discussed in Chapters 6 and 7. Moreover, the causal mechanisms for cross-national health differences and for health gradients within countries may differ in important ways that are only beginning to be understood. For example, studies suggest that some Scandinavian countries with superior aggregate health status have larger health disparities than other European countries with poorer aggregate health status (Bambra, 2007; Bambra and Eikemo, 2009; Dahl et al., 2006; Eikemo et al., 2008a; Huijts and Eikemo, 2009; Kunst et al., 1998; Lahelma and Lundberg, 2009; Mackenbach et al., 1997, 2008; Stirbu et al., 2010).

It is also important to note that, unlike the National Research Council (2011) report that examined trends in mortality above age 50 in high-income countries, this panel’s work focused more on current cross-national differences and less on trends over time. Although current levels are certainly reflections of past trends and suggest the direction of future trends, both time constraints and inadequacies in available data limited our ability to explore changes over time. This work remains an important priority for future research.


This report is structured to address three aims: (1) to document the nature and scope of the U.S. health disadvantage (Part I, Chapters 1-2), (2) to explore potential explanations for this disadvantage (Part II, Chapters 3-8), and (3) to propose next steps for the field (Part III, Chapters 9-10).

Part I

Part I reviews the current evidence on mortality and morbidity differences across high-income countries. This information establishes a preliminary evidence base on cross-national health differences spanning all ages of life:

•   Chapter 1: Shorter Lives

•   Chapter 2: Poorer Health Throughout Life

Part II

Part II of this report is devoted to exploring potential explanations for the U.S. health disadvantage, framed around the factors that are known to influence individual and population health. It is organized as follows:

•   Chapter 3: Framing the Question

•   Chapter 4: Public Health and Medical Care Systems

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