Why Americans Lag in Life Expectancy -- Even as Health Care Spending Soars

Surgery roomIt's often reported that the U.S. lags other nations when it comes to gains in life expectancy, but a new study from Columbia University finds that the reasons aren't the commonly cited obesity, smoking, traffic fatalities and homicide. Rather, the problem has been poor health care, or rather, a poor health care system.

Perhaps even worse, the Commonwealth Fund-supported study, which was published at Health Affairs, found the smaller gains in U.S. survival rates come even as health care spending increased at more than twice the rate of the comparison countries. "It was shocking to see the U.S. falling behind other countries even as costs soared ahead of them," says lead author Peter Muennig, assistant professor at Columbia University's Mailman School of Public Health.

The study, "What Changes In Survival Rates Tell Us About U.S. Health Care," looked at health spending, behavioral risk factors like obesity and smoking, and 15-year survival rates for men and women ages 45 and 65 in the U.S. and 12 other nations (Australia, Austria, Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland and the U.K).

From Fifth to 46th

Yes, the U.S. has improved 15-year survival rates since 1975, but other countries have racked up greater gains, leading the U.S. to slip in country ranking. In 1950, the U.S. was fifth among the leading industrialized nations with respect to female life expectancy at birth, but it ranked 46th in the last available measure. As of Sept. 23, 2010, the U.S. ranked 49th for both male and female life expectancy combined. Americans have 5.7 fewer years of "perfect health" than the typical Japanese.

Specifically, 45-year-old white American women fared the worst, with the lowest ranking among the 13 countries, not even surpassing the 1975 survival rates for Swiss, Swedish, Dutch or Japanese women. The ranking for 45-year-old men fell from 3rd in 1975 to 12th in 2005, according to the study.

"But what really surprised us was that all of the usual suspects -- smoking, obesity, traffic accidents, and homicides -- are not the culprits," Muennig adds.

When the researchers compared smoking habits among the 13 countries, they found very little difference. In fact, the U.S. had faster declines in smoking between 1975 and 2005 than almost all of the other countries. Similarly, the results didn't show that these factors contributed to the growing lag in survival rates.

Health Care Reform Should Help


The authors speculate that the U.S. health system itself, with its emphasis on fee-for-service treatments, specialty care and lack of care coordination, may explain both rising costs and deteriorating relative life expectancy.

They explain: "Many chronic diseases that can be prevented or treated with health interventions arise in midlife, and deaths from these diseases cluster in the second half of life. Significant reforms such as those in the Affordable Care Act will help improve the health care system and lower costs," the authors conclude.

"This study provides stark evidence that the U.S. health care system has been failing Americans for years," says Commonwealth Fund President Karen Davis. "It is unacceptable that the U.S. obtains so much less than should be expected from its unusually high spending on health care relative to other countries."

The Commonwealth Fund previously reported that the U.S. health care system ranked last compared to six other industrialized countries in different measures such as quality and efficiency despite having the highest costs: The U.S. spent $7,290 per capita on health care in 2007, compared to the $3,837 in the Netherlands, which ranked first.

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