH STATUS OF THE UNITED STATES
  • POSSIBLE EXPLANATIONS FOR THE U.S. HEALTH DISADVANTAGE
  • NEXT STEPS
  • COSTS OF INACTION

• Introduction

  • THE ROLE OF DIVERSITY IN HEALTH DISADVANTAGES
  • FINDING ANSWERS IS CRITICAL
  • STUDY CHARGE AND PANEL APPROACH
  • TOPICS BEYOND THE SCOPE OF THIS STUDY
  • THE REPORT

• I. Documenting the U.S. Health Disadvantage

  • 1. Shorter Lives
    * MORTALITY RATES
    * CROSS-NATIONAL DIFFERENCES IN LIFE EXPECTANCY
    * SURVIVAL TO AGE 50
    * YEARS OF LIFE LOST BEFORE AGE 50
    * CAUSES OF PREMATURE DEATH
    * INFLUENCE OF EARLY DEATHS ON LIFE EXPECTANCY AT BIRTH
    * CONCLUSIONS
  • 2. Poorer Health Throughout Life
    * HEALTH ACROSS THE LIFE COURSE
    * CHILDREN AND ADOLESCENTS
    * ADULTS
    * CONCLUSIONS

• II. Explaining the U.S. Health Disadvantage

  • 3. Framing the Question
    * THE DETERMINANTS OF HEALTH
    * THE SOCIAL-ECOLOGICAL FRAMEWORK
    * A LIFE-COURSE PERSPECTIVE
    * CONCLUSIONS
  • 4. Public Health and Medical Care Systems
    * DEFINING SYSTEMS OF CARE
    * QUESTION 1 DO PUBLIC HEALTH AND MEDICAL CARE SYSTEMS AFFECT HEALTH OUTCOMES?
    * QUESTION 2 ARE U.S. HEALTH SYSTEMS WORSE THAN THOSE IN OTHER HIGH-INCOME COUNTRIES?
    * QUESTION 3 DO U.S. HEALTH SYSTEMS EXPLAIN THE U.S. HEALTH DISADVANTAGE?
    * WHAT U.S. HEALTH SYSTEMS CANNOT EXPLAIN
    * CONCLUSIONS
  • 5. Individual Behaviors
    * TOBACCO USE
    * DIET
    * PHYSICAL INACTIVITY
    * ALCOHOL AND OTHER DRUG USE
    * SEXUAL PRACTICES
    * INJURIOUS BEHAVIORS
    * CONCLUSIONS
  • 6. Social Factors
    * QUESTION 1 DO SOCIAL FACTORS MATTER TO HEALTH?
    * QUESTION 2 ARE ADVERSE SOCIAL FACTORS MORE PREVALENT IN THE UNITED STATES THAN IN OTHER HIGH-INCOME COUNTRIES?
    * QUESTION 3 DO DIFFERENCES IN SOCIAL FACTORS EXPLAIN THE U.S. HEALTH DISADVANTAGE?
    * CONCLUSIONS
  • 7. Physical and Social Environmental Factors
    * QUESTION 1 DO ENVIRONMENTAL FACTORS MATTER TO HEALTH?
    * QUESTION 2 ARE ENVIRONMENTAL FACTORS WORSE IN THE UNITED STATES THAN IN OTHER HIGH-INCOME COUNTRIES?
    * QUESTION 3 DO ENVIRONMENTAL FACTORS EXPLAIN THE U.S. HEALTH DISADVANTAGE?
    * CONCLUSIONS
  • 8. Policies and Social Values
    * THE ROLE OF PUBLIC- AND PRIVATE-SECTOR POLICIES
    * THE ROLE OF INSTITUTIONAL ARRANGEMENTS ON POLICIES AND PROGRAMS
    * SOCIETAL VALUES
    * POLICIES FOR CHILDREN AND FAMILIES
    * SPENDING PRIORITIES
    * CONCLUSIONS

• III. Future Directions for Understanding the U.S. Health Disadvantage

  • 9. Research Agenda
    * BACKGROUND
    * DATA NEEDS
    * ANALYTIC METHODS DEVELOPMENT
    * NEW LINES OF INQUIRY
    * CONCLUSIONS
  • 10. Next Steps
    * PURSUE NATIONAL HEALTH OBJECTIVES
    * ALERT THE PUBLIC
    * EXPLORE INNOVATIVE POLICY OPTIONS
    * LOOKING AHEAD

• References and Bibliography

• Appendixes

  • Appendix A Recommendations of the National Prevention Council and Evidence Cited in Its Report
  • Appendix B Biographical Sketches of Panel Members and Staff

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This study was supported by the John E. Fogarty International Center, the National Center for Complementary and Alternative Medicine, the National Institute on Aging, and the Office of Behavioral and Social Sciences Research, all within the National Institutes of Health, and the Office of Women’s Health within the U.S. Department of Health and Human Services through Contract No. N01-OD-4-2139 Task Orders # 237 and 271 and Contract No. HHSN26300011 between the National Academy of Sciences and the U.S. Department of Health and Human Services.

Suggested 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.

Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the panel responsible for the report were chosen for their special competences and with regard for appropriate balance.

Copyright © 2013, National Academy of Sciences.

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  National Research Council (US); Institute of Medicine (US); Woolf SH, Aron L, editors. U.S. Health in International Perspective: Shorter Lives, Poorer Health. Washington (DC): National Academies Press (US); 2013. doi: 10.17226/13497
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