U.S. Health in International Perspective Shorter Lives, Poorer Health (2013) / Chapter Skim
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3 Framing the Question
3 Framing the Question
Pages 95-105
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From page 95... ...
and it encompasses large rural expanses, although comparable cross-national data on the urban-rural mix are limited.1 The United States is also a much younger nation than most 1 According to the OECD, fully 78 percent of the U.S. land mass is "predominately rural" (defined as more than 50 percent of the population living with fewer than 150 inhabitants per square kilometer)
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From page 96... ...
By some estimates, approximately 40 percent of all deaths in the United States are associated 2 Subsequent parts of this report do discuss the role of rural conditions in the United States in contributing to health disadvantages, such as access to medical care. 3 Although it is possible that differences in population gene pools or other innate biological characteristics contribute to observed cross-national health differences, these and other nonmodifiable risk factors receive little emphasis in this report due to their unlikely contributory role.
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From page 97... ...
. Yet health care and health-related behaviors are still not the whole story and raise a bigger question: Why are adverse behaviors or deficiencies in health care more common in the United States than in peer countries?
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From page 98... ...
, in the conceptual framework developed by the World Health Organization (WHO) Commission on Social Determinants of Health, and in a schematic for public outreach developed by the Robert Wood Johnson Foundation Commission to Build a Healthier America (Braveman and Egerter, 2008)
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From page 99... ...
The evidence reviewed in Part I suggests that differences persist even among similarly advantaged groups. Understanding why advantaged populations in the United States appear to be less healthy than their counterparts in other countries led the panel to explore upstream processes that affect everyone, including national policies and other aspects of American life.
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From page 100... ...
, and risk factors documented in Part I Over the past several decades, a great deal of social and biomedical sciences research has been devoted to looking across individuals' life spans in an effort to better understand developmental and health trajectories over time and, more specifically, how characteristics and experiences early in life may influence health and biobehavioral pathways much later in life (Billari, 2009; Braveman and Barclay, 2009; Braveman et al., 2011b; Gluckman and Hanson, 2006; Halfon and Hochstein, 2002; Keating and Hertzman, 1999; Kuh and Ben-Shlomo, 2004; Lynch and Davey Smith, 2005; Mayer, 2009; Palloni et al., 2009; Pollitt et al., 2005; Power and Hertzman, 1997)
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From page 101... ...
. For example, Barker and colleagues were among the first to hypothesize that nutritional status in utero and during infancy and early childhood can cause organ damage that is responsible for hypertension, heart disease, metabolic syndrome, insulin resistance, obesity, and diabetes much later in life (Barker, 1998, 1999; Barker et al., 1993; Godfrey, 2006; Hales et al., 1991; Ravelli et al., 1998)
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From page 102... ...
. On similar grounds, these factors may be relevant in understanding the evidence in Part I regarding the inferior health status and higher risk exposure of young people in the United States compared with those in other high-income countries.
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From page 103... ...
, benefited people of all ages. The panel was acutely aware of one of the most well-known and vexing challenges when studying nonmedical influences on health, that of describing and empirically demonstrating causal pathways between a given health factor and a biological health outcome.
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From page 104... ...
The social-ecological model emphasizes that interactions with health systems, individual behaviors, and disease processes themselves are shaped by social factors and the environment. Chapters 6 and 7, respectively, examine their potential contributory role in the U.S.
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From page 105... ...
The key dynamic trajectories of health, risk factors, socioeconomic circumstances, and physical and institutional environments are all integrally linked and cannot be decomposed in a reductionist fashion. As the following chapters make clear, these synergistic interactions are central to understanding the U.S.
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