Americans may be living longer and even exercising a little more, but we really are not much healthier than we were 10 years ago and we are still far behind other rich countries when it comes to our health, researchers said Wednesday.
The biggest survey of U.S. health in 15 years breaks down death, disease and disability county by county – and makes some very unflattering comparisons to other countries. It’s a big, comprehensive dive into what kills us and what makes us sick.
It finds that how healthy you are depends on where you live. If you live in a rich area like San Francisco, Colorado or the suburbs of Washington D.C., you’re likely as healthy as the Swiss or Japanese. If you live in Appalachia or the rural South, you’re likely to be as unhealthy as people in Algeria or Bangladesh.
Our biggest enemies are our own bad habits – poor diet, smoking and obesity. They’re far more dangerous to our health than pollution or risks from radiation. And although women used to be far healthier than men, men are closing the gap fast, the survey by Dr. Christopher Murray of the University of Washington and colleagues finds.
"There's been a lot of progress in the past 25 years in improving life expectancy for men; less progress for women," Murray told NBC news. "There are some communities where both men and women have seen huge advances in life expectancy, places like New York and San Francisco have seen really enormous strides in expanding lifespan," he added.
“US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; over the same period healthy life expectancy increased from 65.8 to 68.1 years,” the team writes in one of the reports, published in the journal Population Health Metrics and in the Journal of the American Medical Association.
But Americans lost ground compared to people living in other countries in the Organization for Economic Cooperation and Development. “Among 34 OECD countries between 1990 and 2010, the U.S rank for the age-standardized death rate changed from 18th to 27th,” Murray’s team wrote.
Murray’s team looked at the biggest national health surveys, with data on millions of Americans. They broke it down county by county – and then compared the numbers to other big surveys in other countries.
“In the highest-performing counties, life expectancy rivaled countries with the highest life expectancy in the world, such as Switzerland and Japan,” they wrote.
“In the lowest-performing counties, life expectancy was lower than the life expectancy of countries receiving foreign aid such as Algeria and Bangladesh. The lowest life expectancies in the U.S. remained around 73 years for females and below 65 for males between 1985 and 2010."
Compare disease risks and causes in different countries
"There are places with the best life expectancy in the world in the U..S., and there are places in Mississippi, for example, or West Virginia where life expectancies are in the mid-60s for men and low 70s for women. That's about the same as a number of poor developing countries," Murray says.
“The United States spends more than the rest of the world on health care and leads the world in the quality and quantity of its health research, but that doesn’t add up to better health outcomes,” Murray said in a statement.
One place the U.S. does better – treating some cancers.
“Five-year survival for breast cancer and colorectal cancer are higher in the U.S. than in many OECD countries,” they wrote.
The biggest killers: clogged arteries (known medically as ischemic heart disease), lung cancer, stroke, chronic obstructive pulmonary disease and road accidents.
Where are people living the longest and shortest lives?
But the diseases that caused the most misery, known in the lingo as disability-adjusted life years, are low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders.
In fact, Americans are more disabled now than they were 10 years ago, the researchers found.
“The gap between life expectancy and healthy life expectancy, a measure of the expected number of healthy years that an individual loses to disability—increased from 9.4 to 10.1 years. In other words, individuals in the US are living longer, but not necessarily in good health,” they concluded.
“The United States spends the most per capita on healthcare across all countries, lacks universal health coverage, and lags behind other high-income countries for life expectancy and many other health outcome measures. High costs with mediocre population health outcomes at the national level are compounded by marked disparities across communities, socio-economic groups, and race and ethnicity groups.”
One underlying cause is poor diet. “The most important dietary risks in the U.S. are a diet low in fruits, low in nuts and seeds, high in sodium, high in processed meats, low in vegetables and high in transfats,” they wrote.
"For the first time we're saying that the composition of diet, which is made up 14 different components, things like fruits, grains, nuts, seeds (and) other aspects of diet being analyzed is the biggest determinant of health in the US, followed by smoking, followed by obesity, and then followed by high blood sugar and physical inactivity," Murray told NBC news.
"So if you put all of those together there's huge potential to improve health in the U.S. and in fact get ahead of other high income countries if we were to address these modifiable risks."
First Lady Michelle Obama said the report shows communities and policymakers need to help Americans eat better. "We’re going to be working with food companies and restaurants who are offering more healthy options to families so that when they go into a restaurant they have some decent choices," she said at an event at the White House for her "Let's Move" campaign.
But Dr. Steven Woolf of Virginia Commonwealth University, who chaired a National Academy of Sciences panel that reported on U.S. health in January, says it’s more complex than just bad habits.
“It’s unsophisticated to say it’s because we are not eating right,” Woolf said in a telephone interview.
“There is a large contingent of Americans who react by saying this is a matter of personal responsibility. To some extent that’s true but there is much more about the way our lives are structured in the U.S.”.
Counties that score higher in terms of health have social services that support parents and better education outcomes, Woolf argues.
How does your county rate? Check the US health map
And Jeff Levi of the Trust for America’s Health sees a telling pattern in the county-by-county breakdown of U.S. health.
“Those distinctions are really about income and education level,” Levi told NBC News.
“OECD countries are spending more on education and income support than we do and that is what is helping to create this healthier environment,” he added. “We need to really try to get at the social and environmental causes of these issues and really focus on true prevention, which is not managing in a clinical setting but creating the conditions where this doesn’t happen in the first place.”
Woolf says a lot has to do with public perception. “We are much more afraid of plane crashes and being struck by lightning and not afraid of the things that are far more likely to claim our lives,” he said.
“The other reflex people have is to say social programs are important but we just can’t afford it. We have plenty of money for it,” he added.
“If you look at how much money the United States spends on heath, our budget for health exceeds that of every other country in the world.”
Americans may be living longer, but are losing ground compared to other countries in the Organization for Economic Cooperation and development, as seen in this graphic.
This graphic shows the underlying causes of disability and death in the US.
First published July 10 2013, 7:21 AM