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(WHO) ranked the U.S. health care system 37^th in the world.[1] Although this report is often criticized as outdated, the WHO in its World Health Statistics 2012 publication compares the United States to other countries of the world on a variety of health related measures.[2] While the U.S. does outperform many countries, 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.

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 over 86 years on average for females and just under 80 years for males (San Marino men have a longer life expectancy at 82 years).[3] With a life expectancy of 81 years for women and 76 years for men, the United States ranks 29^th among the 193 reporting nations of the WHO.[4] The tab below lists a few other countries for comparison purposes. Life expectancy in the U.S. doesn’t compare to most other developed countries as 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.[5] While many U.S. 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 U.S. counties lag behind these other nations. In fact, 92 U.S. counties for men and 2 U.S. counties for women have life expectancy rates similar to those experienced by other leading nations back in 1957 or earlier. Life expectancy rates in 1,406 U.S. counties are now further behind those of developing nations than they were 7 years earlier.[6]

One of the underlying causes for these differences is the gap in infant mortality rates between the United States and many other countries (see tab below). In 2011, the infant mortality rate for the U.S. was 6 deaths per 1,000 live births, ranking the U.S. 40th among WHO nations.[7] Rates for Denmark, Portugal, Italy, Germany, France, Czech Republic, Norway, and Ireland are all half of the U.S. 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. It should be noted that this rate is dependent on the classification of infant mortality, which varies between countries.

Differences in healthy life expectancy are also impacted by the effectiveness of treating disease, especially diseases that are amenable to care such as 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.[8] This is a considerable improvement from 120.2 deaths per 100,000 population in 1997 to 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 rates in Australia, France, Japan, and Italy. This study estimated that if the United States achieved rates on par with comparative countries, between 59,500 and 84,300 deaths before age 75 would have been saved.

Per capita health care spending in the United States continues to lead the world (see tab below). The median expenditure among OECD countries is around $3,000 per person; in the U.S., it is over $8,000 per person.[9] 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.[10] 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. U.S. patients receive 91 MRI exams per 100,000 population compared to under 50 exams per 100,000 population in the other 5 reporting countries.[11]

Not only does the U.S. spend the most on health care, it also has one of the highest health inequalities compared to other developed countries. The U.S. ranks among the worst OECD countries for child health well-being, having an inequality higher than average.[12] Although the U.S. 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.[13]

Physical inactivity is a major contributor to disease worldwide and is the fourth leading risk factor for global mortality.[14] 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.[15] In the U.S., 40 percent of the population is physically inactive, which is higher than both Canada at 34 percent and Mexico at 38 percent. It is estimated that eliminating physical inactivity in the U.S. could add nearly a year to life expectancy and dramatically reduce the burden of chronic diseases.[16]

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.[17] While the U.S. is only one of several countries that make up North America, they are the only North American nation to rank in the heaviest 10.

Despite the highest per capita spending on health care, the U.S. doesn’t fare well in most comparisons to other developed countries. Key indicators of health and the health care system are substantially lower in the U.S. compared to other countries. The U.S. 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 disparities, result in poor performance. Innovative solutions from the individual to the national level are needed in order to address the health care challenges of the future.