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 2011, 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 healthiness, and it lags behind its peers in other developed countries.
Life expectancy is a measure that indicates the number of years that a newborn can expect to live. Japan is the perennial leader in this measure, with a life expectancy of 85 years on average for females and 80 years for males (San Marino men have a longer life expectancy at 82 years). With a life expectancy of 80 years for women, the United States is 32nd among the 193 reporting nations of the World Health Organization and at 76 years for men, the United States is 34th among nations. Table xx lists a few other countries for comparison purposes. U.S. male life expectancy rates are on par with Chile, Cuba and Slovenia and U.S. female life expectancy rates are on par with Colombia, Cuba, Czech Republic and Poland.
If you view life expectancy at a more granular level, i.e. at the county level, and compare it to other leading nations, U.S. life expectancy rates appear even worse.1 While many U.S. counties (33 counties for men and eight counties for women) exceed the average life expectancy of the 10 leading nations, by far the majority of U.S. counties lag behind these other nations. In fact, 92 U.S. counties for men and two U.S. counties for women have life expectancy rates similar to those experienced by other leading nations back in 1957 or earlier. The authors also show that life expectancy rates in 1,406 U.S. counties are now further behind those of developing nations than they were seven years earlier.
One of the underlying causes for these differences is the gap in infant mortality rates between the United States and many other countries ( Table 1). The infant mortality rate for the U.S. in 2009 was seven deaths per 1,000 live births, ranking the United States 43rd among WHO nations. Rates for Sweden, Spain, Italy, Germany, France, Czech Republic, Slovenia and Iceland are all half of the United States rate. These countries also have considerably lower infant mortality rates than that of non-Hispanic whites in the United States, the ethnic/racial group with the lowest rates in the United States.
Differences in healthy life expectancy are also impacted by the effectiveness of treating disease, especially diseases 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 95.5 deaths per 100,000 population in 2006 to 2007. This is a considerable improvement from 120.2 deaths per 100,000 population in 1997-1998, but the rate of improvement was much slower than in other Organization for Economic Cooperation and Development (OECD) nations studied. The rate in the U.S. remains 50 percent higher than the rate in Australia, France, Japan and Italy. This study estimated that if the United States achieved rates on par with comparative counties, between 59,500 and 84,300 deaths before age 75 would have been saved. 2
Per capita healthcare spending in the United States continues to lead the world. The median expenditure among OECD countries is $2,995 per person; in the United States, it is $7,538 per person. The annual growth rate of spending in the United States from 1998 through 2008 was 3.6 percent, slightly under the median of 3.9 percent among OECD countries.3 Utilization of healthcare in the United States exceeds other OECD countries with 25 percent of adults taking at least four prescriptions regularly compared to a median of 17 percent among studied countries and United States patients receiving 91 MRI exams per 100,000 population compared to under 50 exams per 100,000 population in the other five reporting countries. 4
The results of these studies should be a wake-up call to everyone in the United States to strive to improve all aspects of our health system however possible, including education, safety, prevention and clinical care. Other countries have improved their overall health, indicating that we too can do the same.
| Table 1 |
Infant Mortality Rate
|
|
Life Expectancy (years at birth)
|
Health Expenditure (%)*
|
||||
| Country |
Deaths per 1,000 live births
|
Rank**
|
|
Male
|
Rank**
|
Female
|
Rank**
|
|
| Australia |
4
|
21
|
|
80
|
2
|
84
|
7
|
8.5
|
| Austria |
4
|
21
|
|
78
|
14
|
81
|
11
|
10.5
|
| Belgium |
4
|
21
|
|
77
|
27
|
81
|
11
|
11.1
|
| Canada |
5
|
30
|
|
79
|
7
|
82
|
11
|
9.8
|
| China |
17
|
89
|
|
72
|
53
|
73
|
76
|
4.3
|
| Czech Republic |
3
|
8
|
|
74
|
40
|
79
|
35
|
7.1
|
| Denmark |
3
|
8
|
|
77
|
27
|
79
|
32
|
9.9
|
| Finland |
3
|
8
|
|
77
|
27
|
81
|
11
|
8.8
|
| France |
3
|
8
|
|
78
|
14
|
83
|
2
|
11.2
|
| Germany |
3
|
8
|
|
78
|
14
|
81
|
11
|
10.5
|
| Greece |
3
|
8
|
|
78
|
14
|
81
|
11
|
10.1
|
| Hungary |
5
|
30
|
|
70
|
80
|
76
|
52
|
7.2
|
| Ireland |
3
|
8
|
|
77
|
27
|
79
|
26
|
8.7
|
| Israel |
4
|
21
|
|
80
|
2
|
81
|
11
|
7.6
|
| Italy |
3
|
8
|
|
79
|
7
|
82
|
7
|
8.7
|
| Japan |
2
|
3
|
|
80
|
2
|
85
|
1
|
8.3
|
| Mexico |
15
|
80
|
|
73
|
44
|
77
|
52
|
5.9
|
| Netherlands |
4
|
21
|
|
78
|
14
|
81
|
11
|
9.9
|
| New Zealand |
4
|
21
|
|
79
|
7
|
81
|
11
|
9.7
|
| Norway |
3
|
8
|
|
79
|
7
|
81
|
11
|
8.5
|
| Poland |
5
|
30
|
|
71
|
66
|
78
|
35
|
7
|
| Portugal |
4
|
21
|
|
76
|
34
|
80
|
26
|
10.6
|
| Spain |
3
|
8
|
|
78
|
14
|
83
|
2
|
9
|
| Sweden |
2
|
3
|
|
79
|
7
|
82
|
11
|
9.4
|
| Switzerland |
4
|
21
|
|
80
|
2
|
83
|
7
|
10.7
|
| United Kingdom |
5
|
30
|
|
78
|
14
|
80
|
26
|
8.7
|
| United States of America |
7
|
43
|
|
76
|
34
|
80
|
32
|
15.2
|
| *Total expenditure on health as % of gross domestic product | ||||||||
| **Rank among 193 member countries of WHO | ||||||||
1Karlarni, Sandeep C., Levin-Rector, Alixon, Ezzati, Majid, and Murray, Chirstopher JL, Falling behind: life expectancy in US counties from 2000-2007 in an international context, Population Health Metrics, 2011, 9:16, http://www.pophealthmetrics.com/content/9/1/16.
2 Nolte, Ellen and McKee, Martin, Variations in amenable mortality – Trends in 16 high-income nations, Health Policy 103 (2011), 47-52, http://www.sciencedirect.com/science/article/pii/S016885101100159X .
3 Squires, David A., The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations, Issues in International Health Policy, The Commonwealth Fund, July 2011.
4 Ibid.