CHICAGO — Middle-aged, white Americans are much sicker than their counterparts in England, startling new research shows, despite U.S. health care spending per person that’s more than double what Britain spends.
A higher rate of Americans tested positive for diabetes and heart disease than the British. Americans also self-reported more diabetes, heart attacks, strokes, lung disease and cancer.
The gap between the countries holds true for educated and uneducated, rich and poor.
“At every point in the social hierarchy there is more illness in the United States than in England and the differences are really dramatic,” said study co-author Dr. Michael Marmot, an epidemiologist at University College London in England.
The study, appearing in Wednesday’s Journal of the American Medical Association, 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.
“Everybody should be discussing it: Why isn’t the richest country in the world the healthiest country in the world?” Marmot said.
“It’s something of a mystery,” said Richard Suzman of the U.S. National Institutes of Health, which helped fund the study.
The researchers looked for answers in the data, which came from government-sponsored health surveys. The research was supported by grants from government agencies in both countries. A U.S. researcher from the Rand Corp. was on the team.
Americans more obese
Smoking rates are about the same on both sides of the pond. Brits have a higher rate of heavy drinking, but a higher percentage of Americans are obese.
The researchers crunched numbers to create a hypothetical statistical world in which the British had American lifestyle risk factors, including being as fat as Americans. In that model, the researchers found Americans still would be sicker.
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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 British: 12.5 percent versus 6 percent. For high blood pressure, it was 42 percent for Americans versus 34 percent for the British; cancer showed up in 9.5 percent of Americans compared to 5.5 percent of Britains.
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 British.
Health experts have known the U.S. population is less healthy than that of other industrialized nations, according to several important measurements. U.S. life expectancy, for example, ranks behind that of about two dozen other countries, according to the World Health Organization.
Some have believed the U.S. has lagged because it has a more ethnically diverse population than some of the higher-ranking countries, 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.
“As far as I know, this is the first study showing this,” said Suzman who called the results “surprising.” But some other experts said the findings were predictable.
No financial safety net
Earlier studies have shown the United States does a poorer job than other industrialized countries at providing primary medical care to its citizens, particularly to those with less education and income, said Dr. Barbara Starfield, a professor of health policy and pediatrics at Johns Hopkins University.
“Countries oriented toward providing good primary care basically do better in health,” she said.
Marmot offered yet another 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 British 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.
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