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May 05, 2006

Americans Sicker Than Brits — By Far Science/Technology

Whenever the local public radio station carries a discussion of a national health care system, you can count on men (it's always men) calling in to belligerently assert that "the US has the finest health care system in the world," and they don't want to have to stand in line like people (supposedly) have to do in Canada or the UK. Except the US doesn't have the finest health care system in the world. Americans pay far more than anyone else for their health care, but some two dozen other nations rank ahead of us in life expectancy.

Now comes an astonishing new study that shows that White, middle-aged Americans — even rich ones — are less healthy than their counterparts in the UK — by far. The disparity is so great that rich Americans are no healthier than poor Brits. AP:

White, middle-aged Americans — even those who are rich — are far less healthy than their peers in England, according to stunning new research that erases misconceptions and has experts scratching their heads.

Americans had higher rates of diabetes, heart disease, strokes, lung disease and cancer — findings that held true no matter what income or education level.

Those dismal results are despite the fact that U.S. health care spending is double what England spends on each of its citizens.

"Everybody should be discussing it: Why isn't the richest country in the world the healthiest country in the world?" asks study co-author Dr. Michael Marmot, an epidemiologist at University College London in England.

The study, based on government statistics in both countries, adds context to the already-known fact that the United States spends more on health care than any other industrialized nation, yet trails in rankings of life expectancy.

The United States spends about $5,200 per person on health care while England spends about half that in adjusted dollars.

Even experts familiar with the weaknesses in the U.S. health system seemed stunned by the study's conclusions.

"I knew we were less healthy, but I didn't know the magnitude of the disparities," said Gerard Anderson, an expert in chronic disease and international health at Johns Hopkins University who had no role in the research.

Just why the United States fared so miserably wasn't clear. Answers ranging from too little exercise to too little money and too much stress were offered.

Even the U.S. obesity epidemic couldn't solve the mystery. The researchers crunched numbers to create a hypothetical statistical world in which the English had American lifestyle risk factors, including being as fat as Americans. In that model, Americans were still sicker.

Smoking rates are about the same on both sides of the pond. The English have a higher rate of heavy drinking.

Only non-Hispanic whites were included in the study to eliminate the influence of racial disparities. The researchers looked only at people ages 55 through 64, and the average age of the samples was the same.

Americans reported twice the rate of diabetes compared to the English, 12.5 percent versus 6 percent. For high blood pressure, it was 42 percent for Americans versus 34 percent for the English; cancer showed up in 9.5 percent of Americans compared to 5.5 percent of the English.

The upper crust in both countries was healthier than middle-class and low-income people in the same country. But richer Americans' health status resembled the health of the low-income English.

"It's something of a mystery," said Richard Suzman of the U.S. National Institutes of Health, which helped fund the study.

Health experts have known the U.S. population is less healthy than that of other industrialized nations, according to several important measurements, including life expectancy. The U.S. ranks behind about two dozen other countries, according to the World Health Organization.

Some have believed the United States has lagged because it is more ethnically diverse, said Suzman, who heads the National Institute on Aging's Behavioral and Social Research Program. "Minority health in general is worse than white health," he said.

But the new study showed that when minorities are removed from the equation, and adjustments are made to control for education and income, white people in England are still healthier than white people in the United States. [...]

Marmot offered a different explanation for the gap: Americans' financial insecurity. Improvements in household income have eluded all but the top fifth of Americans since the mid-1970s. Meanwhile, the English saw their incomes improve, he said.

Robert Blendon, a professor of health policy at the Harvard School of Public Health who was not involved in the study, said the stress of striving for the American dream may account for Americans' lousy health.

"The opportunity to go both up and down the socioeconomic scale in America may create stress," Blendon said. Americans don't have a reliable government safety net like the English enjoy, Blendon said.

However, Britain's universal health-care system shouldn't get credit for better health, Marmot and Blendon agreed.

Both said it might explain better health for low-income citizens, but can't account for better health of Britain's more affluent residents.

Marmot cautioned against looking for explanations in the two countries' health-care systems.

"It's not just how we treat people when they get ill, but why they get ill in the first place," Marmot said. [Emphasis added]

Is it really so clear that differences in the two countries' health care systems aren't a factor? Nobody seems to have considered the distorting effect of the profit motive.

It could be, for example, that the British system, being a national, not-for-profit system, places a greater emphasis on preventive measures than here in the US. When was the last time your HMO doctor (here in the US) went out of his/her way to get you to come in for a physical, to check your diet and exercise progress, and so on? How about, never? The US medical culture generally downplays preventive medicine (the big bucks are in treatment), so even doctors who provide care to rich patients probably have a bias against spending their time on prevention. There's no money in it.

For-profit medicine is inherently subject to a conflict of interest. There is a lot more money to be made treating people for cancer or heart disease than there is in getting them to live more healthily to prevent disease. It's not that doctors consciously want patients to get ill. It's that they spend their time performing the activities that provide the greatest financial rewards. That would be treatment, not prevention. Heart surgeons get rich. Providers of holistic preventive care do not.

Posted by Jonathan at May 5, 2006 12:08 AM  del.icio.us digg NewsVine Reddit YahooMyWeb


Prosperity without wealth.

The May 4th. broadcast of The War and Peace report on DemocracyNow.org had a piece on the privatization of “detainment centers” used to house immigrants prior to deport. They're filled to the gills using some 22,000 beds, and a bill in the works, if passed, would double the number of beds.

When there's money to be made in deportation, more immigrants will be deported.

Privatization is a four letter word.

Posted by: Jeff at May 5, 2006 01:05 PM