Comparison to Other Nations

This year, the United States experienced the highest life expectancy in its history – a baby born today can expect to live for 77.9 years as compared to a life expectancy of 75.4 years in 1990 – a substantial gain over a short period of time.  But to understand the potential our country has to improve our health, we must look to other countries.

When the United States is compared to other countries, the picture is disappointing.  The U.S. Census Bureau indicates that 43 countries have life expectancies that exceed the United States, and 40 countries have a lower infant mortality rate than the United States.   Table 3 shows the life expectancies and infant mortality rates for select countries. [1] Even within the U.S., the states with the lowest infant mortality rates rank 25^th or lower when compared to other countries. Canada, Australia, Spain, France and Germany all exceed our best state rates in terms of infant mortality.

The contributing factors to the lower life expectancy rates in the United States can be seen by comparing age-adjusted mortality rates for the United States to seven other developed countries (Canada, France, Germany, Greece, Japan, Spain and the United Kingdom).  Not only does the United States have a higher mortality rate than all of these countries for ischemic heart disease; trachea, bronchitis and lung cancer; and diabetes mellitus; but additionally, the U.S. is higher than six of these seven countries for unintentional injuries, intentional injuries and neuropsychiatric conditions. The United States ranks second for a lower death rate due to colon and rectum cancers, and it ranks third among eight for a low rate of cerebrovascular disease. [2]

The prevalence of many major chronic diseases among adults age 50 and older is higher in the United States when compared to ten European countries.  This includes higher prevalence of heart disease, high blood pressure, high cholesterol, stroke, diabetes, chronic lung disease, arthritis and cancer.  Also, the prevalence of obesity in these European countries is approximately half that of the United States. [3]

Equally discouraging are results from a UNICEF study of child well-being, in which the U.S. ranked second to last when compared to 21 comparably “rich” countries based on 40 different measures.  When UNICEF looked specifically at child health aspects of well-being, the United States fared very poorly due to a high infant mortality rate, a high percentage of low birth weight infants and only an average rate of immunization. [4]

The Commonwealth Fund finds the U.S. is last in the performance of the health care system in comparison to a group of six countries that include Australia, Canada, Germany, New Zealand and the United Kingdom.  The U.S. spends twice as much as these countries on a per-capita basis, yet it is last on dimensions of access, patient safety, efficiency and equity. [5] So, while the U.S. is spending more on health care when compared to other countries, we are getting less in comparison. 

And such poor performance can impact everyone in the country.  Dr. James Banks, et. al. report that the differences between the U.S. and Great Britain show up in all income and education levels.  They conclude that “individuals in the top (half) of the education and income strata in the United States have comparable rates of diabetes and heart disease as those in the bottom (half) strata of income and education in England." [6]

The results of these studies are a wake-up call to everyone in the United States to improve all aspects of our health system from education to prevention and through to clinical care.   The results also indicate that we can improve our health system and our health as other countries already have.

Table 3 - International Comparisons – Infant Mortality Rate and Life Expectancy