The United States spends much more money on health care than any other country. Yet Americans die sooner and experience more illness than residents in many other countries. While the length of life has improved in the United States, other countries have gained life years even faster, and our relative standing in the world has fallen over the past half century.

What accounts for the paradoxical combination in the United States of relatively great wealth and high spending on health care with relatively poor health status and lower life expectancy? That is the question posed to the panel that produced this report, U.S. Health in International Perspective: Shorter Lives, Poorer Health. The group included experts in medicine, epidemiology, and demography and other fields in the social sciences. They scrutinized the relevant data and studies to discern the nature and scope of the U.S. disadvantage, to explore potential explanations, and to point the way toward improving the nation’s health performance.

The report identifies a number of misconceptions about the causes of the nation’s relatively poor performance. The problem is not simply a matter of a large uninsured population or even of social and economic disadvantage. It cannot be explained away by the racial and ethnic diversity of the U.S. population. The report shows that even relatively well-off Americans who do not smoke and are not overweight may experience inferior health in comparison with their counterparts in other wealthy countries. The U.S. health disadvantage is expressed in higher rates of chronic disease and mortality among adults and in higher rates of untimely death and injuries among adolescents and small children. The American health-wealth paradox is a pervasive disadvantage that affects everyone, and it has not been improving.

The report describes multiple, plausible explanations for the U.S. health disadvantage, from deficiencies in the health system to high rates of unhealthy behaviors and from adverse social conditions to unhealthy environments. The panel painstakingly reviews the quality and limitations of evidence about all of the factors that may contribute to poor U.S. health outcomes. In this, and in earlier work the panel cites, many remediable shortcomings have been identified. Thus, the report advances an agenda for both research and action.

The report was made possible by the dedicated work of the panel and staff who conducted this study and by the generous support of the Office of Behavioral and Social Sciences Research and other units of the National Institutes of Health. The National Research Council and the Institute of Medicine are very much indebted to all who contributed.

The nation’s current health trajectory is lower in success and higher in cost than it should be. The cost of inaction is high. We hope this report deepens understanding and resolve to put America on an economically sustainable path to better health.

  • Harvey V. Fineberg
    President, Institute of Medicine
  • Robert M. Hauser
    Executive Director, Division of Behavioral and Social Sciences and Education, National Research Council