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Part I: Documenting the U.S. Health Disadvantage T he scientific evidence pointing to a “U.S. health disadvantage” rela- tive to other high-income countries has been building over time. Several studies using comparable data sources in the United States and United Kingdom have reported that Americans have higher disease rates and poorer health than the British. In 2006, James Banks and col- leagues (2006) compared the self-reported health and biological markers of disease among residents of the United States and England aged 55-64 and found that U.S. residents were much less healthy than their English counterparts. A few years later, Melissa Martinson and colleagues con- firmed these findings but extended them to younger ages, noting that the cross-country differences were of similar magnitude across all age groups (Avendano and Kawachi, 2011; Martinson et al., 2011a, 2011b). The investigators also reported that this health disadvantage persisted even when the comparison was limited to people in the highest socioeconomic brackets, whites, the insured, and those without a history of tobacco use, drinking, or obesity. Other studies have documented a higher prevalence of diseases and risk factors among Americans than among the Japanese (Crimmins et al., 2008; Reynolds et al., 2008), Western Europeans (Banks and Smith, 2011; Michaud et al., 2011; Thorpe et al., 2007), the populations of England and Western Europe (Avendano et al., 2009), and those of England, Western Europe, Canada, and Japan (Crimmins et al., 2010). Although life expec- tancy in high-income countries has been increasing for decades, the pace of the increase in the United States has fallen dramatically behind that of other high-income countries (Meslé and Vallin, 2006; National Research Council, 21

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22 U.S. HEALTH IN INTERNATIONAL PERSPECTIVE 2011; Rau et al., 2008). Between 1980 and 2006, life expectancy in the United States grew more slowly than in almost every other high-income country (Meslé and Vallin, 2006; Rau et al., 2008). Although the U.S. health disadvantage has been ably documented in prior research, much of the focus has been on adults age 50 and older. This age group has received attention because of its higher burden of disease and because comparable international surveys were often only available for older adults. The National Research Council (2011) study that inspired the establishment of this panel was sponsored by the National Institute on Aging and focused on documenting and explaining differences in life expectancy at age 50, not the U.S. health disadvantage at younger ages. The impetus for the present study included a strong interest in extending the earlier analysis to those under age 50. Part I of this report is devoted to documenting the nature and strength of the evidence regarding a health disadvantage of the U.S. population. It draws on prior work in discussing the health and survival of older adults, but it focuses on documenting cross-national differences in the health and life expectancy of children, adolescents, and young adults. Because death is such a defining event and because national mortality and cause of death data tend to be widely available and of high quality, the panel chose to begin its examination by looking at mortality. Chapter 1 provides an initial look at cross-national mortality differences in high- income countries, focusing on Americans’ shorter life spans. The chapter begins by documenting the disparities in cause-specific mortality rates and then summarizes the existing literature on life expectancy differentials between the United States and other countries. So as not to duplicate the prior National Research Council (2011) study of mortality over age 50 and because of time constraints, the panel chose to focus on documenting differences between the United States and other high-income countries in life expectancy under age 50 and the causes of death responsible for years of life lost. The chapter features new analyses, commissioned by the panel, on cross-national life expectancy differentials before age 50. These analy- ses look at differences in life expectancy by sex, age group, and specific causes of death. Chapter 2 moves beyond mortality and adopts a life-course perspective to examine health differences between the United States and other coun- tries by age group. The chapter examines cross-national differences in the prevalence, severity, and mortality rates for specific diseases and injuries affecting each age group across the life course. As in Chapter 1, the panel’s primary focus was on individuals under age 50, especially children. We were particularly interested in adolescence, which is both an important life stage in its own right (Gore et al., 2011; Patton et al., 2009) and may offer

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PART I 23 clues to understanding cross-national differences that emerge later in life. The chapter’s examination of health under age 50 was supplemented with a review of the rich literature on health differences among individuals over age 50, a period of life when chronic illness becomes more prevalent. Given the breadth of material covered in Chapter 2, the panel had to be much more parsimonious in its approach to indicators and data sources.

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