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Why Are Americans So Unhealthy?

The United States is the world’s wealthiest country, but the health of its general population is middling at best. Compared to other high-income countries, Americans live shorter lives and experience higher rates of illness and injury. The difference is so substantial that the National Research Council refers to the discrepancy as a “mortality gap.”

Poorer outcomes may come as no surprise to the average American, who struggles to navigate the country’s healthcare system. Yet, even wealthy Americans may have worse health compared to their peers in other countries. In other words, even those who can afford access to healthcare in the U.S. are still not enjoying the quality of life found in other wealthy countries.

Why are Americans so unhealthy, and what can be done to help close the gap?

A Lack of Social Programs Means More Americans Get Sick

The ills of the American healthcare system are both many and well-known. Americans spend more on healthcare than any other nation (by far) and yet still see worse health outcomes. While this is a problem, there is even another spending issue potentially at work.

Despite increasing its healthcare spending each year, the U.S. spends substantially less on health-adjacent social programs, like housing, education, food, jobs, and transportation. Instead, the U.S. sinks the vast majority of its money into Medicaid, and it has spent relatively little money on social housing or food access.

There is a wealth of research that demonstrates the ability of social assistance programs to protect public health. What’s more, social programs aren’t just a policy issue. The medical community (including regulators like the CDC) refer to the areas these programs tackle as the social determinants of health — essentially, when resources are available to help people overcome potential negative determinants of health, overall population health improves.

Access to Simple Health Tools is Expensive

Let’s briefly forget about how much it costs to go to the doctor or the price of prescription medication and return to the core building blocks of health: healthy food and regular exercise. These are the core building blocks of good health outcomes, but it is also a place where the U.S. does poorly compared to other countries.

The high price of healthy food isn’t a new trend. It didn’t arise with the rapid expansion of Whole Foods, and people have complained about the cost of fresh food for decades now.

It costs money to farm fresh fruit and vegetables, but unlike other countries, the U.S. doesn’t subsidize leafy vegetables like it does corn, soy, and wheat. As a result, the cost of vegetable crops gets passed on to the consumer. The subsidized crops (corn, wheat, and soy) are the ones that make up the vast majority of ingredients in inexpensive foods, including junk food.

Americans don’t just spend more on fresh food, either. Group exercise classes like pilates can be expensive due to the overall time and energy that goes into curating an effective course and routine, and these expensive classes are dominating fitness opportunities now. Even a barebones Crossfit gym can set members back several hundred dollars each month. At the same time, discount box gyms aren’t a one-size-fits-all solution — one survey even found that 80% of people feel nervous about going to a gym.

The U.S. Funds Care for the Elderly Only

The U.S. provides healthcare funding through the Medicare and Medicaid programs for what are supposed to be the two most vulnerable social groups: the poor and the elderly. However, neither program covers everything, and seniors still spend hundreds of thousands on their healthcare during retirement. Only providing for these two populations so assumes that those who are in full employment and of working age need only preventative care, which isn’t true.

Women’s healthcare and pregnant women, in particular, are a good example of population groups whose needs aren’t fully covered through the current system. Postpartum maternal health is widely neglected both in healthcare research and in coverage, but postpartum recovery is a significant indicator of a woman’s future health. Yet, the day women leave the hospital after giving birth is the day they usually fall off the healthcare radar.

The U.S. is the worst developed country for maternal health, not only because other countries provide both prenatal and postpartum care for free but because they provide it at all. And to return to the issue of funding social programs, the U.S. is the only country that doesn’t require paid maternity leave, which means many new mothers need to go back to work immediately — whether or not they are healthy enough to do so.

Public Health Doesn’t Begin and End at the Doctor

The U.S.’s expensive and broken healthcare system is only one factor in the lackluster state of American public health. Health is about more than being able to afford to see a specialist — it includes the total sum of a person’s life or the social determinants of health.

Where the U.S. misses out isn’t just in affordability, it also fails at supporting public health by ensuring that the population has access to healthy food, housing stability, and clean water. It helps to prioritize healthy foods and exercise by making them affordable. And it recognizes that the elderly aren’t the only demographic who need both extra medical and social support.

Until the U.S. takes a holistic view of health, its public will continue to see poorer health outcomes, even with a single-payer or universal program.

Posted by jhamilton at January 28, 2020 12:16 PM
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If Americans stay common sense healthful lives—do not, or stop, smoking, shed pounds, exercising extra—then if you reach 80 in the United States, your lifestyle expectancy is longer than in most other advanced countries. Your choice. But be reassured that in case you live within the U.S. And live to tell the tale center age, statistically talking, in context, you have extended lifestyles in advance of maximum thanks to the U.S.

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