The United States lags in health indicators behind all our high-income peer countries. Most well-informed readers know this and know that we have lower life expectancy and higher mortality on multiple causes than do, for example, Italy, Greece, France, or Norway. It is worth noting that our health measures were not always this poor compared to other countries; as recently as the mid-1980s we were roughly in the middle of the pack in high income countries and we have slowly fallen behind. Other countries have passed us, both high-income nations and other not so usual suspects like Chile, Cuba, and Singapore.
So the bad news is that we have fallen behind. The good news, perhaps, is that if we fell behind on health in such a short period of time, we can reverse course and catch up in the next few short decades.
But can we? A recent paper published in AJPH, the American Journal of Public Health, suggests that we cannot. The analysis found that to achieve United Nations projected mortality estimates for Western Europe by 2030, US life expectancy must grow at 0.32% a year between now and then. Fewer than 10% of US states have health improving at that pace or higher; this makes it highly unlikely that we are going to catch up and suggests, in fact, that we are going to fall further behind.
Why is this? Three explanations in our assessment.
First, much of the US gain in health and survival over the first half of the twentieth century has slowed down significantly in the latter half of the last century and the first two decades of this century. Just to give perspective, we gained 21 years in life expectancy between 1900 and 1950 and only 8.6 years between 1950 and 2000.
Second, we only excel at extending life for persons over 75. In this age group, we have lower mortality than other high-income countries. But these gains are diminishing perhaps as we start reaching natural limits of human lifespan.
Third, we continue to underfund in the foundational forces that shape health. Data show clearly that we continue to under-invest in forces such as education, efforts to promote healthy living, or preventive care, even in states like Massachusetts. Instead we spend our money on inefficient and expensive health services.
It seems odd that we should accept this state of affairs. Why does the United States spend more on health than any other country but get less out of our spending than our peers? Shouldn’t this be something that we talk about at every dinner table around the country until we change course?
Warmly,
Michael Stein & Sandro Galea