U.S. Lagging Other Countries on Many Health Measures
Report finds some gains, but also many areas where Americans' health is slipping
Wednesday, July 10, 2013
And despite being the biggest spender on health care in the world, the United States lags behind many other prosperous countries in the leading causes of premature death, including heart disease, violence, traffic accidents and diabetes.
The main culprit behind the U.S. health problems appears to be eating habits, which are too low in fruits, vegetables, nuts and seeds, and too high in sodium, processed meats and trans fatty acids, according to the report.
The new study is the latest in a series of reports by the Global Burden of Disease Study, a collaboration of 488 researchers in 50 countries. The group is sifting through staggering amounts of information to learn how different countries compare when it comes to life expectancy and overall health.
The project is taking stock of early deaths and disability caused by 291 diseases and injuries around the world. It is also taking a country-by-country look at which risk factors make the biggest contributions to health problems. Reports on China and Great Britain were published earlier this year.
The findings on the United States were published online July 10 in the Journal of the American Medical Association. The White House and National Press Club also hosted separate events on Wednesday to announce the study findings.
"It's rare these days that you get information or studies that give you the big picture," said study author Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, in Seattle.
"It's pretty uncommon to step back and say, 'What does all the evidence tell us about the most important health problems, and where does the U.S. fit in that landscape?'" he said.
Murray said the United States has seen a shift in the last 20 years from illnesses that cut life short to chronic conditions that lead to longer-term disability. That means Americans are living longer on average, but they aren't necessarily spending those years in good health.
The biggest causes of early death in the United States continue to be heart disease, lung cancer, stroke, chronic obstructive pulmonary disease and road injuries, with little change in those killers over time.
The biggest causes of disability are low back pain, depression and other musculoskeletal disorders. Mental problems such as depression and anxiety now comprise about one quarter of all disability in the United States.
The study also found some bright spots. Thanks to powerful new medications, HIV and AIDS, which were the 11th leading causes of death and disability in 1990, dropped to 32 in 2010. Road injuries -- such as traffic accidents, once the fourth leading cause of death and disability -- now rank ninth. Birth defects are also taking less of a toll on health. They ranked 20th in 1990, but have dropped to 29th, thanks, in part, to mandatory fortification of grain products with folic acid, which has reduced the number of babies born with devastating neural tube defects, according to the report.
"We have been gradually improving over the last 20 years, but other countries have progressed even more rapidly, and our relative standing compared to other wealthy countries has actually declined," said Dr. Harvey Fineberg, president of the Institute of Medicine, who wrote an accompanying editorial on the study.
From 1990 to 2010, average life expectancy increased in the United States by three years -- from 75.2 years to 78.2 years for both sexes combined. But other prosperous countries saw larger gains over that period.
Ireland gained 5.1 more years, on average. South Korea gained 7.6 years of life expectancy on average. And life expectancy in Australia grew by an average of 4.6 years.
Murray said Australia makes an interesting comparison to the United States. Both are countries of immigrants with culturally diverse populations. Australia spends half as much as the United States on health care each year. Despite that, Australians are less likely to die prematurely or become disabled than Americans. They also have lower rates of major killers like heart disease, lung cancer, violence and diabetes, he noted.
"Australia has done a better job of bringing down smoking. They have road traffic injury rates that are quite a bit lower than ours. They've done a lot more public health intervention," Murray explained.
And Australia has a much bigger emphasis on primary care. They do a better job of helping people control chronic risk factors such as high blood pressure, he added.
So what can Americans do if they want to spend more of their lives in good health?
The study found the biggest hurdles are related to lifestyle. Poor nutrition and diet were the major contributors to both early death and disability. Tobacco smoking was second on the list of major risk factors, followed by high blood pressure, being overweight or obese, and being physically inactive.
"If we want to be healthier, we have to change the way many of us live," Fineberg said. "Twenty percent of adults in the U.S. still smoke cigarettes. A growing number of adults in some states are overweight or obese.
"We need to get more exercise on average than we do, and we need to stop doing foolish things like driving after we've been drinking alcohol or drinking to excess," he said. "Those are sort of simple to say, but they're really hard to put into everyday practice and to stay with it," he pointed out.
Fineberg said he'd like to see more money spent on helping people make those difficult changes, and far less money spent on expensive but questionable tests and treatments.
"We spend, on average, twice as much as the rest of the countries," he said. "Approximately 30 percent of all health expenditures in the United States, which would amount to $750 billion a year, don't actually contribute to better health," said Fineberg, citing a 2012 Institute of Medicine report.
"We have a big job ahead of us to create a health care system that really adds value and doesn't just cost and waste a lot of money," he added.
Cardiologist Dr. Robert Rosenson, director of cardiometabolic disorders at Mount Sinai Medical Center in New York City, said, "It's quite disappointing that the U.S. is falling behind in outcomes for diseases, such as cardiovascular disease, and especially those diseases with preventable causes.
"We need to make a major effort to make better lifestyle choices daily based on diet," Rosenson continued. "Efforts by communities across our country need to take charge of what we are providing our children to eat at home and at school. The costs due to poor eating and disabling health conditions are overtaxing our society. We can't afford it. Eating more fruits and vegetables is very important, while limiting your calorie intake and not adding salt to your food."