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Americans Have Worse Health Than English Peers, Study Finds
Date:3/9/2011

By Jenifer Goodwin
HealthDay Reporter

WEDNESDAY, March 9 (HealthDay News) -- From birth through old age, Americans have poorer health than their British counterparts, a new study finds.

Researchers used data on nearly 40,000 residents of the United States and 70,000 residents of England taken from nationally representative health surveys of the respective countries.

After all the numbers were crunched, Americans had higher rates of nearly all chronic diseases and markers of diseases than people of a similar age in England.

Those diseases and signs of poor health included: obesity, low HDL (good) cholesterol, high overall cholesterol, high C-reactive protein (a sign of inflammation), diabetes and asthma.

American women had significantly higher rates of high blood pressure, stroke, heart attack or angina than English women of a similar age. For males, heart attack or angina is higher in the United States only at younger ages. High blood pressure is the one measure that was higher in England than in the United States at young ages among males.

Taken together, the worse health of Americans by nearly every measure should be a wake-up call for the public and policymakers, said study author Melissa Martinson, a postdoctoral research associate in the Office of Population Research at Princeton University.

"Across most of these markers of health, Americans fare worse than the English, and the health differences are just as large at very young ages as they are later in life," Martinson said.

And the findings held true even when researchers took into account income level and broke out their sample into groups including only whites, the insured, the non-obese, non-smokers, non-drinkers and the affluent.

In other words, not only were the American poor worse off than the English poor, the affluent in the United States were worse off than the affluent in England.

Likewise, the obese in England were generally healthier than the obese in the United States, and so on.

The finding that even American youths are less healthy than English youths came as something of a surprise, Martinson said. They expected to find that middle-aged and older Americans were in poorer health than those of a similar age in England because of the higher rates of obesity in the United States, higher rates of diabetes, heart disease and other lifestyle and behavioral factors.

But even among kids, some of the differences were stark. For example, 12 percent of American girls and 11 percent of boys aged 4 to 11 are obese, compared to 7 percent in England. More than 17 percent of U.S. boys and girls aged 12 to 19 have asthma, compared to about 8 percent of English youths of that age.

For all age groups over age 4, about 50.5 percent of people in England have a normal weight, compared to only 41 percent of Americans; about 18 percent of people in England are obese, compared to 29 percent of Americans.

More than 13 percent of Americans of all ages have asthma, compared to 6.5 percent of England's residents, the study found.

Nearly 22 percent of Americans aged 12 and up have high cholesterol, compared to 16 percent of their peers in England, the researchers reported in the March 9 online edition of the American Journal of Epidemiology.

The worse health comes in spite of consuming far more health-care dollars than other countries, according to Mauricio Avendano, a research fellow at the Harvard Center for Population and Development Studies, who co-wrote an accompanying editorial.

Americans make up just 5 percent of the world's population, yet they represent more than half of every medical dollar spent on the planet, Avendano said.

And all that money isn't doing them as much good as one might think it would. American life expectancy is near the bottom of rankings that include European nations, he explained.

It's especially notable that this paper compared Americans to people in England, who are considered among the least healthy Europeans, Martinson said.

"I presented this paper in England, and they were all surprised because they are known as the 'sick' European country," she said. "They were saying, 'The U.S. must be doing really bad because they're worse than us, and we're worse than the rest of the European countries.'"

So, how to explain the differences?

There are likely multiple explanations, including obesity, diabetes and higher rates of poverty, Avendano said. The United States actually has lower rates of smoking than England, although that didn't used to be true.

And though lack of access to health care for many Americans certainly isn't good for their health -- England, like other European countries, has universal coverage -- it's not the only explanation for the differences, Avendano said.

Certain aspects of American labor markets and social policy may matter just as much or more. American workers generally have less protection from losing their jobs, and when they do, they get lower unemployment benefits. Americans can expect unemployment benefits to replace 48 percent of lost wages compared to 78 percent in the United Kingdom, 81 percent in Germany and 95 percent in Sweden, according to the editorial.

Women in the United States get no or only limited paid maternity leave, while women in the United Kingdom get more than nine weeks, French women get 47 weeks and Swedish women get 62 weeks, the editorialists noted.

The United States also has higher poverty rates, they added. Among children, for instance, in 2005, 21 percent of children in the United States lived in poverty, compared with 10 percent in the United Kingdom, 4 percent in Sweden and 8 percent in France.

The relative weakness of the U.S. social safety nets may mean less security and more stress, and that can also take a toll on health, Avendano suggested.

"These benefits may not be good for the economy, but we believe these benefits have an impact on health," he said of the system in England.

James P. Smith, a senior economist at the RAND Corp., said prior research has shown the health disparities at older ages, but this study is among the first to look at disparities at younger ages.

"Americans are less healthy than the English across the board," Smith said.

More information

For more on life expectancy, go to the Organization for Economic Co-operation and Development.

SOURCES: Melissa L. Martinson, Ph.D., postdoctoral research associate, Office of Population Research, Princeton University, Princeton, N.J.; Mauricio Avendano, Ph.D., research fellow, Harvard Center for Population and Development Studies, Cambridge, Mass.; James P. Smith, Ph.D., senior economist, RAND Corp., Santa Monica, Calif.; March 9, 2011, American Journal of Epidemiology, online


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