United States not only on health status but also on protecting children from poverty, educating youth, and promoting social mobility.

It is highly likely that the U.S. health disadvantage has multiple causes and involves some combination of unhealthy behaviors, harmful environmental factors, adverse economic and social conditions, and limited access to health care.1 Although there are a number of explanations for the U.S. health disadvantage, the panel began to consider the possibility that this confluence of problems reflects more upstream, root causes. Is there a “common denominator” that helps explain why the United States is losing ground in multiple domains at once? This pattern began decades ago. As long ago as the 1970s and 1980s, the United States began losing pace with other high-income countries in preventing premature death, infant mortality, and transportation-related fatalities; in alleviating income inequality and poverty; and in promoting education.

More research is needed to determine if there is a common underlying cause, but the panel did discuss possibilities, such as characteristics of life in America that create material interests in certain behaviors or business models. For example, those characteristics include the typically pressured work and child care schedules of the modern American family, the strong reliance on automobile transportation, and delays created by traffic congestion often leave little time for physical activity or shopping for nutritious meals. Busy schedules create a market demand for convenient fast food restaurants.2 It is plausible, but as yet unproven, that societal changes in the United States in the post–World War II period set the stage for many of the deteriorating conditions that appeared in the 1970s and continue to this day.3

Certain character attributes of the quintessential American (e.g., dynamism, rugged individualism) are often invoked to explain the nation’s great achievements and perseverance. Might these same characteristics also be associated with risk-taking and potentially unhealthy behaviors? Are there health implications to Americans’ dislike of outside (e.g., government)


1Similarly, there are also probably multiple explanations for the health advantages the United States experiences relative to other countries, such as the potential dietary, medical, and policy explanations for the country’s below-average rate of stroke mortality.

2The panel notes the “chicken and egg” question of whether U.S. preferences—for fast foods, traveling in large automobiles, etc.—originated historically from consumer demand or from efforts by companies to create a market for these products and build an infrastructure for them (e.g., highways, drive-in restaurants) that is less prevalent in other rich nations. The currently strong market demand for these products in a society that has grown accustomed to a life-style that depends on these conveniences provides less incentive for businesses to change and strengthens the argument that they are providing products and services that consumers want.

3Some of these trends are increasingly observed in other countries as well.

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