U.S. fares poorly in international health comparisons.

While most Americans can expect to live into old age, international comparisons indicate a strikingly poor showing on basic health statistics. At every age under 65 (infants, children, and young and middle-aged adults), death rates are higher for U.S. residents than they are in many or most other developed countries. Only after reaching age 65 is the chance of dying in a given year lower in the United States than in most other countries. The Office of Technology Assessment (OTA) released a report examining the differences in health statistics between the U.S. and its international peers and why those differences occur.

The U.S. continually spends a higher proportion of national income on healthcare than other countries, yet continues to rank poorly on health indicators. While policymakers have hoped to find some solutions in countries with better health status measures and lower spending, OTA found that the healthcare system itself is only one of many factors affecting health status. Contributing factors range from unhealthy behavior to the level of violence in society to the wide ranging effects of unequal income distribution; changes in the healthcare system alone will not necessarily improve health indicators. Clearly, factors outside the health system play a larger role in many U.S. health problems.

Deaths of young and middle-aged people are particularly disturbing, because many of them might be preventable. OTA found that among young adults, death rates from injuries, violence, and AIDS are at least twice as high in the U.S. as in other developed countries. In a comparison with Canada, OTA found that if the U.S. had Canada's more favorable mortality rates, 192,200 deaths - 9% of all deaths - would have been avoided in 1989, most in the 45 to 64 age group.

Because most deaths in developed countries occur among the elderly, the leading causes of death overall are chronic diseases such as heart disease and cancer. In the U.S., these two causes accounted for more than half of all 1991 deaths. Rates of death from heart disease have declined precipitously in all developed countries, but the U.S. rates remain among the highest.

On some measures, the U.S. compares favorably: relatively fewer people smoke in the U.S. than in Canada and Western Europe. Even so, OTA found that smoking is by far the most important single cause of premature mortality; as many as 20% of deaths in developed countries are attributable to smoking.

Greater access to healthcare may contribute to the fact that childhood immunization rates are higher and other facets of well-child care are more widespread in Europe than in the U.S. These measures are important, but they cannot explain the poor U.S. showing overall. OTA concludes that while comparisons are useful for identifying health differences and beginning to elucidate the reasons for them, they are not particularly useful in formulating immediate prescriptions for the U.S. healthcare system, either for saving money or for dramatically improving health status.

Copies of International Health Statistics: What the Numbers Mean for the United States may be ordered from the Superintendent of Documents, Government Printing Office, [phone]. The GPO stock number is 052-003-01354-1.