When health in the United States is compared to health in other countries, the picture is disappointing.  The World Health Organization, in its annual World Health Statistics 2008, compares the United States to the nations of the world on a large variety of measures.  While the U.S. does exceed many countries, it is far from the best in many of the common measures used to gauge our healthiness and lags behind its peers in other developed countries. 

Healthy life expectancy (HALE) is a measure that indicates the number of years that a newborn can expect to live a healthy and productive life.  Japan is the perennial leader in this measure with a HALE of 75 years on average for both genders.  At 69 years, the United States has the same HALE as Portugal and Slovenia.  There are 27 other countries that exceed the United States in healthy life expectancy, including Australia, Greece, United Kingdom, Italy, Germany and France.  The difference between Japan and the United States for females is 7 years; the difference for males is 5 years (Table 6).

One of the underlying causes for these differences is the gap in infant mortality rates between the United States and many other countries (Table 6).  The infant mortality rate for the U.S. in 2006 was seven deaths per 1,000 live births; the infant mortality rates for Japan, Sweden, Finland, Singapore, Slovenia, Italy, Norway, Denmark, Portugal and the Czech Republic were three deaths per 1,000 live births.  Other countries that had lower rates than the United States in this area include Canada, Australia, the United Kingdom, France and Germany.  Of the over 150 countries rated, fully 38 countries had lower infant mortality rates than the United States.

Table 6 also shows the age-adjusted mortality rate for cancer and cardiovascular disease and the prevalence of obesity. Among the top nations, the U.S. is rated average to slightly below average when judged by cancer and cardiovascular death rates and is rated comparably in the prevalence of smoking.  Citizens in the U.S. are clearly more obese than those of other countries, often at more than twice the rate of other countries.

Differences in healthy life expectancy are also affected by the effectiveness of treating disease, especially those that are amenable to care, including bacterial infections, treatable cancers, diabetes, cardiovascular and cerebrovascular disease, some ischemic heart disease and complications from common surgical procedures.  The age-adjusted amenable mortality rate before age 75 for the United States was 109.7 deaths per 100,000 population in 2002, which meant it ranked last among the nineteen countries of the Organization for Economic Cooperation and Development (OECD) nations studied.  The rate in the U.S. is 50 percent higher than the rate in France, Japan, Spain, Italy, Canada and Australia. 

Additionally, the study indicated that despite spending more than any other country on health care, the United States continues to slip further behind other countries.  In 1997, the U.S. ranked 15th in this mortality rate. Since then, Finland, Portugal, United Kingdom and Ireland have reduced their mortality rate from disease amenable to care more rapidly than the United States.  All now have better rates than the U.S. (see note 1)

Equally discouraging are results from a UNICEF study of child well-being, in which the U.S. ranked second to last when compared to 21 comparably “rich” countries based on 40 different measures.  When UNICEF looked specifically at child health aspects of well-being, the United States fared very poorly due to a high infant mortality rate, a high percentage of low birth weight infants and only an average rate of immunization coverage.(see note 2)

The Commonwealth Fund rates the U.S. last in health care system performance when compared to a group of six countries that include Australia, Canada, Germany, New Zealand and the United Kingdom.  The U.S. spends twice as much as these six countries on a per-capita basis, yet it is last on dimensions of access, patient safety, efficiency and equity. (see note 3)   So, while the U.S. is spending more on total health care when compared to other countries, the country is getting less access, patient safety, efficiency and equity.

The results of these studies are a wake-up call to everyone in the United States to strive to improve all aspects of our health system however possible, including education, prevention and clinical care.   Other countries have improved their overall health by improving their health care system, indicating that we too can do the same.

Table 6- International Comparisons

Source: Various years of data, World Health Statistics, 2008, World Health Organization, Geneva, Switzerland.

Notes: