WASHINGTON, DC, January 9, 2013 (ENS) – Environmental factors contribute to higher rates of disease and injury among Americans compared to people in other high-income countries, , finds a new report from the National Research Council and Institute of Medicine.
The report shows that this health disadvantage exists at all ages from birth to age 75 but is more pronounced among people younger than 50.
The U.S. has relatively high rates of poverty and income inequality and is lagging behind other countries in the education of young people, but the report shows that even advantaged Americans with health insurance, college educations, higher incomes, and healthy behaviors – appear to be sicker than their peers in other rich nations.
“We were struck by the gravity of these findings,” said Steven Woolf, professor of family medicine at Virginia Commonwealth University in Richmond and chair of the panel that wrote the report.
“Americans are dying and suffering at rates that we know are unnecessary because people in other high-income countries are living longer lives and enjoying better health,” said Dr. Woolf. “What concerns our panel is why, for decades, we have been slipping behind.”
The report is the first comprehensive look at multiple diseases, injuries, and behaviors across the entire life span, comparing the United States with 16 peer nations, all affluent democracies: Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom.
Among these countries, the United States is at or near the bottom in nine key areas of health: infant mortality and low birth weight; injuries and homicides; teenage pregnancies and sexually transmitted infections; prevalence of HIV and AIDS; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability.
This health disadvantage exists even though the U.S. spends more per capita on health care than any other nation. Although documented flaws in the health care system may contribute to poorer health, the panel concluded that many factors are responsible for the nation’s health disadvantage.
Many conditions that might explain the U.S. health disadvantage – from individual behaviors to systems of care – are also influenced by the physical and social environment in U.S. communities, the report finds.
The panel “conceptualizes the environment more broadly to encompass a range of human-made physical and social features that are affected by public policy,” in contrast with traditional environmental health approaches that focus on toxic substances in air, water, and soil.
“These economic, social, urban or rural, transportation, and other policies that affect the environment were not traditionally thought of as relevant to health policy but are now attracting greater attention because decision makers are beginning to recognize their health implications,” explains the panel in its report.
“For example, built environments that are designed for automobiles rather than pedestrians discourage physical activity. Patterns of food consumption are also shaped by environmental factors, such as actions by the agricultural and food industries, grocery store and restaurant offerings, and marketing.”
“Asthma rates may be higher because of unhealthy housing and polluted air,” the report states. But it also says, “The effects of particulate matter on mortality appear to be consistent across countries.”
Ana Diez Roux, professor and chair of epidemiology, and director of the Center for Social Epidemiology and Population Health at the University of Michigan, wrote the report’s chapter on environmental factors.
She told reporters on a conference call today that the committee did not do a comprehensive review of air and water quality, but said, “There is no strong evidence air quality is worse in the United States than in the other rich countries we compared it with.”
Nor, said Dr. Roux, is there “strong evidence” that water pollution contributes to discrepancies between the United States and the other rich countries.
Youth is a factor, the report found to the surprise of many panelists. More children and adolescents than other age groups are affected by many of these health conditions, the report says. For decades, the U.S. has had the highest infant mortality rate of any high-income country, and it also ranks poorly on premature birth and the proportion of children who live to age 5.
U.S. adolescents have higher rates of death from traffic accidents and homicide, the highest rates of teenage pregnancy, and are more likely to acquire sexually transmitted infections.
Nearly two-thirds of the difference in life expectancy between males in the U.S. and these other countries can be attributed to deaths before age 50.
These findings build on a 2011 Research Council report that documented a growing mortality gap among Americans over age 50. “It’s a tragedy. Our report found that an equally large, if not larger, disadvantage exists among younger Americans,” Woolf said. “I don’t think most parents know that, on average, infants, children, and adolescents in the U.S. die younger and have greater rates of illness and injury than youth in other countries.”
The panel did find that the U.S. outperforms its peers in some areas of health and health-related behavior. People in the U.S. over age 75 live longer, and Americans have lower death rates from stroke and cancer, better control of blood pressure and cholesterol levels, and lower rates of smoking.
The panel was given 18 months for the task, enough time to “pull back the curtain” but not to conduct a systematic review of every contributory factor and every relevant study or database. This report serves only to open the inquiry, the panel said.
Don’t wait for more research – act now, the report urges. Dr. Woolf recommends a comprehensive outreach campaign to alert the American public to the U.S. health disadvantage and to stimulate a national discussion about what it means and how to lessen the risks.
“The strength of our findings – which was a surprise to us – led us to consider what public-and private-sector leaders can do to begin to catch up with the health advances that other countries are achieving,” the panel says.
In parallel, it recommends data collection and research to better understand the factors responsible for the U.S. disadvantage and potential solutions, including lessons that can be learned from other countries.
“Research is important,” Dr. Woolf said, “but we should not wait for more data before taking action, because we already know what to do. If we fail to act, the disadvantage will continue to worsen and our children will face shorter lives and greater rates of illness than their peers in other rich nations.”
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