Murders, Accidents and Public Health

Two big reasons why Americans live shorter lives than Europeans: traffic accidents and gun murders.

by James A. Bacon

The United States spends more money per capita on health care than any other nation yet Americans have a shorter life expectancy than citizens in 16 countries with advanced economies. The conventional wisdom blames the fragmented and dysfunctional American health care system. A new National Research Council and Institute of Medicine report, “Shorter Lives, Poorer Health,” doesn’t let the health care system off the hook. But it does point out that the behavior of Americans explains much of the difference .

“The problem is not simply a matter of a larger uninsured population or even of social and economic disadvantage,” states the report foreword . “It cannot be explained away by the racial and ethnic diversity of the U.S. population. … The U.S. disadvantage is expressed in higher rates of chronic disease and mortality among adults and in higher rates of untimely death and injuries among adolescents and small children.”

American rate of young male mortality from violence shown in red. Rate for 16 peer nations shown in gray.

In other words, Americans are far more likely to kill each other with guns and die in automobile accidents. Americans also experience a higher infant mortality rate, higher mortality rates from alcohol and drugs, a higher rate of HIV infection and a higher rate of sexually transmitted diseases. The U.S. blows out other nations in the number of “years of life lost” by males before age 50.

“Concerted action is required on many levels of society if the nation is to change the conditions described here and to give the people of the United States — particularly the nation’s children — the superior health and life expectancy that exist elsewhere in the world,” writes Steven H. Woolf, chairman of the panel of authors and a professor of family medicine at Virginia Commonwealth University.

Lifestyle and environmental factors play a significant role. Just four health behaviors — tobacco use, unhealthy diet, physical inactivity and problem drinking — are associated with 40% of all deaths in the U.S. While Americans actually smoke and drink less than citizens of peer countries, the U.S. has the highest obesity rate, which is strongly associated with diabetes, heart disease and disability. Although these problems are most pronounced among “socioeconomically disadvantaged” groups, even “advantaged” Americans fare worse.

If Americans make it to age 75, they actually have a higher survival rate than other countries. The U.S., says the report, “has higher rates of cancer screening and survival, better control of blood pressure and cholesterol levels [and] lower stroke mortality.” These indicators suggest that the U.S. health care system out-performs those of other countries in important ways.

While the U.S. health care system also has shortcomings, most notably the fragmentation of delivery and barriers to access for lower-income Americans, the authors are cautious about blaming health disparities on those flaws. “One difficulty in attributing the U.S. health disadvantage to deficiencies in public health or medical care system is that countries with better health outcomes lack consistent evidence that their system systems perform better,” states the report.

Conversely, the report concludes, despite noting the difficulties in finding comparable data across countries: “Although no single behavior can explain the U.S. health disadvantage, the high prevalence of multiple unhealthy behaviors in the United States may play a large role.” The debate is between those who would attribute those behaviors to a lack of “personal responsibility” versus those who would blame social and economic factors. The authors lean toward the idea that there may be a relationship between worsening in comparable social conditions in the U.S. — income inequality, poverty, child poverty, single-parent households, divorce and incarceration — and the health gap with other countries.

Also, the authors suggest that differences in the built environment in the U.S. — human settlement patterns, as we like to say on Bacon’s Rebellion — contribute to the American health disadvantage. “It is plausible to hypothesize that factors in the built environment related to low-density land development and high reliance on automobile transportation; environmental factors related to the wide availability, distribution, and marketing of unhealthy foods; and residential segregation by income and race … may be important contributors to the U.S. health disadvantage in many domains.”

Bacon’s bottom line: Only one conclusion seems indisputable from this report: Understanding the causes of the health gap between the U.S. and other developed countries is incredibly difficulty and fraught with methodological issues. All conclusions seem tentative and subject to additional research. However, that said, it seems clear, though perhaps not indisputable, that the health gap can be attributable only in part, if at all, to differences between the U.S. and other health care systems. (The high cost of the U.S. health care system is a different issue, which this study did not address.)

Any intelligent discussion of public health needs to consider differences in socio-economic conditions, social values, individual behaviors and the built environment. I come away from this report feeling vindicated about Bacon’s Rebellion‘s editorial emphasis on walkable/bikable communities, food deserts/locally grown food, and clean water. If we want to improve community health, those are very good places to start.

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6 responses to “Murders, Accidents and Public Health”

  1. these kinds of narratives about health care and costs in this country are almost Alice-in-Wonderland in some respects.

    It goes sorta like this.

    We’d compare more favorably with other countries on life expectancy if we :

    1. – did not kill each other more
    2. – did not eat too much fast food
    3. – did not drive so wrecklessly
    4. – blah, blah, blah,
    5. denial, denial, denial.

    seems like if we killed each other more and died earlier from bad habits, we’d actually save money on health care, right?

    Auto accident rates and smoking, if not mistaken are higher in other countries these days…

    but the essential point is that we are willing to talk endlessly and make innumerable excuses about our health care system – rather than actually do something about it.

    This is the basic GOP approach to many issues now days.

    It’s: ” we don’t believe this [insert your favorite anti-science, anti-factual position]

    and… ” we’ll oppose anything to address it regardless, if it involves govt”.

  2. Larry, the report makes no excuses for the *cost* of the U.S. health system. It criticizes the system for being expensive, fragmented and posing difficult access to the poor. But it also acknowledges the difficulties in comparing different health systems and health outcomes. Despite what you think, it’s very complex. Sorry if reality doesn’t fit the LarryG narrative!

  3. Touche!

    Indeed.. it does burrow through the plethora of issues but I’m highly doubtful about the difference in injury and death stats when looked at in isolation. It’s hard to believe that most of the other nations are pretty much like each other and that of all the industrialized nations (OCED) in the world, that we alone are really that unique to the point where it really does profoundly affect our life expectancy.

    but this is a legitimate journal.. so it does count for something.

    1. I was listening to Rush Limbaugh in the car today, and he was trashing the study because it blames so much of the health gap on guns!

  4. I thought you did not listen to right wing extremist media?

    I can take about 80% of O’Reilly, 20% of Hannity and 0% of Limbaugh ( vitriol is not a strong enough word to describe most
    of his words)

    In general.. anything I hear from the right-wing echo chamber, I go check other sources to get the real story.

    we have a full-blown propaganda war these days … I’ve noted for instance, that even people who support things like Social Security actually buy the right-wing echo chamber lies…about it in part because it requires some time on task to really understand it and people are basically lazy and if a lie is repeated often enough, it become de-facto truth.

    How many people believe it’s the Trust Fund that provides SS benefits? How many people realize that there are 4 Medicare(s) and only Part A is funded from mandatory payroll taxes and the other 3 entirely voluntary fee-for-service insurance?

    this is the state of our politics these days.

  5. we have people now days that are not only willfully ignorant – they are defiantly ignorant. They revel in their revisionist histories and right wing echo chamber propagandized world.

    We have an ongoing effort to include Social Security in the current budget discussions even though it is completely self-funded right now AND the law REQUIRES that benefits be paid ONLY from FICA and, in fact be limited to what FICA generates in revenues.

    So we have folks who say that SS should be “cut”.

    even though it has zero impact on the current budget

    even though by law it is “self cutting” – the law requires benefits to reduce to what FICA generates.

    but nevermind the facts – the zealots want it included in the entitlements issue and want it “cut”.

    think about this.

    we have a trillion + deficit and 16+ debt and instead of looking at the things that are actually causing the deficit – we insist that social security also be on the table.

    the only real problem with SS is that there will have to be some modest changes to it – in the next 10-20 years and only then just to keep benefits at the current levels.

    but if you listen to the zealots – SS is “broke”, has “failed” and is a direct threat to the current budget.

    this is the world we live in now days. You actually have leaders in the Republican Party who say this.

    and when you ask them for specifics – they bail out completely and insist that it’s not their job to cut Social Security but Obama’s job.

    we live in an Alice-in-Wonderland world now days. It’s truly ironic that we live in a so-called “information age” but the reality is that it’s not truly “information” if it does not actually represent facts and realities.

    but as I said at the top – there are people – who will openly admit that they really don’t want to hear the facts – unless they conform to their own personal biases… the world they see must reflect the world they want to believe they see and anything else is unacceptable.

    We are seeing the emergence of a culture based on ignorance – willful ignorance – in an internet age.

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