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JAMA Patient Page
November 13, 2013

US Health Compared With Like Countries

JAMA. 2013;310(18):1996. doi:10.1001/jama.2013.282122

A 2013 report commissioned by the Institute of Medicine concluded that “Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries.”

Many people found these negative results surprising because the United States is one of the wealthiest countries in the world. Some additional context can help explain what the data mean for the big picture of US health—and what might be done to improve it.

Negative Findings From the Report

When compared with 16 other high-income countries (such as England, Japan, and Australia), Americans younger than 75 years have one of the shortest life expectancies.a People in the United States also are at higher risk of many diseases and injuries. Moreover, the results hold true for both rich and poor Americans.

The report found that compared with other high-income countries, Americans have the

  • Highest infant mortality rate

  • Highest death rates from motor vehicle crashes and violence, including homicide

  • Highest teen pregnancy and sexually transmitted disease rates

  • Highest incidence of AIDS

  • Highest incidence of death related to alcohol and other drugs

For chronic conditions, the United States has the highest rate of obesity, high diabetes rates for people older than 20 years, and the second highest rate of heart disease.

Positive Findings

The report found some positive outcomes. Compared with the other countries, Americans have

  • The second lowest rate of smoking

  • Among the highest life expectancy at age 75 years or older

  • High survival rates after a diagnosis of cancer or stroke

  • Better control of blood pressure and cholesterol levels

  • Lower death rates for cervical and colorectal cancer

  • At- or below-average suicide rates

How Is the United States Different?

The United States is much larger than most of the other countries in the study—and there are large health differences among US states. Some US states and counties have life expectancies that are higher than any other country. Compared with many high-income countries, the United States has more immigrants from more countries, more diversity, and higher poverty rates. In addition, many Americans lack health insurance.

Ways to Better Health

  • The United States has very high rates of obesity. One important way to improve the nation’s health is to encourage better eating habits and more exercise to reduce obesity.

  • Drunk driving is a significant cause of avoidable deaths. Stricter measures are needed to reduce alcohol-related injuries.

  • Develop more aggressive alcohol and drug use policies.

  • Although the United States had made progress in reducing cigarette smoking rates, deaths due to lung disease could be reduced by further reductions in smoking.

  • Improved efforts are needed to teach young people about sexually transmitted diseases and how to avoid them.

  • Improved education is needed about pregnancy and the importance and availability of women’s health and prenatal services.

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Article Information

Conflict of Interest Disclosures: Ms Sugarman has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Source: Institute of Medicine

aThe 2013 report was based on 2007 data. More recent life expectancy data are depicted in the figure.

Topic: Health Statistics