The U.S. health disadvantage also appears to be costing lives: Americans are not living as long as their counterparts in other countries. According to a report from the Paris-based OECD (2011b), 27 countries now outperform the United States on life expectancy at birth.2 At 78.2 years, the United States is well below the average of 79.5 years among OECD member nations and far below the life expectancy (83.0 years) of Japan, the top-ranking country. Looking at mortality trends only among adults over age 50, a recent National Research Council (2011) study found that the United States began losing ground relative to other high-income countries around 1980, falling from the middle of the group in 1980 to near the bottom by 2007. Between 1980 and 2007, life expectancy at age 50 increased by only 2.5 years in the United States compared with 6.4 years in Japan, 5.2 years in Italy, and an average of 3.9 years in nine high-income countries other than the United States (National Research Council, 2011).

THE ROLE OF DIVERSITY IN HEALTH DISADVANTAGES

Compared with many other high-income countries, the population of the United States is more racially and ethnically diverse, receives immigrants from multiple countries, and struggles with higher poverty rates (OECD, 2011e). In addition, unlike the populations of most comparable countries, many Americans—especially racial and ethnic minorities and socioeconomically disadvantaged groups—lack health insurance coverage (National Center for Health Statistics, 2012). The poor health of racial and ethnic minorities and socioeconomically disadvantaged groups is well documented (Agency for Healthcare Research and Quality, 2011). As a result, some might question whether the poor health status of the U.S. population in the aggregate reflects the adverse health status of minorities or the poor and whether affluent, white Americans are just as healthy as their counterparts in other countries.

A growing body of research is beginning to suggest that the U.S. health disadvantage is not limited to socioeconomically disadvantaged groups: even the most advantaged Americans are in worse health than their counterparts in other countries. For example, a study that purposely limited its analysis to non-Hispanic whites found that U.S. residents aged 55-64 were less healthy than their English counterparts (Banks et al., 2006). The authors added that “health insurance cannot be the central reason for the better health outcomes in England because the top SES [socioeconomic status] tier of the U.S. population has close to universal access but their health outcomes are often worse than those of their English counterparts” (p. 2,043). Likewise, a similar comparison with England found that “the patterns were similar when

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2Life expectancy at birth is the average number of years a newborn can expect to live if, over a lifetime, he or she experienced the age-specific mortality rates that were reported in that year.



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