this chapter we focus on 17 high-income countries:2 Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, the United Kingdom, and the United States.


For many years, global health statistics compiled by the OECD3 and the World Health Organization (WHO) have documented higher mortality rates in the United States relative to other high-income countries. Among the 17 peer countries examined by the panel, Americans faced the second highest risk of dying from noncommunicable diseases in 2008 (418 per 100,000 persons) and the fourth highest risk of dying from communicable (infectious) diseases in 2008 (World Health Organization, 2011a) (see Figures 1-1 and 1-2).

Death rates from noncommunicable diseases, notably cardiovascular diseases, have declined everywhere but less so in the United States. As of 2009, ischemic heart disease mortality among males in the United States was 129 per 100,000, higher than the other 16 peer countries except Finland (OECD, 2011b).4Table 1-1 provides cause-specific mortality rates


2The panel selected these 17 as “peer countries” because they are most comparable to the United States. We set three criteria for designating peer countries: (1) high levels of development for a long period of time, (2) sufficient population size to ensure stability of estimates, and (3) data from the Human Mortality Database (2012) of suitable quality and availability for the time period used in our analysis, 2006-2008. Excluded countries did not meet one or more of these criteria. For example, data quality has been a problem in Belgium, and its latest year of available data was 2005; Greece and Korea were not included in the Human Mortality Database at the time of our analysis; and several other high-income countries are former Soviet satellites with atypical mortality experiences. For consistency, this report’s documentation of the U.S. health disadvantage is based on comparisons with these 16 peer countries. The panel uses a more general term, “high-income countries,” to refer to other groups of high-income countries. On occasion, we make comparisons with these other high-income countries and even emerging economies (e.g., Mexico, Russia) because data were available for this larger comparison group, because we cited studies that included these countries, and because for certain conditions (e.g., mortality rates, child poverty) comparisons with emerging economies underscore the United States’ relative position.

3The OECD is a membership organization of 34 member countries that share a commitment to democratic government and the market economy. Well known for its publications and statistics, the work of the OECD covers both economic and social issues, including macroeconomics, trade, employment, education, health, and social welfare. The organization was established in 1961 when the United States and Canada joined the 18 former members of the Organization for European Economic Cooperation (established in 1947 for postwar reconstruction) to work together on shared economic development. The OECD’s 34 members now include countries from North and South America, Europe, and the Asia-Pacific region, and it includes not only most advanced economies, but also such emerging economies as Chile, Mexico, and Turkey.

4U.S. mortality rates from ischemic heart disease are even higher than those of some emerging economies, such as Mexico and Slovenia (OECD, 2011b).

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