U.S. Health in International Perspective Shorter Lives, Poorer Health (2013) / Chapter Skim
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10 Next Steps
10 Next Steps
Pages 273-291
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From page 273... ...
• More specifically, when compared with the average of other high income countries, the United States fares worse in nine health domains: o adverse birth outcomes (e.g., low birth weight and infant mortality) ; o injuries, accidents, and homicides; o adolescent pregnancy and sexually transmitted infections; o HIV and AIDS; o drug-related mortality; 273
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From page 274... ...
In addition, although the United States was once the world leader in education, it has not kept pace with many other countries for several decades. • There are stark differences in land use patterns and transporta tion systems between the United States and other high-income countries.
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From page 275... ...
health disadvantage is daunting, but it is also very familiar to experts in public health and social policy. The list of specific health problems have been long-standing concerns: infant mortality, injuries, violence, adolescent pregnancy, sexually transmitted infections and HIV, drug abuse, obesity, diabetes, heart and lung disease, and disability.
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From page 276... ...
Health Disadvantages Disadvantages Relative to Other High-Income Countries Examples of Relevant Healthy People 2020 Objectives Chapters 1-2: Shorter Lives, Poorer Health Higher prevalence and death rates HDS-2: Reduce coronary heart disease deaths. from cardiovascular disease HDS-16: Increase the proportion of adults age 20 and older who are aware of, and respond to, early warning symptoms and signs of a heart attack.
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. Chapter 4: Public Health and Medical Care Systems Low childhood immunization IID-7: Achieve and maintain effective vaccination rates coverage levels for universally recommended vaccines among young children.
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SA-19: Reduce the past-year nonmedical use of prescription drugs. Earlier initiation of adolescent FP-9: Increase the proportion of adolescents age 17 sexual activity and more sexual and under who have never had sexual intercourse.
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. Appendix A catalogues the specific policy solutions to address these problems and the supporting evidence and citations provided by the National Prevention Council.
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• xpand use of interoperable health information technology. E • upport implementation of community-based preventive services and S enhance linkages with clinical care.
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• upport workplace policies and programs that increase physical activity. S • ssess physical activity levels and provide education, counseling, and A referrals.
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• romote early identification of mental health needs and access to P quality services. NOTE: See Appendix A for specific policy recommendations and supporting evidence cited by the National Prevention Council.
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Some evidence is circumstantial or ecological: health outcomes may have improved in a country after the introduction of a policy, but evidence of a causal relationship may be lacking. And debates continue about proper outcomes for measuring health: for example, some critics argue that mortality rates or life expectancy are less meaningful than measures of healthrelated quality of life, such as quality-adjusted life years (Institute of Medicine, 2011e)
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From page 284... ...
The depth and breadth of the problem, as documented in this report, came as a surprise to many of us. Although we do not know of survey or poll data that gauge Americans' awareness of their poor health rankings relative to other high-income countries, we suspect that the information detailed in this report is not widely known.
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. Many people may also mistakenly attribute unfavorable health statistics to the conditions of poor, unemployed, or uninsured Americans, when several studies now suggest that even advantaged Americans are in poorer health than their counterparts in other countries.
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. A national discussion could help determine whether the American people deem such tradeoffs acceptable.
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Although it did include several European and foreign-born experts, its members did not include authorities from outside the United States with extensive knowledge of the policy landscape in comparable countries.3 The panel therefore recommends that an appropriate organization or federal or international agency undertake a follow-up effort that involves appropriate experts from many of the high-income countries considered in this report.4 In some ways, what we envision would amount to the third report in a trilogy. The first report by the National Research Council (2011)
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Besides health, the report would need to examine specific policies related to education, family support, workplace benefits, and other social factors that affect health outcomes, as well as contextual factors and other secular trends that bear on all countries' health patterns (e.g., globalization, population aging)
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From page 289... ...
The inquiry into adverse birth outcomes can attempt to tease out the specific reasons that U.S. infant mortality rates have not kept pace with other countries for decades by examining differences in not only prenatal or newborn care, but also preconception and prenatal efforts in public health or social policy to lessen maternal risks for adverse birth outcomes.
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So is the continuing rise of income inequality in the United States, the persistence of poverty (especially child poverty) at rates that exceed those of most other rich nations, and the relative lack of social mobility.
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From page 291... ...
Overall, young Americans are entering adulthood in poorer health than their counterparts in other countries and therefore face a future with greater risks of disease and the other life challenges they bring than did their parents. This alone is reason enough for concern, but the nation's leaders -- in government and business -- also understand what the nation can expect from a future generation of workers, executives, and military recruits whose illnesses and socioeconomic disadvantages compromise their productivity and require more intensive health care.
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