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America's Health Disadvantage

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The editors at Master of Science in Nursing Degrees decided to research the topic of:

America's Health Disadvantage

The United States spent $2.6 trillion on health care in 2010 - more than any other country in the world. Yet based on research from a collaborative effort within the National Academy of Sciences, Americans live shorter lives and experience more injuries and illnesses than people in similar high-income countries.


Out of 17 countries surveyed (Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom), the U.S. finished dead-last (or perhaps dead first is more appropriate) in nearly every category.*

Deaths from Disease and Injury per 100,000 people in 2008

- Japan: 349
- Switzerland: 370
- Australia: 378
- Italy: 383
- France: 397
- Spain: 398
- Canada: 401
- Sweden: 410
- Austria: 421
- Norway: 426
- Netherlands: 427
- Germany: 440
- Finland: 446
- United Kingdom: 462
- Portugal: 468
- Denmark: 500
- United States: 505

Average Infant Mortality Rate per 1,000 Live Births in 2005-2009

- Sweden: 2.5
- Japan: 2.6
- Finland: 2.7
- Norway: 3.0
- Portugal: 3.4
- Spain: 3.5
- Italy: 3.6
- Germany: 3.7
- Austria: 3.8
- Denmark: 3.8
- France: 3.8
- Switzerland: 4.2
- Netherlands: 4.2
- Australia: 4.5
- United Kingdom: 4.8
- Canada: 5.2
- United States: 6.7

Years of Life Expectancy at Birth in 2007


- Switzerland 79.33
- Australia 79.27
- Japan 79.20
- Sweden 78.92
- Italy 78.82
- Canada 78.35
- Norway 78.25
- Netherlands 78.01
- Spain 77.62
- United Kingdom 77.43
- France 77.41
- Austria 77.33
- Germany 77.11
- Denmark 76.13
- Portugal 75.87
- Finland 75.86
- United States 75.64

- Japan 85.98
- France 84.43
- Switzerland 84.09
- Italy 84.09
- Spain 84.03
- Australia 83.78
- Canada 82.95
- Sweden 82.95
- Austria 82.86
- Finland 82.86
- Norway 82.68
- Germany 82.44
- Netherlands 82.31
- Portugal 82.19
- United Kingdom 81.68
- United States 80.78
- Denmark 80.53


Out of 57 health indicators (i.e. diabetes, BMI, cholesterol, BP, etc.) divided into four age groups, the U.S. scored lowest in half (28). Furthermore, when compared to its peer countries, the United States' composite score in each of the four age groups was ranked last.

- Ages 0-4: Last (17 of 17)
- Ages 5-19: Last (17 of 17)
- Ages 20-34: Last (17 of 17)
- Ages 35-49: Last (17 of 17)

"The tragedy is not that the United States is losing a contest with other countries but that Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary." -Steven Woolf, Chair, Panel on Understanding Cross-National Health Differences Among High-Income Countries

As of 2010, the United States had the highest prevalence of diabetes (for adults aged 20-79) among the 17 peer countries. Related, the United States has the highest prevalence of adult obesity among the 17 peer countries. As of 2009, the prevalence of obesity in the United States (33.8 percent) was twice the average (16.9 percent).

Compared with the aforementioned countries, the United States fares worse in the following nine health domains:

- 1. Adverse birth outcomes. The United States continues to experience the highest infant mortality rate of high-income countries. Additionally, American children are less likely to live to age 5 than children in similar countries.
- 2. Injuries and homicides. Deaths from car accidents, injuries, and violence occur at much higher rates in the United States than in other countries.
- 3. Adolescent pregnancy and sexually transmitted infections. For nearly two decades, the U.S. maintains the highest rate of adolescent pregnancies and its teenagers are more likely to acquire sexually transmitted infections than adolescents in high-income countries.
- 4. HIV and AIDS. The United States has the second highest prevalence of HIV infection among the 17 peer countries and the highest incidence of AIDS.
- 5. Drug-related mortality. Americans lose more years of life to alcohol and other drugs than people in peer countries, even when deaths from drunk driving are excluded.
- 6. Obesity and diabetes. The United States has had the highest obesity rate among high-income countries for decades.
- 7. Heart disease. The U.S. death rate from ischemic heart disease is the second highest among the 17 peer countries.
- 8. Chronic lung disease. Lung disease is more prevalent and associated with higher mortality in the United States than in the United Kingdom and other European countries.
- 9. Disability. Older U.S. adults report a higher prevalence of arthritis and activity limitations than their counterparts in the United Kingdom, other European countries, and Japan.


- Experts at the National Research Council and Institute of Medicine posit four possible explanations for the United States' declining health.
- Health systems. Unlike its peer countries, the United States has a relatively large uninsured population and more limited access to primary care. Americans are more likely to find their health care inaccessible or unaffordable and to report lapses in the quality and safety of care outside of hospitals.
- Health behaviors. Although Americans are currently less likely to smoke and may drink alcohol less heavily than people in peer countries, they consume the most calories per person, have higher rates of drug abuse, are less likely to use seat belts, are involved in more traffic accidents that involve alcohol, and are more likely to use firearms in acts of violence.
- Social and economic conditions. Although the income of Americans is higher on average than in other countries, the United States also has higher levels of poverty (especially child poverty) and income inequality and lower rates of social mobility. Other countries are outpacing the United States in the education of young people, which also affects health. And Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages.
- Physical environments. U.S. communities and the built environment are more likely than those in peer countries to be designed around automobiles, and this may discourage physical activity and contribute to obesity.
- *The panel did find that the U.S. outperforms its peers in some areas of health and health-related behavior. People in the U.S. over age 75 live longer, and Americans have lower death rates from stroke and cancer, better control of blood pressure and cholesterol levels, and lower rates of smoking.

SOURCE: National Research Council and Institute of Medicine. (2013). U.S. Health in International Perspective: Shorter Lives, Poorer Health. Panel on Understanding Cross-National Health Differences Among High-Income Countries, Steven H. Woolf and Laudan Aron, Eds. Committee on Population, Division of Behavioral and Social Sciences and Education, and Board on Population Health and Public Health Practice, Institute of Medicine. Washington, DC: The National Academies Press.