U.S. Health in International Perspective Shorter Lives, Poorer Health (2013) / Chapter Skim
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5 Individual Behaviors
5 Individual Behaviors
Pages 138-160
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health disadvantage documented in Part I, particularly among younger adults. A life-course perspective is important in studying health behaviors, many of which are adopted at young ages (especially in adolescence)
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Comparing health behaviors across high-income countries is difficult due to a scarcity of data and extensive challenges with measurement. In contrast with such health indicators as blood pressure or serum lipid concentrations, which are easy to measure in standardized units across countries, health behaviors are rarely examined in a uniform fashion, even within the same country, and in some countries they are not measured at all.
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health disadvantage (see Part I) : noncommunicable diseases, such as coronary artery disease, stroke, cancer, and chronic lung disease, as well as adverse birth outcomes, such as low birth weight and infant mortality.
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Since 1992, current smokers included adults who reported smoking 100 or more FIG5-1.eps cigarettes during theirbitmap with new type in legend, landscape smoked every day lifetimes and specified that they currently or on some days. Figure depicts trend over time.
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estimated the attributable fraction of deaths after age 50 from smoking2 and its effect on life expectancy at age 50 among 10 high-income countries in 1955, 1980, and 2003. The authors calculated that by 2003 smoking accounted for 41 percent of the difference in male life expectancy at age 50 between the United States and 9 comparison countries and for 78 percent of the difference in female life expectancy at age 50 (Preston et al., 2010b)
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women experienced relative to 20 other countries between 1950 and 2003. These findings implicate smoking as a potential cause of the shorter life expectancy of adults age 50 and older, but they do not explain the lower life expectancy observed in younger people.
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Data collected within the United States suggest that the American diet has become less nutritious over time. Between 1971 and 2000, average daily caloric consumption increased from 2,450 kcals to 2,618 kcals among men and from 1,542 kcals to 1,877 kcals among women;5 similarly, carbohydrate intake increased by 67.7 grams and 62.4 grams, respectively for men and women, and total fat intake increased by 6.5 grams and 5.3 4 We do not review the extensive evidence regarding the dietary benefits of breastfeeding, but we do discuss below the relatively low prevalence of breastfeeding in the United States.
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.7 Among the 17 peer countries 6 Per capita consumption statistics do not account for wastage and therefore overestimate actual nutrient intake. 7 two-country comparison showed a rate of consumption of 53.8 calories per minute for A the United States and 28.4 minutes for France (Brunello et al., 2008)
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estimated that obesity accounted for 42 percent of the shortfall in female life expectancy at age 50 years in the United States relative to countries with higher life expectancies, and 67 percent of the shortfall among males.
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exerts its own protective effect on the risk of heart disease and stroke and possibly other conditions, including cancer, depression, and dementia (Lee et al., 2012; U.S. Department of Health and Human Services, 2008a)
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However, a recent cross-national comparison of data from 155 surveys in 122 countries reported that the prevalence of physical inactivity in the United States among those age 15 and older (40.5 percent) was lower than in 7 of the 16 peer countries that provided data (Hallal et al., 2012)
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Although there is evidence that moderate consumption of alcohol can offer some health benefits, excessive drinking increases the risk of liver disease, various forms of cancer, hypertensive heart disease, stroke, pregnancy complications, and many other conditions (see, e.g., Rehm et al., 2009)
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was below the consumption levels of 11 peer countries and below the OECD average (OECD, 2011b)
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health disadvantage. Conditions that give rise to substance abuse, such as stressful living conditions (see Chapters 6-7)
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Failure to use contraception and sexual activity with multiple partners can lead to unintended pregnancies and its consequences and can expose the participants to sexually transmitted infections, such as chlamydia, gonorrhea, syphilis, herpes zoster, HIV, and human papilloma virus (which can cause cervical cancer)
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adolescents to have multiple sexual partners, to not use oral contraceptives as often as their peers in other countries, to rely on less effective barrier methods, such as condoms, and to use them less often than their counterparts in some other countries could explain the higher rates of pregnancies and sexually transmitted infections among U.S. adolescents, the high burden of HIV/AIDS in the United States, and perhaps the excess deaths from some congenital anomalies.
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As detailed in Chapter 1, transportationrelated injuries and violence account for many of the extra years of life lost in the United States relative to other high-income countries. Unintentional injuries include poisonings, motor vehicle crashes, falls, drowning, fires, asphyxiation, and burns (National Center for Health Statistics, 2012)
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. And only 58 percent of motorcyclists in the United States wear helmets, far less than the rate reported in most other high-income countries, where more than 95 percent of motorcyclists reportedly wear helmets (World Health Organization, 2009)
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Nonetheless, despite having higher per capita rates of alcohol consumption, Australia, Germany, Sweden, and the United Kingdom appear to have achieved lower rates of alcohol-related traffic fatalities than the United States, both as a percentage of fatalities and as measured per vehicle kilometer of travel (Transportation Research Board, 2011)
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The statistics are dramatic: • The United States has the highest rate of firearm ownership among peer countries. As shown in Figure 5-5, there are 89 civilian-owned firearms for every 100 Americans.20 • The United States is home to approximately 35-50 percent of the world's civilian-owned firearms.
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Health Disadvantage? There are inadequate data to know whether higher death rates from unintentional injuries in the United States are the result of more injurious behaviors or environmental factors.
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Alcohol consumption, other drug use, and unsafe sexual practices contribute to drug-related mortality, HIV/AIDS, sexually transmitted infections, and adolescent pregnancies. Substance abuse also contributes to injuries (unintentional and intentional)
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also limit the ability of individuals to adopt and sustain behavioral changes. Finally, policy and culture are important factors in understanding why health behaviors might differ between high-income countries: these are discussed in Chapter 8.
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