U.S. health disadvantage relative to other high-income countries will continue to worsen, as it has for years.

A number of factors support the prediction that the health of Americans will continue to slip behind that of people in other countries. For example, to the extent that education of today’s youth predicts the health of tomorrow’s adults, the failure of the United States to keep pace with the educational advances occurring in other countries is a discouraging sign. So is the continuing rise of income inequality in the United States, the persistence of poverty (especially child poverty) at rates that exceed those of most other rich nations, and the relative lack of social mobility. The increasing prevalence of obesity and diabetes among U.S. children at rates that exceed those of other countries is certainly an ominous trend in a country whose adults already suffer from high rates of cardiovascular disease.

Other factors, however, could mitigate these trends and perhaps improve the rankings of the United States relative to other countries. For example, there is some evidence that the obesity epidemic is beginning to stabilize in the United States (Ogden et al., 2012a) while it is continuing to spread globally (Finucane et al., 2011). The prevalence of smoking in the United States has fallen considerably while rates in other countries continue to increase (OECD, 2011b).5 These trends might temper the excessive burden of chronic disease in the United States relative to other countries, especially as today’s middle-aged adults (the beneficiaries of lower smoking rates) become older adults.6 And as these behaviors begin to affect morbidity and mortality in other countries, it is possible that they may “catch up” with the United States, in a negative sense, and so improve the country’s relative ranking. However, such an “improvement” would mean only that progress in safeguarding public health is faltering globally, and that would hardly be good news for the United States.

Indeed, the important point about the U.S. health disadvantage is not that the United States is losing a competition with other countries, but that Americans are dying and suffering at rates that are demonstrably unnecessary. The fact that other high-income countries have better health outcomes


5The rate of decrease in tobacco use among young adults has decreased in recent years in the United States, and smokeless tobacco use has increased (U.S. Department of Health and Human Services, 2012b). These trends could diminish the salutary effects of tobacco control on the U.S. health disadvantage of the next generation. Nonetheless, it bears noting that smoking rates among U.S. youth are generally lower than rates among their peers in other high-income countries.

6As noted in Chapter 5, Wang and Preston (2009) predicted that deaths attributable to smoking among men would decline relatively soon but that improvements for women would come later. Other authors, however, have questioned whether the obesity epidemic will outweigh any gains in life expectancy achieved by lower smoking rates (Stewart et al., 2009). Furthermore, specific aspects of the U.S. health disadvantage, such as the high prevalence of low-birth-weight babies, may persist if smoking rates remain high for women of childbearing age.

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