“The U.S. health disadvantage is more pronounced among socioeconomically disadvantaged groups, but even advantaged Americans [described as ‘white, insured, college-educated’] appear to fare worse than their counterparts in England and some other countries.”
What to make of this?
The report’s most important contribution is to show that much of the U.S. “health disadvantage” doesn’t reflect an inadequate health-care system but lifestyle choices, personal behaviors and social pathologies. The gap in life expectancy is concentrated in Americans under 50. Among men, nearly 60 percent of the gap results from more homicides (often gun-related), car accidents (often alcohol-related) and other accidents (often drug-related) than in comparable nations. For children under 5, car accidents, drowning and fire are the largest causes of death.
Teen pregnancy is another big problem. Among girls 15 to 19, the pregnancy rate is about 3.5 times the average of other advanced societies. “Adolescent motherhood affects two generations, children and mothers,” the report notes. Adolescent mothers often don’t finish high school. “Their children face a greater risk of poor child care, weak maternal attachments [and] poverty.” Similarly, the incidence of AIDS in America is nearly nine times the OECD average.
The health-care system can’t cure these ills, which are social problems with health consequences. Those who expect the introduction of the main elements of the Affordable Care Act (”Obamacare”) in 2014 to improve Americans’ health dramatically are likely to be disappointed. The lack of insurance is a problem, but it is not the main health problem, in part because the uninsured already receive much uncompensated care.
To be fair: Some of these social problems show progress. America’s slippage is mostly relative to better outcomes elsewhere. Since 1980, the U.S. murder rate has dropped by roughly half (but remains higher than in many peer countries); traffic deaths per miles traveled have fallen by more than half since 1975 (though decreases abroad are greater); teen birth rates have fallen to a seven-decade low (but are higher than in most wealthy nations); and U.S. life expectancy is rising (but more slowly than elsewhere).