Future Now
The IFTF Blog
The health of Americans
The United States spends more on health care than any other nation in the world, yet it ranks poorly on nearly every measure of health status. How can this be? What explains this apparent paradox?
This line of inquiry, with which I often struggle, is posed by former head of the Robert Wood Johnson Foundation, Steven A. Schroeder, M.D., who is now at the University of California at San Francisco Medical School. Schroeder tries to provide some answers in an article (really a lecture) in this week's issue of the New England Journal of Medicine.
Schroeder's short answer to America's health problems is two-fold:
first, the pathways to better health do not generally depend on better health care, and second, even in those instances in which health care is important, too many Americans do not receive it, receive it too late, or receive poor-quality care.
Schroeder suggests that changing unhealthy behavior is one of the possible pathways to improving population health. It turns out that 40% of all premature deaths are behavior-related (see Figure 1). Schroeder examines the successes we've seen in terms of people changing their behavior with regard to tobacco; he posits that obesity may be this country's next tobacco (see Figure 2 for comparison).
Figure 1
Figure 2
Schroeder also discusses non-behavioral causes of premature death and how they often relate to class issues. Although the quality of our healthcare may be open to dispute, it should come as no surprise that the real issue in this country has to do with access to healthcare.
[W]e trail nearly all the countries: 45 million U.S. citizens (plus millions of immigrants) lack health insurance, and millions more are seriously underinsured. Lack of health insurance leads to poor health. Not surprisingly, the uninsured are disproportionately represented among the lower socioeconomic classes.
Schroeder makes the case that concentrating on the health of the less fortunate will go a long way to improving the overall population health of the United States. He closes with the observation that,
Americans take great pride in asserting that we are number one in terms of wealth, number of Nobel Prizes, and military strength. Why don't we try to become number one in health?
Yeah. . . Why don't we?