The Health of Nations: British, Canadians Healthier Than Americans
Americans may share a common mother tongue with their Canadian and British friends, but when it comes to health care, they're speaking different languages. Their national health systems, emphasizing preventive care, appear to provide much better outcomes at dramatically lower cost than the ad hoc market-driven approach in the U.S. That's the clear message from two recent studies showing that the people of Canada and the UK are far healthier than Americans.
A Harvard Medical School study in the upcoming issue of American Journal of Public Health reveals that Americans experience suffer from a range of ailments and diseases at substantially higher levels than our neighbors to the north. Phone surveys of 3,500 Canadians and 5,200 Americans showed Americans 12% more likely to suffer from arthritis, 32% more likely to be plagued by high blood pressure and a whopping 42% more likely to have diabetes. Despite spending nearly double on health care per capita and smoking less than Canadians, the Harvard study revealed that Americans experience "higher rates of nearly every serious chronic disease examined in the survey."
The study also dispels many of the negative myths perpetuated by American conservatives regarding a lumbering, unresponsive Canadian health care bureaucracy. Harvard's Karen Lasser noted that "most of what we hear about the Canadian health care system is negative; in particular, the long waiting times for medical procedures." The data simply does not bear that out; while Canadians much more frequently reported long waiting times as a barrier to care (3.5% to 0.7% for Americans), treatment delays were not a major factor for either nation.
The HMS study does, however, provide incontrovertible confirmation that high costs and the lack of insurance are undermining the health of Americans. Citizens in the United States, with 46 million uninsured among them, were almost 10 times more likely to report cost as a barrier to care (7.0% to 0.8%). That figure catapults to 30% for Americans without insurance. Poor Americans were 2.6 times more likely to go without a regular doctor than their more affluent counterparts, compared to only 1.7 times in Canada.
The Canadian results follow closely on the heels of major study published in the Journal of the American Medical Association (JAMA) similarly showing Americans' dismal health compared to their British friends across the Atlantic. Again, despite doubling the health care expenditure per Briton, Americans are less healthy at every level of income and education. More disturbing and more difficult to explain, wealthier Americans were sicklier than working class British.
Seeking to control for the different mix of immigrants and ethnic minorities in the two countries, researchers looked only non-Hispanic whites among people ages 55 to 64. Across the board, Americans were less healthy than the English:
Americans reported twice the rate of diabetes compared to the English: 12.5 percent versus 6 percent. For high blood pressure, it was 42 percent for Americans versus 34 percent for the English; cancer showed up in 9.5 percent of Americans compared to 5.5 percent of English.
And as with the Canadian study, Americans smoked less but were more obese and enjoyed shorter life expectancy than those in the U.K.
In response to the stunning findings, study co-author Dr. Michael Marmot asked in amazement, "Why isn't the richest country in the world the healthiest country in the world?"
The explanations vary and include both expected and surprising answers. The authors of both the Canadian and British comparisons stress the role that universal health coverage and preventive care play in producing healthier citizens. But given the superior health of lower class Britons relative to upper class Americans, universal coverage alone can't provide the explanation. Robert Blendon of the Harvard School of Public Health (and who did not participate in the U.K. study) suggests Americans' financial insecurity may play a key role. "The opportunity to go both up and down the socioeconomic scale in America may create stress," Blendon said. "Americans don't have a reliable government safety net like the English enjoy."
There can be no doubt, of course, that Americans share common roots and common law with the Canadians and the English. But apparently when it comes to health care, we don't share common sense.