U.S. found to be unhealthiest among 17 affluent countries
■ Obesity rates are cited as one contributing factor. But efforts need to go beyond medical care and include social changes and education, say some physicians.
San Francisco family physician Paula Braveman, MD, MPH, hopes a new report that shows Americans have worse health than people in other countries empowers primary care doctors to advocate for wellness, not just in their practices, but in their communities as well.
Such advocacy could include writing letters to local newspapers about various health issues, Dr. Braveman said. Physicians also could join a community effort to establish bicycle lanes on local roads or call congressional leaders to highlight the health consequences of pending legislation, she said.
“It's very powerful when a physician speaks out about the need to look beyond medical care to social issues, education” and other factors in an effort to improve public wellness, Dr. Braveman said. “Doctors don't need to feel like they have to drop their practice” to do this advocacy work.
Dr. Braveman was a member of an expert panel that issued a report Jan. 9 on the health of the United States and other countries. The 10-person panel was convened by the National Research Council and the Institute of Medicine to examine why the U.S. has a poorer health status and lower life expectancy than other countries, despite spending the most money on health care. The experts examined data from a variety of national and international sources, including information from the Centers for Disease Control and Prevention and the World Health Organization.
The panel, which included experts in epidemiology, medicine and social sciences, found that Americans on average die sooner and experience higher rates of disease and injury than the populations of 16 other high-income countries. Those other countries are: Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the United Kingdom.
The health disadvantage in the U.S. exists at nearly all ages, from birth to age 75, the panel said. Even Americans who have a college education and medical insurance and who follow healthy behaviors have poorer health compared with their counterparts in other wealthy countries.
“I expected we would find some problems in certain areas and some good news in other areas,” said panel Chair Steven H. Woolf, MD, MPH. “I personally was stunned by how pervasive the disadvantage was across so many different topic areas.”
Health areas in which Americans ranked poorly compared with the other countries include prevalence of cardiovascular disease, diabetes and obesity.
Obesity's impact on America's health
The U.S. has the highest childhood overweight and obesity rate of the 17 countries. In the U.S., 35.9% of girls and 35% of boys ages 5 to 17 are overweight or obese, according to 2011 data.
The lowest obesity rates were found in Switzerland, where 13.1% of females and 16.7% of males are overweight or obese, the report said.
Among adults, Americans 20 and older have the highest average body mass index and one of the highest rates of diabetes. Americans older than 50 are more likely to develop and die of cardiovascular disease than are older adults in other countries.
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Americans die sooner and have higher rates of disease and injury than people in 16 other high-income countries.
“What we might be seeing is that we're on the leading edge of the global trend” of obesity, said Dr. Woolf, a family physician in Fairfax, Va., and professor of family medicine at Virginia Commonwealth University School of Medicine in Richmond.
He encourages other countries to take note of how obesity and related health problems negatively affect Americans to prevent similar outcomes.
The report was clear that multiple factors, not just obesity, are contributing to the country's poor health. Other factors include limited access to medical care due to the nation's large uninsured population and a shortage of primary care doctors.
Also likely impacting Americans' health are communities designed to favor automobile use rather than walking and an insufficient number of safety net programs such as child care, the panel said.
What doctors can do
“The message for primary care doctors is to strengthen their commitment to involvement in advocacy to change environments to make them healthier for their patients,” Dr. Braveman said.
New York City internist Gary I. Rogg, MD, agrees that physicians unifying to improve health is important. But he said there still are steps primary care doctors could take at the patient level to enhance the nation's health.
For instance, he encourages doctors to spend one or two minutes talking to patients about basic nutrition.
“Point out the obvious, because sometimes patients are afraid to ask basic questions,” said Dr. Rogg, assistant professor and assistant director of the Dept. of Medicine at Montefiore Medical Center in New York.
Dr. Rogg keeps colorful, nonbranded nutrition brochures from pharmaceutical companies in his office for patients to read and take home. He refers individuals who need more extensive dietary assistance to local nutritionists.
Beyond obesity and related conditions, health areas where the U.S. fared poorly compared with other countries include:
- Infant mortality and low birth weight.
- Injuries and homicides.
- Adolescent pregnancy and sexually transmitted infections.
- HIV and AIDS.
- Drug-related deaths.
- Chronic lung disease.
“Our recommendations warn against waiting for more research before taking action,” Dr. Woolf said. “If we fail to act, the [U.S. health] disadvantage will continue to worsen, and our children will face shorter lives.”