We also emphasize that our call for more research should not be used as an excuse for inaction on the part of the nation. As detailed in Chapter 10, the causes of the U.S. health disadvantage are clear enough, and there is sufficient evidence to justify an immediate response on the part of the nation, states, and local communities. The public health and social policy priorities are evident, and interventions of proven effectiveness are known. Delaying action to wait for more data will only allow the U.S. health disadvantage to grow (see Chapter 10).

Research can point to priority areas for action, but its value will depend on the quality of available cross-national data. This chapter focuses on how to build capacity for productive scholarship on international health differences and the need for an ongoing and coordinated commitment by research agencies, funding bodies, statistical agencies, and investigators. We focus on four areas: (1) data needs, (2) analytic methods development, (3) new lines of inquiry, and (4) stable research funding.


High-income countries currently collect extensive data on health indicators and a variety of factors that contribute to health and illness. The United States is among the countries with the most extensive efforts to collect health-related data using large population-based surveys. Large nationally representative population health surveys conducted by the U.S. Department of Health and Human Services include the National Health Information Survey (NHIS), the Behavioral Risk Factor and Surveillance System (BRFSS) survey, the National Health and Nutrition Examination Survey (NHANES), and the National Ambulatory Medical Care Survey (NAMCS). The BRFSS program has been systematically collecting risk factor data in a state-based system for nearly three decades. It is one of the few worldwide examples of a sustained systematic collection of data that tracks risk factors over time at the population level. Population surveys conducted by other agencies are also relevant to this topic, including the decennial U.S. census, the American Community Survey, the Current Population Survey, and surveys conducted by the U.S. Department of Education.

Data collection efforts in other countries range from local or provincial surveys to nationally representative survey methodologies and some cooperative multinational efforts to administer similar survey instruments to comparable populations in each country. An example of the latter is the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Study on Ageing (ELSA), and the Health and Retirement Study (HRS). For a detailed list of data sets that are available for research (see Table 9-1).

In the United States, the National Institutes of Health (NIH)—and the National Institute on Aging in particular—has played a leadership role in

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