Comparison to Other Nations

When health in the United States is compared to health in other countries, the picture is disappointing. In an often cited report from 2000, the World Health Organization (WHO) ranked the US health care system 37th out of 191 nations in the world.[1] In WHO’s 2013 publication, World Health Statistics, the United States outperforms many countries on a variety of health-related measures, but it is far from the best in many of the key measures used to gauge healthiness and it lags behind its peers in other developed countries.[2] The latest updates on global health indicators by the WHO are at http://apps.who.int/nha/database/DataExplorerRegime.aspx.

On nearly all indicators of mortality, survival, and life expectancy, the United States ranks at or near the bottom among high-income countries.[3] Life expectancy is a measure that indicates the number of years a newborn is expected to live. Japan, San Marino, and Switzerland are the persistent leaders for developed countries in this measure, with an overall life expectancy of 83 years.2 Men of Qatar and women of Japan have the highest life expectancies of 83 years and 86 years, respectively.2 With a life expectancy of 81 years for women and 76 years for men, the United States ranks 33rd (36th for men and 35th for women) among the 193 reporting nations of the WHO2  The tab below lists a few other countries for comparison purposes. Life expectancy in the United States does not compare to most other developed countries as US male life expectancy rates are on par with Chile, Cuba, Brunei Darussalam, and Maldives.2 US female life expectancy rates are on par with Colombia, Costa Rica, Czech Republic, Estonia, Poland, and Qatar.

At a more granular level (ie, at the county level), US life expectancy rates appear even worse when compared to other leading nations.[4] While many US counties (33 counties for men and 8 counties for women) exceed the average life expectancy of the 10 leading nations, by far the majority of US counties lag behind these other nations. In fact, 92 US counties for men and 2 US counties for women have life expectancy rates similar to those experienced by other leading nations dating back to 1957 or earlier. Life expectancy rates in 1,406 US counties are now further behind those of developing nations than they were 7 years earlier.[4]         

Premature death contributes to lower life expectancy. For decades, the United States has experienced the highest infant mortality rate of high-income countries (see tab below).2 In 2011, the infant mortality rate in the United States was 6 deaths per 1,000 live births, ranking 40th among WHO nations.2 Infant mortality rates in Finland, Japan, and Sweden are one third the US rate. These countries also have considerably lower infant mortality rates than that of non-Hispanic whites in the United States, which is the ethnic/racial group with the lowest infant mortality rate. The persistent racial/ethnic disparities related to infant mortality within the United States could be related to differences in risk factors for infant mortality among different racial/ethnic groups (eg, risk for low birthweight delivery, socioeconomic status, access to medical care). However, many of the racial and ethnic differences in infant mortality remain unexplained.[5] It should be noted that the reporting and classification of infant mortality varies among countries, which may be reflected in the ranks.

In addition to infant mortality, deaths among youth and young adults impact life expectancy. Among US adolescents and young adults, unintentional injuries claim about 30 percent of the years lost before age 50, along with violence and suicides. Noncommunicable (chronic) diseases, such as heart disease, cancer, and other conditions not caused by infections, become more of a contributing factor after age 30.3

Differences in healthy life expectancy are also impacted by the effectiveness of treating disease, especially treatable diseases such as bacterial infections, certain cancers, diabetes, cardiovascular and cerebrovascular diseases, and complications from common surgical procedures. The age-adjusted amenable mortality rate before age 75 for the United States was 95.5 deaths per 100,000 population in 2006 to 2007.[6] Although this rate was down 25 deaths per year from 10 years prior, the rate of improvement was much slower than in other Organization for Economic Cooperation and Development (OECD) nations. The rate in the United States remains 50 percent higher than the rates in Australia, France, Japan, and Italy, reportedly contributing to 59,500 to 84,300 excess deaths before age 75 in the United States.[6]

Per capita health care spending in the United States continues to be the highest in the world. The median expenditure among OECD countries is around $3,000 per person. In the United States, it is more than $8,000 per person.7 The annual growth rate of spending in the United States from 2000 through 2010 was 4.3 percent, slightly under the average of 4.7 percent among OECD countries.[7] Utilization of health care in the United States also exceeds other OECD countries, with 25 percent of adults taking at least 4 prescriptions regularly compared to a median of 17 percent among studied countries. US patients receive 91 MRI exams per 100,000 population compared to fewer than 50 exams per 100,000 population in the other 5 reporting countries.[8]

The United States spends the most on health care, but this does not translate into better care for everyone, as the United States has one of the highest inequalities in health compared to other developed countries. The United States ranks among the worst OECD countries for child health well-being, having an inequality higher than average.[9] Although the United States has the highest national income per person, it continues to rank as the worst country for income inequality. This inequality is thought to explain why it has the highest index of health and social problems compared to other wealthy nations.[10]

Physical inactivity is a major contributor to disease worldwide and is the fourth leading risk factor for global mortality.[11] With roughly a third of the world’s population inactive, physical inactivity is responsible for an estimated 6 to 10 percent of non-communicable diseases such as heart disease, type 2 diabetes, breast cancer, and colon cancer. Overall it is responsible for 9 percent of premature deaths—5.3 million deaths in 2008.[12] It is estimated that eliminating physical inactivity in the United States could add nearly 1 year to life expectancy and dramatically reduce the burden of chronic diseases.[12]

Obesity is another major contributor to disease. North America has 34 percent of the world’s biomass due to obesity, yet it only makes up 6 percent of the world population. Asia, on the other hand, has 61 percent of the world population yet only 13 percent of its biomass due to obesity.[13] While the United States is only 1 of several countries that make up North America, they are the only North American nation to rank among the heaviest 10 globally.

Despite the highest per capita spending on health care (see tab below), the United States does not fare well in most comparisons to other developed countries. Key indicators of health and the health care system are substantially lower in the United States compared to other countries. The United States has some of the most state-of-the-art health care facilities, yet behavioral factors such as physical inactivity, smoking, and dietary choices, combined with inequalities, result in poor performance. Innovative solutions from the individual level to the national level are needed in order to address the health care challenges of today and the future.



[1] The world health report 2000 - health systems: Improving performance. Bulletin- World Health Organization. 2000;78:1064.

[2] World Health Organization (2013). World Health Statistics 2013.

[3] National Research Council (US), Institute of Medicine (US). US health in international perspective: shorter lives, poorer health. 2013. http://www.nap.edu/catalog.php?record_id=13497.

[4] Kulkarni SC. Falling behind: Life expectancy in US counties from 2000 to 2007 in an international context. Population Health Metrics. 2011;9(1):16. doi: 10.1186/1478-7954-9-16.

[5] MacDorman MF, and Mathews TJ. Recent Trends in Infant Mortality in the United States. Hyattsville, MD: US Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2008.

[6] Nolte E. Variations in amenable mortality—trends in 16 high-income nations. Health Policy. 2011;103(1):47.

[7] Organization for Economic Co-operation and Development. OECD Health Data 2012.

[8] Squires DA. The US health system in perspective: A comparison of twelve industrialized nations. Issue Brief (Commonwealth Fund). 2011;16:1-14.

[9] UNICEF. The children left behind: A league table of inequality in child well-being in the world’s rich countries. Innocenti Research Centre: Report Card 9. 2010.

[10] Wilkinson RG, Prickett KE. Income inequality and social dysfunction. Annual Review of Sociology. 2009.

[11] World Health Organization. Global Health Risks Mortality and Burden of Disease Attributable to Selected Major Risks. Updated 2009.

[12] Lee I, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. The Lancet. 2012.

[13] Walpole SC, Prieto-Merino D, Edwards P, Cleland J, Stevens G, Roberts I. The weight of nations: An estimation of adult human biomass. BMC Public Health. 2012.

 

  • Infant Mortality
  • Life Expectancy
  • Health Expenditures

Infant Mortality

Deaths per 1,000 live births

Country

Deaths per 1,000 live births

Rank*

Australia

4

22

Austria

4

22

Belgium

4

22

Canada

5

33

China

13

74

Czech Republic

3

9

Denmark

3

9

Finland

2

1

France

3

9

Germany

3

9

Greece

4

22

Hungary

5

33

Ireland

3

9

Israel

4

22

Italy

3

9

Japan

2

1

Mexico

13

74

Netherlands

3

9

New Zealand

5

33

Norway

3

9

Poland

5

33

Portugal

3

9

Spain

4

22

Sweden

2

1

Switzerland

4

22

United Kingdom

4

22

United States of America

6

40

*Rank among 194 member countries of WHO