The American Health-Wealth Paradox

An Institute of Medicine report published earlier this year examined the American health-wealth paradox: while the US enjoys great wealth and spends much more money on healthcare than other high-income countries, Americans are in poorer health and have a lower life expectancy than people in other countries.  Comparing the US and other high-income countries, the U.S. Health in International Perspective: Shorter Lives, Poorer Health investigates several factors that might plausibly explain the American health disadvantage, from individual behaviors and systemic deficiencies, to social and environmental conditions.

The report shows that:
- The US health system suffers from a large uninsured population, financial barriers to care, a shortage of primary care providers, and potentially important gaps in the quality of care.
- Americans have a higher prevalence of certain unhealthy behaviors involving caloric intake, sedentary behavior, drug use, unprotected sex, driving without seatbelts, and the use of firearms.
- The US lags in educational achievement, and it has high income inequality and poverty rates, and lower social mobility than most other high-income countries.
- Americans live in an obesogenic built environment that discourages physical activity, and they live in more racially segregated communities.

The authors conclude that "[a]lthough each of these unfavorable patterns could be examined in isolation, what emerged is that the US is losing ground to other high-income countries on multiple measures of health and socioeconomic well-being.  It is highly likely that the US health disadvantage has multiple causes and involves some combination of unhealthy behaviors, harmful environmental factors, adverse economic and social conditions, and limited access to health care.  This confluence of problems reflects more upstream, root causes."

Read more: resources:
Sociology of Healthcare (
Wealth and Health of Nations ($majorMode=chart$is;shi=t;ly=2003;lb=f;il=t;fs=11;al=30;stl=t;st=t;nsl=t;se=t$wst;tts=C$ts;sp=5.59290322580644;ti=2012$zpv;v=0$inc_x;mmid=XCOORDS;iid=phAwcNAVuyj1jiMAkmq1iMg;by=ind$inc_y;mmid=YCOORDS;iid=phAwcNAVuyj2tPLxKvvnNPA;by=ind$inc_s;uniValue=8.21;iid=phAwcNAVuyj0XOoBL_n5tAQ;by=ind$inc_c;uniValue=255;gid=CATID0;by=grp$map_x;scale=log;dataMin=283;dataMax=110808$map_y;scale=lin;dataMin=18;dataMax=87$map_s;sma=49;smi=2.65$cd;bd=0$inds=;modified=75)
Chronic Disease Indicators (
Behavioral Risk Factor Surveillance System (BRFSS) Prevalence and Trends Data (
Investigating Bias and Measurement Validity (
IHME: Data Visualizations (
Health Expenditure per Capita (

Frederique Laubepin

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