Explaining Divergent Levels of Longevity in High-Income Countries (2011) / Chapter Skim
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The relatively poor performance of the United States with respect to achieved life expectancy over the recent past is surprising given that it spends far more on health care than any other nation in the world, both absolutely and as a percentage of gross national product. Motivated by these concerns, the National Institute on Aging requested that the National Research Council convene a panel of leading experts to clarify patterns in the levels and trends in life expectancy across nations, to examine the evidence on competing explanations for the divergent trends, and to identify strategic opportunities for health-related interventions to narrow this gap.
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Among high-income countries that have recorded reductions in adult mortality at advanced ages, the Netherlands and Denmark stand out as the only other two countries that have recently underachieved. For both men and women, the divergence of experience between the United States and the other countries examined is clear both before and after age 50, although it is starker for women than for men.
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The panel found some evidence to suggest that adults aged 50 and over in the United States are somewhat more sedentary than those in Europe, but the research base is insufficient even to identify a reasonable range of uncertainty in estimates of the contribution of physical activity to international differences or trends in mortality. In other cases, the panel determined that certain risk factors are unlikely to have played a major role in the divergence of life expectancy in various countries over the past 25 years.
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Certainly, the lack of universal access to health care in the United States has increased mortality and reduced life expectancy. However, this is a smaller factor above age 65 than at younger ages because of Medicare entitlements.
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The panel concluded that a history of heavy smoking and current levels of obesity are playing a substantial role in the relatively poor longevity performance of the United States. Yet these behaviors are products of a broad social and economic context encompassing, for example, a level of affluence that supports large numbers of automobiles, low taxes on gasoline, and dispersed residences and workplaces that encourage driving; a climate and soil in part of the country that are conducive to growing tobacco; a productive agricultural sector that produces inexpensive foods; and a public health system that is highly dispersed and thus heavily dependent on regional rather
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From page 6... ...
Finally, the panel did not undertake any analysis of the cost-effectiveness of public interventions designed to change personal health behaviors; therefore, recommendations as to what might be undertaken in this regard are not appropriate. It is clear, however, that failures to prevent unhealthy behaviors are costing Americans years of life compared with their counterparts in other wealthy countries.
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