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Why Is Our Life Expectancy Shorter Than in Other Developed Countries?

The gap is growing.
 
 
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Let’s talk life expectancy.

The stats first. They tell a clear story: Americans now live shorter lives than men and women in most of the rest of the developed world. And that gap is growing.

Back in 1990, shouts a  new study published last week in the prestigious Journal of the American Medical Association, the United States ranked just 20th on life expectancy among the world’s 34 industrial nations. The United States now ranks 27th — despite spending much more on health care than any other nation.

Americans, notes an editorial the journal ran to accompany the study, are losing ground globally “by every” health measure.

Why such poor performance? Media reports on last week’s new  State of U.S. Healthstudy hit all the usual suspects: poor diet, poor access to affordable health care, poor personal health habits, and just plain poverty.

In the Wall Street Journal, for instance, a chief wellness officer in Ohio  opined that if Americans exercised more and ate and smoked less, the United States would surely start moving up in the global health rankings.

But many epidemiologists — scientists who study health outcomes — have their doubts. They  point out that the United States ranked as one of the world’s healthiest nations in the 1950s, a time when Americans smoked heavily, ate a diet that would horrify any 21st-century nutritionist, and hardly ever exercised.

Poor Americans, then as now, had chronic problems accessing health care. But poverty, epidemiologists note, can’t explain why fully insured middle-income Americans today have significantly worse health outcomes than middle-income people in other rich nations.

The University of Washington’s Dr. Stephen Bezruchka  has been tracking these outcomes since the 1990s. The new research published in the Journal of the American Medical Association, Bezruchka told Too Much last week, should worry Americans at all income levels.

“Even if we are rich, college-educated, white-skinned, and practice all the right health behaviors,” he notes, “similar people in other rich nations will live longer.”

A dozen years ago, Bezruchka published in Newsweek the first mass-media commentary, at least in the United States, to challenge the conventional take on poor U.S. global health rankings.

To really understand America’s poor health standing globally, epidemiologists like Bezruchka posit, we need to look at “the social determinants of health,” those social and economic realities that define our daily lives.

None of these determinants matter more, these researchers contend, than the level of a society’s economic inequality, the divide between the affluent and everyone else.  Over 170 studies worldwide have so far linked income inequality to health outcomes. The more unequal a society, the studies show, the more unhealthy most everyone in it — and not the poor alone.

Just how does inequality translate into unhealthy outcomes? Growing numbers of researchers place the blame on stress. The more inequality in a society, the more stress on a daily level. Chronic stress, over time, wears down our immune systems and leaves us more vulnerable to disease.

This same stress drives people to seek relief in unhealthy habits. They may do drugs or smoke — or eat more “comfort foods” packed with sugar and fat.

Inequality has an equally potent impact on policy decisions around health.

“A substantial proportion of our adult health,” as Stephen Bezruchka explained last week, gets programmed in the early years of a child’s life. Given this reality, guaranteeing every child the best possible supports in the early years ought to be priority number one for any society committed to better health for all.

But unequal nations do precious little of this guaranteeing. The nations with the highest ranking for child well-being turn out to be the nations with the most equal distributions of income.

 
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