During the great debate over health care reform, one recurring question was why the USA spends twice as much per capita on health care as other industrialized nations, yet our life expectancy ranks 28th in the world, behind the UK, Korea, Luxembourg and Malta.
As the graph at right shows, the US (red dots) onced rank near the top, and while it has improved, the rest of the world has improved much more.
The National Research Council took a close look at the data and came up with some surprising results. The report published this week, Explaining Divergent Levels of Longevity in High-Income Countries, listed all the usual suspects, such as obesity, sedentary lifestyle, and uneven access to health care, but surprisingly, the number one cause, accounting for 78 percent of the gap for women and 41 percent for men was smoking.
While anyone who has traveled to Europe or Asia might think people in those countries smoked far more than American’s, back in the 1940’s and 50’s when today’s aging population was growing up the USA was relatively wealthier than most of today’s rich nations and had an agricultural environment uniquely suited to growing tobacco.
The red line in the graph at right shows smoking in the USA, which was far higher than the rest of the world until it peaked in the 60s. If there is one cause for optimism, it is that the earlier decline in smoking should make for more rapid improvement in the future.
Similarly, while Americans lead the world in obesity and sedentary lifestyle, the rest of the world is catching up — apparently there is a limit to how much you can eat if you never get up from in front of the TV.
The other piece of good news is that the health care system in the US is pretty good at fixing people up when we get sick.
It’s just that our unhealthy behavior gets us into more trouble than the health care system can fix.