U.S. Health in International Perspective Shorter Lives, Poorer Health (2013) / Chapter Skim
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9 Research Agenda
9 Research Agenda
Pages 241-272
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This chapter focuses on advancing the science for understanding the U.S. health disadvantage, but we emphasize that such efforts should not come at the expense of vitally important fields of research that focus on how to reduce morbidity and mortality from today's leading health threats, including the nine conditions responsible for the U.S.
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It is one of the few worldwide examples of a sustained systematic collection of data that tracks risk factors over time at the population level. Population surveys conducted by other agencies are also relevant to this topic, including the decennial U.S.
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2,283 1960 Pres X X X China Health and Retirement Longitudinal Study (CHARLS) 17,000 2008 Pres X X X X Chinese Longitudinal Healthy Longevity Survey (CLHLS)
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4,200 2007 X Irish Longitudinal Study on Ageing (TILDA) 8,000+ 2009 Pres X X X X X Korean Longitudinal Study of Aging (KLoSA)
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8,000+ 2011 Pres X X X National Long Term Care Survey (NLTCS) 20,485 1982 2004 X X X National Longitudinal Mortality Study (NLMS)
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13,981 2003 2004 X X Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) 4,997 1999 2003 X X Panel Study of Income Dynamics (PSID)
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Twin Pairs Victoria Longitudinal Study 1,594 1987 Pres X X X X DATA SETS AVAILABLE THROUGH PRINCIPAL INVESTIGATOR Epidemiology of Aging and Physical Functioning 2,092 1993 2006 X X The Longitudinal Study of Aging Danish Twins 4,371 1995 2005 X X X X Maine-Syracuse Longitudinal Study ~2,400 1975 Pres X X X The UAB Study of Aging: Mobility Among Older African-Americans and 1,000 1999 2008 X X X Whites The UNC Alumni Heart Study 6,340 1986 Pres X Vietnam Era Twin Study of Aging (VETSA) 1,006 2002 Pres X X X SOURCE: National Institute on Aging (2012)
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The English Longitudinal Study on Ageing (ELSA) began in 2002 with a sample of about 12,000 people age 50 and older and now has had five waves of data collection.
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health disadvantage is a lack of data to identify, monitor, and analyze epidemiological changes over time. Ambiguities in how best to define and measure health outcomes and determinants of health and inconsistent measurements across countries plague any effort to compare countries on meaningful terms.
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Internationally comparable data are needed on the prevalence of ambulatory-sensitive conditions beyond the current focus on asthma and diabetes. 2 Examples include precise quantification of the role of diet in causing cardiovascular disease, cancer, and other conditions; disentangling the effects of physical activity independent of obesity and diet; and which forms of "problem drinking" are predictive of disease or injury.
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. An accepted international standard is lacking not only for established mental illnesses such as clinical depression, but also for relevant psychological factors, such as stress.
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4 Survey instruments like the International Physical Activity Questionnaire (Bauman et al., 2009) hold promise as a standardized tool for assessing physical activity.
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Age Groups Many of the data sources for the seminal studies on the U.S. health disadvantage -- SHARE, ELSA, and HRS -- were studies of aging that focused on adults age 50 and older.
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As shown in Figure 9-1, a social-ecological interaction is occurring at age each stage of life, and the challenge of sophisticated longitudinal study of this process is to evaluate the effects of an evolving cast of potential influences at each stage. Measures of adolescent health deserve particular attention because this is the life-cycle stage when so many nonmedical determinants of health come into play and when many life-long health behaviors are established.
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health disadvantage, but also to expand knowledge of the biological and social determinants of disease over the life course. Other agencies in the U.S.
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. Examples of such activities include the European Health Survey System (which aims to harmonize health interview sur veys)
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. In 2011, WHO issued the Rio Declaration on Social Determinants of Health, which included a commitment to 12 strategies of data collection, listed below.
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Use intersectoral mechanisms such as a Health in All Policies approach for addressing inequities and social determinants of health; enhance access to justice and ensure accountability, which can be followed up; believes that the role of coordinating these efforts should logically occur at the departmental level and not any one agency. Data Access Another opportunity for overcoming the limitations of data is to broaden access to existing data sets.
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Expanding Current Surveys Another important opportunity to enhance data is to add new questions (or replace outdated questions) on existing longitudinal or cohort studies and on national population surveys, such as the National Health
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health disadvantage in particular. Cross-National Surveillance In addition to expanding the collection of survey data in the United States, the National Center for Health Statistics and the CDC could maintain an ongoing effort to look abroad to track how efforts to improve public health in the United States compare with those in other countries.
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health disadvantage appears to persist across racial and ethnic groups in the United States and among college-educated and upper income populations (Banks et al., 2006; Martinson et al., 2011a, 2011b) , but the studies to date have their limitations.
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health disadvantage. Randomized controlled trials, which are considered the strongest evidence of effectiveness 7 Similarly, like the United States, comparison countries also experience important health disparities by province or canton.
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The more important question in understanding the U.S. health disadvantage is to explore the relationship between antecedent factors and health outcomes, some of which occur relatively soon after a risk exposure (e.g., unintended pregnancies)
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Other examples include the Panel Study of Income Dynamics, the longest running longitudinal household survey in the world (Institute for Social Research, 2011) , and the National Longitudinal Surveys (U.S.
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An important avenue the panel identified, which it did not have time to explore, would be to map historical trends in social factors, such as poverty and social capital, from post–World War II and to track their evolution over time as the U.S. health disadvantage has grown more pronounced.
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For example, important information about the role of smoking in explaining the U.S. health disadvantage among adults aged 50 and older (see Chapter 6)
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15) argues: "policy cannot be intelligently conducted without an understanding of mechanisms; correlations are not enough."9 A particular suite of questions is especially important in understanding why the United States is experiencing a health disadvantage relative to other countries.
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However, it is important to note some of the crucial unanswered research questions about the U.S. health disadvantage: • What specific factors explain the unfavorable birth outcomes (e.g., high infant mortality rates)
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• To what extent do working conditions in the United States differ from those in peer countries, and how might these contribute to the U.S. health disadvantage?
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Academic centers of excellence, such as the CDC prevention centers, or academic institutions with expertise on social determinants of health, could be further expanded with appropriate funding to study the underlying causes of the U.S. health disadvantage.
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health disadvantage, ranging from biomedicine to political science, should compel scientists to enthusiastically embrace interdisciplinary collaborations. Medicine, public health, epidemiology, sociology, demography, behavioral science, economics, marketing, and other diverse disciplines and fields can all contribute to the study of the U.S.
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Yet the collaboration of experts with different perspectives and skills produces insights that are greater than the sum of the parts and holds the greatest promise in solving the mysteries of the U.S. health disadvantage.
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