Is the U.S. sicker than other countries? Part 2

Posted by Nolan Miller on Nov 5, 2009

Filed Under (Health Care)

A couple of weeks ago I wrote about how Americans may spend more on health care because we are sicker than those in other countries.  A recent paper provides additional evidence on this point.  (Thanks to the Economic Logic blog, which pointed out the paper.)   The paper, by RAND Corporation researchers Pierre-Carl Michaud, Dana Goldman, Darius Lakdawalla, Adam Gailey and Yuhui Zheng, is entitled “International Differences in Longevity and Health and their Economic Consequences”, and it begins by noting that in 1975, life expectancy at age 50 was about the same in the U.S. and Europe.  Since then, however, Europeans have gained more than Americans.  In 2004, a typical 50 year old Eurpoean expected to live another 32.5 years, while his American counterpart expected to live only 31 more years.  Next, they note that Americans appear worse on several health indicators than Europeans.  For example, the U.S. looks worse than the group of Eurpean countries they study (Demnark, France, Germany, Greece, Italy, The Netherlands, Spain, Sweden) in terms of obesity, whether the person has ever smoked, heart disease, diabetes, stroke, lung disease, cancer, hypertension and disability.  This leads to the main question of the paper: how much of the difference in life expectancy from age 50 is driven by these differences in health?  If observed differences in health do not account for the difference in longevity, then it is possible that “‘being American’ an independent mortality risk factor, in the same way that being poor or being black increase risk above and beyond observed health.”  This ‘being American’ effect could be due to shortcomings of our health care system relative to that of other countries.

The main finding of the paper is that, if Americans had the same baseline health status as the Europeans in the study, they would live about 1.2 years longer.  So, differences in health status account for about 80% of the 1.5 year difference.

Of course, differences in health status at age 50 could, themselves, be a product of the health care system.  So, it is not immediately clear from the Michaud et al. paper that Americans are genetically sicker or that we make behavioral choices (e.g., eat too much) that make us sicker.  It could be that we get worse health care throughout our lives, and this leaves us sicker at age 50.  I suspect that this is not the case, but it is certainly a possibility.

This reminded me of a paper I saw a few years ago by Daniel Polsky and others entitled “The Health Effects of Medicare for the Near-Elderly Uninsured.”  The study found that if a person was basically in good health when they went on Medicare at age 65, Medicare helped to keep them that way.  But, for those who were already in declining health, Medicare was not that effective.  Now, if as the previous study showed, Americans have higher prevalence of chronic disease at age 50 than other countries, it may be that we, for whatever reason, enter the period of “declining health” earlier than Europeans do.  If insurance (as proxied by Medicare) is more effective in maintaining good health than restoring one to good health once deterioration has begun, then this suggests that the place to focus our efforts if we want to close the longevity gap with Europe would be in increased prevention and disease management efforts in middle age.

Next week: does preventative care save money?

7 Responses to “Is the U.S. sicker than other countries? Part 2”

  • Jim says:

    The reasons Europeans live longer may be related to the obesity problem in America or the way America’s healthcare is structured, but maybe it actually is caused by the differences in the way Americans live. Studying abroad in Austria for 6 months has allowed me to witness the European culture or way of life. Everyone in Europe seems laid back and relaxed. School is not as stressful. Due dates and deadlines for homework are often very flexible. Also, people do not work as hard as they do in the U.S. Most stores close at 5pm during the week days, and almost all stores are closed on Sundays. This is totally different than in the States, where we have Wal-Mart opened 24/7, and Sunday is just considered another day in the business world. So maybe our life expectancy isn’t caused by our healthcare system, obesity, or anything else in that sense. Maybe it is due to the fact Americans are always pressured to be “on go at all times” and never get the chance to relax and kick back like they do in Europe. It seems that Americans live to work while Europeans work to live and this could be affecting American’s health and life expectancy

  • Lisa V says:

    It is clear that the main contributing factor to America being “sicker” is obesity. However, over eating is not the only cause for obesity. Our society is set up like a rat race, the stress, the anxiety, the entire behavior of the “America” people is completely different from Europe. It is set up that work is the most important thing and making money is all that matters. Our days consist entirely of revolving around getting ahead of your neighbor and making more and more money. This causes adverse health risks, eating at skewed times, eating on the go (i.e fast food). Our entire nation is built on the “on the go” idea, it is no wonder that we are obesity rates are sky high. It just goes to show that the “European” lifestyle is completing different from the “American” lifestyle which is leading to many ailments and sicknesses.

  • Annie N says:

    I feel as this can be a continuing chicken or the egg debate. As some of the others have mentioned it is evident that the Americans have caused many of the issues that contribute to the current shortened lifetime expectancy. Was it the obesity and stressful lives that caused this decline first, or the inability of healthcare system that led us to these lifestyles? I feel like that is something that is difficult to understand. I just feel that if our culture has created such a strain on our health, what is preventing our healthcare from adapting and evolving to help reduce the strain. When you look at how much money we are pumping into the healthcare system, it should be one that can adapt to our culture’s needs. We need to find a way to perhaps boost preventative care so people don’t get in these poor health conditions at all. In addition, we need to find a better way to take care of those that succumb to the poor health conditions. I feel that because we spend as much money as we do, we need to have the best healthcare available.

  • Jonathan La Berg says:

    I very much agree with the author that Americans need to step up and take the blame for their declining health status when compared against Europeans. I feel very strongly that it is not our faulty health care system, but instead our unhealthy lifestyle as a nation that has led to this declining life expectancy. Yes, we need to increase disease prevention and preventative medicine as a whole in our middle aged years, but that does not distract that we are doing a lot of damage to ourselves as a society much earlier on. As the author says, this seems to be a problem that’s only getting worse for Americans as we move into the future, so unless we make a societal change, we’re looking at increasingly shorter lifestyles than our European counterparts.

  • Brian Tschanz says:

    As other people have already said, I believe our American lifestyle has a huge impact on our perceived lack of quality health care. I think we as a culture try to “take the easy way out” which is why some people would rather not go for a walk for 30 minutes a day to stay in shape, and then when their weight gets out of control they try new fad diets or expensive surgical options.

    I truly was amazed when I spent a semester in Europe how few obese people there were. By the end of the semester I had gotten used to it, and then I was shocked again when I came home. I think the biggest difference, at least in the European cities that I visited, is that people there are much more active, and they tend to walk places whenever they can. In America, people hop in their cars to drive a couple of blocks away. Overall, I don’t really think we can expect our healthcare industry to “save us” if we don’t take better care of ourselves.

  • Ryan Reed says:

    I agree with Jim’s idea that “Americans are always pressured to be on go at all times”. With such stressful and demanding jobs, many Americans chose to engage in unhealthy habits, such as eating fast-food on a regular basis and/or neglecting to partake in physical activity. These factors are well known to increase the likelihood of obesity, cardiovascular disease, and possibly even cancer. To me, it seems more like a product of our business environment than poor quality health-care.

  • Rebecca says:

    Its the highfructose corn syrup made from GE corn. Its the beef that is fed GE soy and GE corn. ITs the processed food made wiht GE corn and wheat.

    Monsanto is making us all sick.

    We have a polluted country full of their chemicals and their franken foods.