1980s), but as noted throughout this report, current health outcomes may have been influenced significantly by social conditions experienced much earlier, particularly for children in the post–World War II era. To understand the current U.S. health disadvantage, it would be important to examine cross-nationally the trajectories of social factors, including programs, services, and spending, that were in place four to six decades before the relevant health outcomes appeared.

Whether the worsening social conditions in the United States and its growing health disadvantage are causally interrelated, their co-occurrence during the same time span in recent U.S. history certainly warrants further scrutiny. As documented in this and the next chapter, there have been dramatic changes in the social fabric of the United States; see in particular the discussion of social capital in Chapter 7. These unsettling trends present a potentially important explanation for the U.S. health disadvantage and are shaped by a range of more deeply rooted societal and structural factors. An examination of these underlying causes can shed light on why the United States appears to be losing ground in so many domains: not only health, but also education, economic equality, and child well-being.

Chapter 7 explores the role of the physical and social environment as an explanatory factor. Chapter 8 explores the important role of life-styles, cultural attributes, public policies, spending priorities, and values as contributors to the patterns observed in this report. These societal factors cannot be ignored when trying to understand either the U.S. health disadvantage or the unfavorable social and economic circumstances reported in this chapter.

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