disadvantaged groups, but several studies have found that even the most advantaged Americans may be faring worse than their counterparts in other countries. In comparisons with England and some other countries, Americans with healthy behaviors or those who are white, insured, college-educated, or in upper-income brackets are in worse health than similar groups in other countries.

The United States enjoys some health advantages, including a suicide rate that is at or below the OECD average, low cancer mortality rates, and possibly greater control of blood pressure and serum lipids. And despite objective measures to the contrary, American adults are more likely than others to rate their health as good.

The disappointing U.S. rankings across the life course suggest the existence of “tracking” between early life behaviors and risk factors: that is, patterns related to obesity, self-reported diabetes, and mental disorders appear to carry forward into successive age groups. Furthermore, the conditions that affect one generation may affect the next, as when poor maternal health or adolescent pregnancy leads to low-birth-weight newborns and infant mortality. Current research is attempting to delineate and quantify the interaction variables in these relationships (see, e.g., Gavin et al., 2011). Although statistical associations may represent an artifact of the available data, a more likely explanation is that they reflect the influence of common underlying conditions on all stages of the life course or causal connections across ages.

The health disadvantages that exist in the United States relative to other countries are all the more remarkable given the size and relative wealth of the U.S. economy and the nation’s enormous spending on health care. National health expenditures in the United States have grown from an annual $256 billion (9.2 percent of gross domestic product [GDP]) in 1980 to $2.6 trillion (17.9 percent of GDP) in 2010 (Martin et al., 2012). No other country in the world spends as much on health care, and per capita spending on health care is also much higher in the United States than in any other country (Squires, 2011).

Although this report focuses on health and not economics, it bears noting that the health disadvantage of the United States does have implications for other domains, such as the economy and national security. For example, military and national security experts have warned that rising rates of obesity and illness in young adults are making it harder to recruit healthy soldiers (Cawley and Maclean, 2010). Major corporations are also concerned about the effects of obesity on workforce productivity and competitiveness in the international marketplace (see, e.g., Heinen, 2006).

The economic costs of higher rates of illness and premature death may be substantial. As LaVeist and colleagues (2009, p. 2) explain:



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