Preface (original) (raw)

In 2011 the Office of Behavioral and Social Sciences Research (OBSSR) of the National Institutes of Health (NIH) asked the National Research Council (NRC) and the Institute of Medicine (IOM) to undertake a study on understanding cross-national health differences among high-income countries. The NRC’s Committee on Population and the IOM’s Board on Population Health and Public Health Practice established our panel for this task.

The impetus for this project came from a recently released NRC report that documented that life expectancy at age 50 had been increasing at a slower pace in the United States than in other high-income countries. The charge to our panel was to probe further and to determine whether the same worrying pattern existed among younger Americans, to explore potential causes, and to recommend future research priorities.

As readers who know this issue can appreciate, this is a daunting and complex charge. The questions put to the panel involve many fields, including medicine and public health, demography, social science, political science, economics, behavioral science, and epidemiology. They require the examination of data from many countries, drawn from disparate sources. The panel was given 18 months for the task, enough time to pull back the curtain on this issue but not to conduct a systematic review of every contributory factor and every relevant study or database. This report serves only to open the inquiry, with the invitation to others to probe deeper and with the disclaimer that the evidence cited here can only skim the surface of highly complex issues.

The report that follows could not have been produced without the help of many dedicated individuals. We begin by thanking the report’s sponsor, OBSSR, and also the National Institute on Aging (NIA), which contributed financing for our work and was the primary sponsor of the prior NRC report that led to this study. We are especially grateful for guidance and contributions from Robert M. Kaplan, director, and Deborah H. Olster, deputy director of OBSSR, and Richard M. Suzman, director of the Division of Behavioral and Social Research at NIA. Ronald Abeles and Ravi Sawhney, both formerly with NIH, were also instrumental in conceiving of this project and seeing it get off the ground.

In fulfilling its charge, the panel also relied heavily on presentations and background papers and analyses from many of the world’s leading experts on the social and health sciences that relate to cross-national health disparities. Specifically, the panel benefited greatly from presentations by Michele Cecchini, OECD; Neal Halfon, University of California, Los Angeles; Ronald Kessler, Harvard University; Sir Michael Marmot, University College London; Ellen Nolte, RAND Europe; Robert Phillips, Robert Graham Center; Cathy Schoen, Commonwealth Fund; and David Stuckler, Cambridge University. Also critical to the panel’s deliberations and thinking were presentations and commissioned background papers from Clare Bambra, University of Durham; Jason Beckfield, Harvard University; and Russell Viner, University College London.

Several postdoctoral and graduate students worked intensively with a number of panel members to produce unique and compelling data analyses that appear throughout this report. We thank these contributors: Jessica Ho, University of Pennsylvania, who collaborated with Samuel Preston on developing much of the evidence presented in Chapter 1; Stéphane Verguet, University of Washington, who collaborated with Dean Jamison on a “years-behind” analysis presented in Chapter 1; James Yonker, University of Wisconsin, who collaborated with Alberto Palloni on an extensive analysis of health indicators across the life course presented in Chapter 2; and Aïda Solé Auró, University of Southern California, who collaborated with Eileen Crimmins on evaluating the health of adults at age 50.

Several other individuals at the home institutions of panel members contributed to their analyses for this report. In particular, the panel thanks Jung Ki Kim at the University of Southern California for assisting Eileen Crimmins; Malavika Subramanyam at the University of Michigan for assisting Ana Diez Roux with her review of environment factors for Chapter 7; and Karen Simpkins at the University of California, San Francisco, for assisting Paula Braveman with tables and figures for Chapter 6.

We also thank the authors of two background papers the panel commissioned: Russell Viner, University College London, for an assessment of cross-national differences in adolescent health and the importance of adolescence in shaping life-long health outcomes; and Clare Bambra, Durham University, and Jason Beckfield, Harvard University, for an analysis of how cross-national differences in political systems, governance structures, and public policy making might influence health at the national level.1

During the course of this project, the panel also benefited from targeted consultations with national experts to help make sense of data uncovered in this review. In particular, the panel thanks Sheldon H. Danziger, University of Michigan; Thomas Getzen, International Health Economics Association; and Timothy M. Smeeding, Institute for Research on Poverty, University of Wisconsin–Madison, for their advice on interpreting poverty statistics and Clemencia Cosentino de Cohen for her advice on interpreting data on educational attainment. We also thank J. Michael McGinnis, senior scholar at the IOM, for the valuable advice he offered this panel and for serving as a discussant at a crucial panel meeting.

This report would not have been possible without the support of NRC staff. I first thank Laudan Aron, our study director, who toiled over every page of this document. The panel is also indebted to Barney Cohen, former director of the NRC’s Committee on Population; Thomas Plewes, who succeeded him and shepherded the report to its release; and Rose Marie Martinez, senior director of IOM’s Board on Population Health and Public Health Practice, who provided oversight and support of this project at every level. The panel also thanks Wendy Jacobson and Robert Pool for assistance with background research and writing; Danielle Johnson for administrative and logistical support and formatting of references, figures, and tables; Alina Baciu, Amy Geller, and Keiko Ono, for assembling the bibliography; Amy Geller, Hope Hare, and Rose Marie Martinez for assistance with graphics; Kirsten Sampson Snyder for guiding the report through review; Eugenia Grohman for editing; Yvonne Wise for managing the production process; and Sara Frueh, Patricia Morison, Lauren Rugani, Christine Stencel, and Steve Turnham for help with communications.

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Academies’ Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report: James Banks, Department of Economics, Institute for Fiscal Studies, University College London; Daniel G. Blazer, Duke University Medical Center; James S. House, Survey Research Center, University of Michigan Institute for Social Research; David A. Kindig, School of Medicine, University of Wisconsin–Madison; Cato T. Laurencin, University of Connecticut Health Center; David Melzer, Department of Epidemiology and Public Health, Exeter University; Carlos Mendes de Leon, University of Michigan; Angelo O’Rand, School of Social Sciences, Duke University; Mauricio Avendano Pabon, Center for Population and Development Studies, Harvard University; David Vlahov, School of Nursing, University of California, San Francisco; and John R. Wilmoth, Department of Demography, University of California, Berkeley. Dana Glei of Georgetown University also provided a focused mid-project technical review of the commissioned data analysis conducted by Jessica Ho and Samuel Preston for Chapter 1.

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. Robert Wallace, College of Public Health, University of Iowa, and Patricia Danzon, Health Care Management Department, The Wharton School, University of Pennsylvania, oversaw the review of this report. Appointed by the NRC and the IOM, they were responsible for ensuring that this report underwent an independent examination in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring panel and the institution.

Finally, I would like to thank my fellow panel members for their wisdom, collegiality, and energy in producing this important report. Every member was immensely helpful, but I wish to specifically acknowledge Samuel Preston, Alberto Palloni, Paula Braveman, and Ana Diez Roux for their first drafts of Chapters 1, 2, 6, and 7, respectively. This report is truly an ensemble effort. I hope that readers will notice the interdisciplinary collaboration reflected in the pages of this document. The panel members, all highly regarded experts in their fields, contributed wonderful insights and the literatures of their disciplines to give our discussions and data analysis the holistic perspective this topic deserves. I am indebted to these colleagues, who despite many demanding responsibilities, gave generously of themselves and operated under a very demanding timeline. I am sure I speak for the panel and staff in collectively thanking our spouses and families for the disruption in lives this undertaking required.

Our panel was unprepared for the gravity of the findings we uncovered. We hope that others will take notice. Our charge was to give advice to the scientific community, and this report fulfills that charge by outlining ways that the NIH, other research agencies, and investigators can collect new data and advance understanding of the causes of cross-national health disparities. But the gravity of our findings also deserves attention outside the scientific community. A broader audience—most importantly the American public—should know what this report says. Concerted action is required on many levels of society if the nation is to change the conditions described here and to give the people of the United States—particularly the nation’s children—the superior health and life expectancy that exist elsewhere in the world.

Steven H. Woolf, Chair

Panel on Understanding Cross-National Health Differences Among High-Income Countries

1

All background papers and analyses are available directly from the authors.