on the topic, with knowledge of relevant data sources, clinical practices, and policy strategies for addressing the conditions in other rich nations (or knowledgeable contacts in each country for obtaining this information). Like the TRB report, such studies would seek to find discrete explanations for how and why other high-income countries are achieving lower morbidity and mortality rates for the specific conditions under study and perhaps model or estimate the predicted health and economic effects of alternative policy strategies that target different components of the causal chain.

These issue-focused inquiries are likely to uncover many of the same general themes raised in this report. For example, it is likely that social factors or the lack of universal health insurance in the United States will be found to interfere with access to health care for many of the above conditions. But these focused inquiries will also be able to “unpack” the specifics. They can examine, for example, whether strategies for treating drug abuse or controlling access to prescription opioids account for lower drug-related deaths in other countries. The inquiry into adverse birth outcomes can attempt to tease out the specific reasons that U.S. infant mortality rates have not kept pace with other countries for decades by examining differences in not only prenatal or newborn care, but also preconception and prenatal efforts in public health or social policy to lessen maternal risks for adverse birth outcomes.

Our vision is a published series of issue-specific reports that would be released over several years, with each study building on the findings and insights of those coming before it. The first report could be commissioned immediately. The series would support a critical ongoing cycle of evidence production, guidance regarding effective policies and practices, implementation and evaluation, and learning from practice. The rollout of these reports over time will not only deliver practical solutions to enable the United States to begin to turn the tide in specific domains in which there is a disadvantage, but it will also provide a basis for steady and continued public attention on this issue. It is important to this panel that the public and the nation’s leaders maintain awareness of the U.S. health disadvantage and not lose momentum in efforts to find solutions.


Although the evidence reviewed in this report documents a U.S. health disadvantage that spans decades and continues to trend downward, no one knows for certain what will come next. The health trajectory of the United States and many other countries will be affected by known global trends—such as climate change, dwindling sources of energy, military conflicts, and overcrowding—but also by unforeseen influences yet to emerge. However, almost all trend lines indicate that, in the absence of corrective action, the

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