Best Health System in the World?

If one big thing you want out of life is to live a long time in good health, the U.S. is not doing a good job, says a major report from the National Research Council and the Institute of Medicine, entitled "Shorter Lives, Poorer Health."

There's no explaining it away. A panel of physicians and researchers from around the country found a health disadvantage at all ages -- from birth to 75 -- when compared against people in 16 other "high income" countries.

The breadth and scale of this report is something: 405 pages of analysis across diseases, ages and incomes groups.

Even well-off Americans, "those who have health insurance, college educations, higher incomes and healthy behaviors," according to the press release, seem to be in worse health than their counterparts in the other well-off countries.

Dr. Steven Woolf, chair of the panel that wrote the report, said they were "struck by the gravity" of what they learned. "Americans are dying and suffering at rates that we know are unnecessary because people in other high-income countries are living longer lives and enjoying better health. What concerns our panel is why, for decades, we have been slipping behind."

Pretty sobering.

This study builds on a 2011 report that looked at people over 50, but that report largely blamed past smoking history and obesity for the shorter longevity of older Americans. Today's news broadens to include younger Americans, news which is a "tragedy" according to Woolf. "I don't think most parents know that, on average, infants, children, and adolescents in the U.S. die younger and have greater rates of illness and injury than youth in other countries." (The report includes a depressing interactive chart that compares the U.S. to other countries by disease.)

UCSF's Dr. Paula Braveman was on the panel and repeatedly used the word "shocked" in an interview today to discuss the findings. Still, she said there were a couple bright spots. The U.S. does better on cancer and stroke mortality, but "the rule is we're worse on everything," she told me.

The U.S. is famous for spending significantly more per capita on health care than any other country, "about 90% higher than in many other countries that we would consider global competitors," according to the Kaiser Family Foundation (see pg. 7). But the panel was unanimous, Braveman said, in its agreement that these health disparities go beyond the health care system itself.

Yes, the panel acknowledges obesity and other unhealthy behaviors as drivers of poor health. But they also point to a multitude of other factors, including the social determinants of health -- things like high rates of poverty, income inequality and the (poor) quality of schools -- as well as social policy that can contribute dramatically to poor health outcomes.

"I'm hoping this will shake people up enough that they will finally be willing to consider what we have to learn from other countries," Braveman says. "I think coming to grips with the fact that we're the bottom of the heap on health, I'm hoping that that will make people willing to take a look at what's being done in other countries and what we can learn from that."