Health in the U.S. is worse than it is in other developed countries. Despite spending much more on actual health care, we have shorter lives. Compared to 16 other wealthy countries, we are at or near the bottom of the list for sickness, injuries and death.
A recent report from the Institute of Medicine documents this. Health differences are dramatic and they start at birth. Rates of low birth weight and death before the first birthday are much higher in the U.S., and so is death before 5 years of age. U.S. adolescents are more likely to die from homicide and auto accidents. They have the highest pregnancy rates and the highest incidence of STDs. We have the second-highest rate of HIV infection as well as the highest rate of AIDS.
The U.S. has the highest obesity rates and along with that, more diabetes. We have the second-highest rate of heart disease. We have more lung disease and drug- and alcohol-related deaths than other countries. Two-thirds of the poor health scores are apparent by the age of 50, but those of us who do reach 50 are in worse health and have more arthritis and other activity limitations than comparable countries.
Why are we doing so badly? This report finds problems in nearly every health determinant area it reviewed. As opposed to all other developed countries, the U.S. lacks universal health insurance. Our health care system has a much weaker primary care base. Care coordination for those with chronic illness is often not good. We have more specialists, ER visits and readmissions to hospitals.
But health is more than health care. Americans eat more calories, abuse more drugs, use less seatbelts, own more firearms, and are less likely to practice safe sex. Poor health in all countries is more pronounced in lower socioeconomic groups. The U.S. ranks lowest in social mobility and highest in child poverty. But even those with more education and higher incomes are less healthy than their counterparts.
Our environmental and social structures are also different. Land use, the built environment and transportation are less conducive to physical activity; food availability, distribution and marketing discourage healthy diets; our communities are more heavily segregated by income; our social safety net system is less robust. We tend to emphasize individual responsibility as opposed to social responsibility for our collective well-being.
This report suggests that our social values determine our policies and process. These determine our health. There are multiple examples, but probably none clearer than the current legislative debate over extending health insurance to the poorest members of Montana; those who cannot now afford health insurance and because of that cannot access adequate health care. This is called Medicaid expansion. Experience has shown that providing Medicaid insurance to those who are uninsured does improve their physical, mental and financial health. Montana physicians, nurses and hospitals know that medical care will be better. People will be able to access care when and where they need it, not just in our emergency rooms. Many lives will be saved each year.
We have the financial ability to make health insurance available to everyone. This program will bring more dollars and jobs to our state. The cost to Montana is low and the benefits are high. The real issue is whether our collective values allow us to make this kind of positive social choice. We’ll find out as the question of Medicaid expansion is resolved in our Legislature this session.
To learn more about the issue of individual versus social responsibility in determining health, you should attend all or part of this year’s Mansfield Conference at the University of Montana. Starting the evening of Tuesday and going through the afternoon of Thursday, local and national speakers will be exploring this important topic in detail.
Dr. Tom Roberts has practiced internal medicine in Missoula for 32 years. He is the president of the Western Montana Clinic. He is a board member of the Missoula Public Health Department, the Executive Committee of the Montana Medical Association, and the Montana Health CO-OP. Read “U.S. Health in International Perspective: Shorter Lives, Poorer Health” on the web at the Institute of Medicine.