By Lola Butcher
February 03, 2021 "Information Clearing House" - In 2013, a research team comprised of some of the nation’s top epidemiologists and demographers compared the health of Americans with the health of people in other high-income nations. They summarized their findings in the report’s title: “U.S. Health in International Perspective: Shorter Lives, Poorer Health.”
Compared to 16 other nations, the U.S. ranked dead last in life expectancy for males and second-to-last for females. Beyond that, the nation ranked at or near the bottom in nine broad areas, including injuries and homicides, drug-related deaths, heart disease, and diabetes. Lung disease was both more common and more deadly in the U.S. than in most of the comparison countries, while older adults were more likely to have arthritis than people in the United Kingdom, Europe, and Japan. The U.S. surpassed all other nations in its rate of infant death. It had the highest rate of new AIDS cases. American young people were more likely than their international peers to die in traffic accidents.
A “catalog of horrors,” as a writer at the Council on Foreign Relations summed up the report. Newspaper coverage included words like “stunned” and “surprised.” “It is now shockingly clear that poor health is a much broader and deeper problem than past studies have suggested,” read an editorial in The New York Times.
Since the report’s publication, the Organization for Economic Cooperation and Development, the World Health Organization, and others have continued to document the ongoing slide in U.S. health compared to other countries. “As bad as things were then, they’ve only gotten worse,” said Steven Woolf, a physician and public health researcher at Virginia Commonwealth University who chaired the panel of experts behind the Shorter Lives study.
Indeed, as of 2019, the U.S. ranked 36th in the world in terms of life expectancy at birth, behind Slovenia and Costa Rica, not to mention Canada, Japan, and all the rich countries in Europe. And new research published in the Journal of the American Medical Association in December found that, although White people living in the nation’s highest-income counties have better health outcomes than the average U.S. citizen, even they fare worse on infant mortality, maternal mortality, and deaths after heart attacks than the average citizens of Norway, Denmark, and other developed countries.
In retrospect, the 420-page report was a harbinger of things to come, and many experts now say it foreshadowed the U.S. experience with Covid-19. “The abysmal performance of the U.S. — leading the world in death counts and unable to mount the kind of national response that so many peer nations achieved — adds a fresh twist to the U.S. health disadvantage,” Woolf said.
His research team was convened by the National Academy of Medicine and the National Research Council to suss out why the U.S. suffers the “health disadvantage” that it documented, but it was unable to do so. Common explanations — obesity, lack of access to health care, health disparities between White and Black people — were all at play, but the exact cause, or combination of causes, was not clear.
The troubling portrait of America’s health did not spur action to paint a better one. Two presidential administrations have ignored it, as has Congress, mirroring a lack of interest shown by the wider public. Still, some social scientists have not stopped asking: What’s causing the U.S. health disadvantage? Recent work points to a surprising culprit: conservative policies.
This idea stems from a new line of research focusing on individual states, rather than the country as a whole, which has found that states with more liberal policies have longer life expectancy rates than those with more conservative policies. If all states adopted policies similar to those of Hawaii, for example — including on labor, tobacco, and the environment — U.S. life expectancy would increase to such an extent that it would be on par with other high-income countries, according to Jennifer Karas Montez, a sociologist at Syracuse University and lead author of the new research.
Of course, the findings do not definitively prove that a given set of state policies causes people to live longer; rather, they suggest a statistical association between a state’s policies and the health of its residents. And not everyone is convinced that transposing one state’s policies onto other states’ populations will lead to better health outcomes. Still, public health researchers say the question is worth pursuing — though the next step will be a tricky one: getting the public and their political representatives on board.
In 2002, Ravi K. Sawhney moved to Washington, D.C. to look for any job that would allow him to work in health policy. An orthodontist by training, Sawhney describes himself as a person who likes to fix things. He chose orthodontics because he liked the way braces fixed his own teeth. Then he studied molecular and cellular biology to better understand how teeth move and develop ways to improve orthodontics. “But I started to realize that we’re not suffering from a lack of good orthodontists or molecular biologists,” he said. “It’s that we have weird policies that aren’t working to make health better.”
After two jobs on Capitol Hill, he landed in Building One, the Office of the Director of the National Institutes of Health campus in Bethesda, Maryland. The NIH, the largest biomedical research organization in the world, includes the National Cancer Institute, the National Institute on Aging, the National Institute of Mental Health, and 24 other institutes or centers. Its 2020 budget was almost $42 billion. The Office of the Director, which oversees the entire enterprise, is comprised of dozens of administrative units, including the Office of Science Policy. That’s where Sawhney was working when, in 2006, he learned of some new research findings that became his obsession.
By then, the U.S. had been losing ground on life expectancy, relative to other countries, for decades. The disparity had been attributed to America’s high poverty rate and racial inequality. But that reasoning became more complicated when a research team stumbled upon the fact that White Americans are significantly less healthy than the British. “It was a bit of a big shock,” Michael Marmot, a professor of epidemiology and public health at University College London who led the research, said in an NPR interview at the time. “I just didn’t imagine we’d find it consistently across the board, with worse health in the United States compared with England.”
Marmot — actually Sir Marmot, having been knighted in 2000 for his extensive research into health inequalities throughout the world — and three colleagues were trying to find out why poor people are less healthy than rich people. Because they were exploring how income and education influenced health independently of other factors, they looked only at non-Hispanic White people aged 55 to 64 in the U.S. and England. What they learned: In both countries, people with less education and income had worse health than their more advantaged countrymen. Writing in the Journal of the American Medical Association, they reported that White Americans had worse health than their British peers at all rungs of the socioeconomic ladder.
In Sawhney’s view, that should have prompted some introspection at the NIH. But in the ensuing years, Sawhney grew frustrated that America’s health disadvantage did not get high-level attention, even though additional research showed that older Americans were not just less healthy than their British counterparts, but less healthy than other Europeans as well. “When you find out that every other rich country in the world — without better technology, without more spending on biomedical research — is healthier, it undermines your case that what you are doing is right,” he said.
So he spearheaded the effort to get a bigger set of eyes focused on the issue. The National Academy of Medicine (then known as the Institute of Medicine) is a nonprofit organization that, as part of the National Academies of Sciences, Engineering, and Medicine, is authorized by Congress to advise the federal government on medical and public health issues. Its members are elected because of their important contributions to their fields, and it undertakes big-picture research studies on a contract basis along with the National Academies’ research arm, the National Research Council. In this case, the NIH funded research to review health data for all ages of life, not just older people.
Woolf was recruited to chair the panel; other members were primarily academic experts in epidemiology, demography, and economics. Many had spent their careers looking at international health comparisons, but none had ever seen the data for all health conditions in one place before. “There were many of us, including myself, who expected we would outperform some countries in some disease areas and underperform in others,” Woolf said. “But what was so stunning to us was that, with very few exceptions, we were consistently underperforming.”
Laudan Aron, now a senior fellow at the Urban Institute, a Washington D.C.-based think tank, was the Shorter Lives study director, responsible for editing and writing the report along with Woolf. Panel members were struck, she said, by how consistently the U.S. health disadvantage washed across Americans from all subsets of the population — rich and poor, highly educated and not, old and young. Members of some racial and ethnic minority groups have much worse health than their White compatriots, but even well-to-do, highly educated White people with health insurance suffered a health disadvantage because they lived in the U.S.
There were some bright spots. Americans who manage to reach the age of 75 live longer than their peers in other countries. The U.S. also has higher rates of cancer survival, better blood pressure and cholesterol control, lower stroke mortality, and lower smoking rates. But, compared to peers in other rich nations, many Americans do not live to see old age; since 1980, the U.S. has consistently had the first or second lowest probability of surviving to age 50. Continue
Visual: Matt Anderson - - "Source" -
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