ALL eyes are on London as it hosts the 2012 Olympic Games. Nations from across the globe have united to cheer the prowess of incredibly healthy individuals who compete to make their countries proud. In past Olympics, the United States has won more medals than any other country. But if the health of each country’s entire population — not just its elite athletes — were an Olympic event, the U.S. would have been eliminated in the trials.
Let’s measure the health of a country by its life expectancy. If a population lives longer it must be healthier. In the Life Expectancy Olympics, the United Nations Human Development Report ranks the United States at 34th. A survey of U.S. medical students found that one-third believed the U.S. to have the best health worldwide. Why is this shameful standing in a major indicator of health not better known?
We stand nearly five life-expectancy years behind the world’s longest-lived country, Japan. If the U.S. were to eradicate cardiovascular disease, the condition that will kill nearly half of Americans, we would gain about three-and-a-half years of average expected life — and still not be the longest-lived country. We aren’t close to winning any medal in this event.
Other mortality measures, such as infant or maternal deaths, tell a similar story. Among developed countries, we are laggards. Even our healthiest subgroups don’t compare favorably to the average life expectancy of the 10 healthiest countries. King County’s health is falling behind the world’s best. Having a long and healthy life eludes most people living in the richest, most powerful country in history.
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We get the gold medal in spending on medical care, nearly half the world’s total, but these expenditures are not buying health.
If spending money on health care does not make U.S. healthier, what does? There is one strong predictor of national health: income inequality. Countries with bigger gaps between the rich and the poor tend to have poorer health. Our inequality gap is associated with a higher and increasing life-span gap. A recent Harvard study found one U.S. death in three can be attributed to our high income gap.
Close to half of our health is programmed in the first thousand days after conception. Stresses of the inequalities in modern life experienced by the mother, fetus and baby result in biologic adaptations that bring about many of our chronic diseases of aging. Healthier nations invest resources gained from a smaller economic gap in that early period to guarantee better health later. Those countries provide financial support to families by giving pregnant women and parents paid leave, allowing them to spend quality time with their newborns and young children.
We have the highest rate of child poverty of all rich countries, and that poverty and deprivation in early life drives our nation’s poor health. We use medicines as we age to treat avoidable health problems, but no amount of medical care — no pills, patches or surgery — can remove the adverse health effects of those first thousand days.
Sixty years ago, we would have been proud of the ranking of the United States in a Health Olympics event. But since the middle of the last century, our life-expectancy ranking has fallen almost every year. Science has granted the U.S. something akin to a silver bullet. Having the political will to support early life for all would produce the good health that we now lack, saving immense costs as we age in the form of fewer medical interventions.
Can we make these Olympics our clarion call to health?
Stephen Bezruchka is a doctor and senior lecturer at the University of Washington School of Public Health.