Chicago – The English are known by several stereotypes that suggest poor health, including pallid complexions, bad teeth, terrible food and an affinity for pubs.
Well, so much for stereotypes.
Startling new research shows that white, middle-aged Americans – even those who are rich – are far less healthy than their peers in England, a finding that flummoxed some experts.
Americans had higher rates of diabetes, heart disease, strokes, lung disease and cancer, findings that held true no matter what income or education level. And that’s despite the fact that U.S. health care spending is double what England spends on each of its citizens.
“Everybody should be discussing it: Why isn’t the richest country in the world the healthiest country in the world?” asks study co-author Dr. Michael Marmot, an epidemiologist at University College London in England.
The study, based on government statistics in both countries, adds context to the already known fact that the United States spends more on health care than any other industrialized nation, yet trails in rankings of life expectancy.
The United States spends about $5,200 per person on health care while England spends about half that in adjusted dollars.
Even experts familiar with the weaknesses in the U.S. health system seemed stunned by the study’s conclusions.
“I knew we were less healthy, but I didn’t know the magnitude of the disparities,” said Gerard Anderson, an expert in chronic disease and international health at Johns Hopkins University who had no role in the research.
Exact reason a mystery
Lack of exercise, too much stress and too little money are possible explanations. Excessive obesity is not.
Just why the United States fared so miserably wasn’t clear.
Answers ranging from too little exercise to too little money and too much stress were offered.
Even the U.S. obesity epidemic couldn’t solve the mystery. The researchers crunched numbers to create a hypothetical statistical world in which the English had American lifestyle risk factors, including being as fat as Americans.
In that model, Americans were still sicker.
Smoking rates are about the same on both sides of the pond. The English have a higher rate of heavy drinking.
Only non-Latino whites were included in the study to eliminate the influence of racial disparities. The researchers looked only at people ages 55 through 64, and the average age of the samples was the same.
Americans reported twice the rate of diabetes compared with the English, 12.5 percent versus 6 percent. For high blood pressure, it was 42 percent for Americans versus 34 percent for the English; cancer showed up in 9.5 percent of Americans compared with 5.5 percent of the English.
The upper crust in both countries was healthier than middle- class and low-income people in the same country. But richer Americans’ health status resembled the health of the low-income English.
“It’s something of a mystery,” said Richard Suzman of the U.S. National Institutes of Health, which helped fund the study.
Health experts have known the U.S. population is less healthy than that of other industrialized nations, according to several important measurements, including life expectancy. The U.S. ranks behind about two dozen other countries, according to the World Health Organization.
Ethnic diversity ruled out
Minorities’ health in the U.S. lags behind whites’, so researchers removed them from the equation.
Some have believed the United States has lagged because it is more ethnically diverse, said Suzman, who heads the National Institute on Aging’s Behavioral and Social Research Program.
“Minority health in general is worse than white health,” he said.
But the new study showed that when minorities are removed from the equation, and adjustments are made to control for education and income, white people in England are still healthier than white people in the United States.
“As far as I know, this is the first study showing this,” said Suzman.
The study, supported by grants from government agencies in both countries, was published in today’s Journal of the American Medical Association.
