A comprehensive study on the state of U.S. health has found high rates of chronic illness and disability have caused the country to lag behind other wealthy nations.
However, overall health has improved among Americans since 1990, the report found. We may just have a ways to go to reverse negative trends and improve health care.
"The United States spends the most per capita on health care across all countries, lacks universal health coverage, and lags behind other high-income countries for life expectancy and many other health outcome measures," wrote the authors of the new report, published July 10 in JAMA.
"High costs with mediocre population health outcomes at the national level are compounded by marked disparities across communities, socioeconomic groups, and race and ethnicity groups," added the authors, led by Dr. Christopher J.L. Murray, a professor of Global Health at the University of Washington and Institute Director of the Institute for Health Metrics and Evaluation (IHME).
To quantify the country's health compared to that of other nations, researchers at institutions across the country worked together with the U.S. Burden of Disease Collaborators to review the past two decades worth of data on 291 diseases and injuries across 34 countries. Measures calculated included years of lost life due to early death, years of living with disability and healthy life expectancy, which looks at overall population health and factors in overall life expectancy and levels of poor health experienced at different ages.
From 1990 to 2010, the U.S. fell from ranking number 18 among wealthy nations to the 27th spot in terms of early deaths. Life expectancy at birth dropped from the 20th spot to 27th, while healthy life expectancy fell from 14th to the 26th ranking.
That's despite overall life expectancy for both sexes rising from 75.2 years in 1990 to 78.2 in 2010, and healthy life expectancy increasing from 65.8 years to 68.1 years during that time.
"Individuals in the United States are living longer but are not necessarily in good health," wrote Murray.
Illness and chronic disability accounted for nearly half of U.S. health burdens, according to the report.
Mental and behavioral disorders, musculoskeletal disorders, vision and hearing loss, anemias and neurological disorders all were found to contribute to increases in chronic disability. The authors pointed out that research and drug development has had more success finding solutions against heart disease and cancer but has been far less successful than the leading causes of disability.
In 2010 alone, the disabilities people lived the most years with were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain and anxiety disorders. The leading risk factors associated with illness and disability were unhealthy eating, tobacco smoking, high body mass index (BMI, a measure of obesity), high blood pressure, high fasting plasma glucose (a risk factor for diabetes), physical inactivity and alcohol drinking.
Despite the life expectancy increase, premature death was still found to be a U.S. health burden.
Diseases and injuries with the largest number of years of life lost due to early death were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease (COPD), and road injuries, which include bicycle, motorcycle, motor vehicle, and pedestrian injuries. Alzheimer's, drug use disorders, chronic kidney disease, kidney cancer and falls also contributed to premature death rates.
The researchers hope the study could be used to show whether shifts in health care spending have affected disease burden, so officials could allocate resources into areas of the U.S. health care system that will bring the most benefits to the country's health.
"In many cases, the best investments for improving population health would likely be public health programs and multisectoral action to address risks such as physical inactivity, diet, ambient particulate pollution and alcohol and tobacco consumption," the report concluded.
Dr. Harvey Fineberg, president of the Institute of Medicine, wrote in an editorial accompanying the study that an undertaking by public and private sectors is necessary to make the changes to improve America's health.
"Setting the United States on a healthier course will surely require leadership at all levels of government and across the public and private sectors and actively engaging the health professions and the public," he wrote. "If all constituents do their parts, the apt subtitle for the next generation's analysis of U.S. health will be not 'doing better and feeling worse (still)' but 'getting better faster than ever.'"