This post was written by Gerry Fairbrother, Ph.D., a Senior Scholar at AcademyHealth.
The United States spends more than 2.5 times as much on health care as its peer nations and yet it constantly suffers from inferior health. A new article in Pediatrics, titled Higher Cost, But Poorer Outcomes: the US Health Disadvantage and Implications for Pediatrics, highlights the factors responsible for the United States’ health care disadvantage, comments on implications for policy, practice, and research, and proposes a call to action. The article, based on a symposium exploring the findings of an Institute of Medicine (IOM) Report on relative health disadvantages between the United States and peer nations, includes research I worked on with other professionals in my field, including Lisa Simpson, Astrid Guttman, Jonathan Klein, Pauline Thomas, and Allison Kempe.
The original IOM report found at that all of these nations, including the United States, have sufficient national wealth to support a variety of health and social services policies and programs to address the health needs of their populations. Yet a pervasive disadvantage exists for the United States’ population beginning at birth and affecting all age groups. The substantially higher rates of infant mortality, below average birth weight, and preterm birth have been known for years. What is perhaps less well known is that this disadvantage continues through childhood and adolescence. For example, United States adolescents have higher all-cause mortality, including mortality from injuries and violence. Additionally, obesity among United States adolescents is more than twice the mean and the prevalence of diabetes is in the top third, compared with peer nations.
My colleagues and I agree that reversing the sub-optimal health outcomes in the United States will require a wide-range of policy solutions at all levels of government. One of the difference in policies and spending between the United States and other peer nations is that the latter spend much more than the United States on social services such as education, home visiting, maternity leave, and food security. In response, we call for recalibrating spending for health and social welfare, with greater investments in social services that have been proven protective in other peer nations such as high-quality early care and education, or for those that support families with young children, such as paid parental leave, subsidies, income transfers and other social programs.
My colleagues and I also recommend additional focus on the establishment of cross-sectoral governance such as the ones in Canadian provinces and Western Europe, with linkages established between health, welfare, education and other social services. Critical to achieving this this type of governance is cross-sectoral linked data and research refocused on the most leading causes of mortality and morbidity. In addition, focus on translational research that informs that development of effective policy and system and service intervention is needed.
Together, we acknowledge that generating action to address the United States health disadvantage will not be easy. First, there needs to be a collective understanding that the United States health care system is not the greatest in the world, but rather one of the worst among high income countries when health outcomes are measured. Public awareness of this and even outrage may be necessary to spur policy action. In addition, it is clear that solutions for improving health for children will require solutions outside of the health care sector.
It is a tragedy for all Americans, especially children, that the health of Americans does not meet the standards that exist in peer countries. Given the evidence, the question becomes, “what will we do about it?”
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