found that Americans had a higher summary risk score, including higher levels of serum lipids, glycosylated hemoglobin, and obesity, especially before age 50 (Crimmins et al., 2008).*

The percentage of American adults who describe their health as “good” or “very good” is the highest among people in high-income countries (OECD, 2011b), but this metric is subject to some limitations. Questions about self-rated health may be answered differently across countries due to cultural differences—such as differences in the likelihood or threshold for reporting good health—and may not always track well with objective health indicators. Danish residents, for example, are known to have shorter life expectancy than people in many other countries, but they are more likely to report their health as good or excellent (Oksuzyan et al., 2010). To some extent, this paradox may reflect attitudinal differences across cultures about the relative importance of physical health for a satisfying life. Self-rated health is influenced by mental health, which may differ in the United States from other countries. Finally, questions have been raised about the statistical validity of questions about self-rated health when presented to subjects of varied nationalities. The significance of the high self-rated health of Americans is therefore not entirely clear.

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*Some of these inconsistencies may reflect cross-national differences in treatment patterns. Americans with hypertension and hyperlipidemia may be more likely than others to receive medication for these conditions (see Chapter 4), and this may account for lower levels of blood pressure and serum lipids observed in some studies.

States. As a result, the U.S. ranking in life expectancy at age 50 fell from the middle of the distribution for peer countries in 1980 to the bottom quartile by 2007. The drop was especially sharp for U.S. women (National Research Council, 2011).

Data on life expectancy at birth reveal an even more alarming pattern. Figure 1-5 shows that, among peer countries, male life expectancy at birth in the United States ranked near the bottom in 1980 and at the bottom in 2006. Figure 1-6 shows that female life expectancy, which had been near the median in 1979, ranked at the bottom in 2006. As documented in Box 1-3, the U.S. ranking on life expectancy has been deteriorating for decades and is now decades behind many peer countries.

A notable exception to this unfavorable pattern is the higher life expectancy



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