No single factor can fully explain the U.S.
health disadvantage. Deficiencies in the health
care system may worsen illnesses and increase
deaths from certain diseases, but they cannot
explain the nation’s higher rates of traffic accidents
or violence. Similarly, although individual
behaviors are clearly important, they do not
explain why Americans who do not smoke or are
not overweight also appear to have higher rates of
disease than similar groups in peer countries.
More likely, the U.S. health disadvantage has
multiple causes and involves some combination
of inadequate health care, unhealthy behaviors,
adverse economic and social conditions, and environmental
factors, as well as public policies and
social values that shape those conditions.
The Costs of Inaction
Without action to reverse current trends, the
health of Americans will probably continue to fall
behind that of people in other high-income countries.
The tragedy is not that the United States
is losing a contest with other countries but that
Americans are dying and suffering from illness
and injury at rates that are demonstrably unnecessary.
Superior health outcomes in other nations
show that Americans also can enjoy better health.
The health disadvantage also has economic
consequences. Shorter lives and poorer health
in the United States will ultimately harm the
nation’s economy as health care costs rise and the
workforce remains less healthy than that of other
With lives and dollars at stake, the United States
cannot afford to ignore this problem. One obvious
solution is to intensify efforts to improve public
health by addressing the specific conditions
responsible for the U.S. health disadvantage, from
infant mortality and heart disease to obesity and
violence. Public health leaders have already identified
many promising strategies to address these
problems, and the nation has adopted detailed
health objectives aimed at their implementation.
Although these are positive steps, addressing the
U.S. health disadvantage will require not only
a list of goals, but also a societal commitment of
effort and resources to meet them.
Little is likely to happen until the American
public is informed about this issue. Americans may
know about some deficiencies in the U.S. health
care system, but most might be surprised to learn
that they and their children are, on average, in
worse health than people in other high-income
countries. Greater public knowledge may require
an organized media and outreach campaign to
raise awareness about the U.S. health disadvantage.
One goal of this effort should be to stimulate a
thoughtful national discussion about what actions
the country is willing to take to achieve the health
gains that other countries are enjoying.
The United States may also be able to learn
from other countries. Although conditions in other
countries often differ from those in the United
States, strategies and approaches that have helped
them achieve better health outcomes are worthy of
study. The NIH or a similar entity should commission
a study of policies that countries with superior
health status have found useful and that might
be adapted for the United States. A series of more
focused studies is also needed to find explanations
for the specific health disadvantages documented
in the report.