With these important exceptions, Americans under age 75 fare poorly among peer countries on most measures of health. This health disadvantage is particularly striking given the wealth and assets of the United States and the country’s enormous level of per capita spending on health care, which far exceeds that of any other country.


The panel’s search for potential explanations revealed that important antecedents of good health—such as the quality of health care and the prevalence of health-related behaviors—are also frequently problematic in the United States. For example, the U.S. health system is highly fragmented, with limited public health and primary care resources and a large uninsured population. Compared with people in other countries, Americans are more likely to find care inaccessible or unaffordable and to report lapses in the quality and safety of care outside of hospitals.

In terms of individual behaviors, Americans are less likely to smoke and may drink less heavily than their counterparts in peer countries, but they consume the most calories per capita, abuse more prescription and illicit drugs, are less likely to fasten seatbelts, have more traffic accidents involving alcohol, and own more firearms than their peers in other countries. U.S. adolescents seem to become sexually active at an earlier age, have more sexual partners, and are less likely to practice safe sex than adolescents in other high-income countries.

Adverse social and economic conditions also matter greatly to health and affect a large segment of the U.S. population. Despite its large and powerful economy, the United States has higher rates of poverty and income inequality than most high-income countries. U.S. children are more likely than children in peer countries to grow up in poverty, and the proportion of today’s children who will improve their socioeconomic position and earn more than their parents is smaller than in many other high-income countries. In addition, although the United States was once the world leader in education, students in many countries now outperform U.S. students. Finally, Americans have less access to the kinds of “safety net” programs that help buffer the effects of adverse economic and social conditions in other countries.

Although all of these differences are compelling and important, no single factor fully explains the U.S. health disadvantage, for example:

•   Problems with the health care system might exacerbate illnesses and heighten mortality from certain diseases but cannot account for transportation-related accidents or violence.

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