As a McNair scholar at the University of Wisconsin-Eau Claire who will soon be moving on to graduate studies in biostatistics, biomedical science and public health are often on my mind. One major function of public health is assessment, the collection and analysis of information pertaining to health issues in a population. Biostatistics is the analysis of health related data in either public health or biomedical research settings, meaning it is a primary tool for which public health is assessed. Health outcomes in the United States have been improving by several measures, especially during the 20th century. Many common pathogenic diseases such as influenza, pneumonia, and tuberculosis are no are no longer leading causes of death in the United States. While that is certainly a victory for public health, the question remains, does that mean Americans are generally healthier today than they were a century ago? Despite having one of the highest healthcare expenditures in the world, the United States consistently ranks lower in several health outcomes compared to other similarly wealthy nations.
Quantifying Population Healthiness
In developing a broad picture of how healthy a population is, there are several key data points used. Life expectancy, mortality rates, and disease burden give us an idea of how long people are living on average, how common a disease is, to what extent particular diseases cause premature death, and how impactful a disease is to an individual's daily life. From the years of 1980-2020, the all cause mortality rate in the United States fell 19%, while rates in similar countries such as the United Kingdom, Japan, Australia, the Netherlands, Austria, and Switzerland whose all cause mortality rates fell by 43% according to the Petersen KKF Health System Tracker. Similar figures were reported for years of life lost, which weighs younger deaths more heavily, suggesting that America is not performing as well as other countries in reducing premature deaths. Since 1980 onwards, the life gap in life expectancies of average United States citizens versus citizens in other comparable countries has only grown larger. The Petersen KKF Health System Tracker reports that as of 2021, the average life expectancy in the United States is 76.4 years, as compared with an average of 82.3 years. Based on 2022 data from the CDC, the leading causes of death in the U.S. are heart disease, cancer, accidents/unintentional injuries, COVID-19, stroke, chronic lower respiratiory disease, alzheimers, diabetes, kidney conditions, and chronic liver disease. Conditions such as heart disease, cancer, alzheimers, diabetes, and kidney diseases are complex diseases with many risk factors at play. While they are not necessarily immediately dangerous, they profoundly impact an individual's health in the long term. These diseases have a high burden, meaning that they cause premature death and cause disability in individuals suffering from them. The culmination of all of this information tells us that Americans are perhaps not very healthy, and while we have made strides in combatting infectious disease and protecting people's health through safety regulations in various settings, public health has a long way to go in combatting chronic disease.
Why the United States Underperforms
In 2022, a study compared U.S. healthcare spending rates per capita with 12 other wealthy countries. The specific countries included were Switzerland, Germany, Canada, France, Belgium, Netherlands, Sweden, Australia, Ireland, the United Kingdom, Japan, and Italy. The U.S. spent an estimated $12,742 per person on healthcare, the highest amongst all the countries sampled, and about $1000 short of being twice of the average expenditure for all of the countries sampled. With respect to chronic disease rates and life expectancy, it is well known that the American diet and lifestyle is a major player in what sets us so far behind. What is less commonly discussed, however, are the reasons why health outcomes in the United States are so comparatively poor, despite our healthcare expenditure. The Commonwealth Fund presents some statistics which seem to suggest health incomes in the United States are subpar because of healthcare expenditures, not in spite of them. In fact, they reported that as of 2021, 38% of adults did not receive medical care due to the barrier of cost in the last year, more than four times the rates for people in both Norway and the Netherlands. If cost is posing a barrier to improved health outcomes, we might consider the reasons why costs remain so high in the United States. According to the Peter G. Petersen foundation, the United States spends over $1,000 per person on administrative costs, about five times more than other wealthy countries on average, and $973 on long term care per capita, whereas the average for wealthy countries is about $1350. These large expenditures on administrative costs could be attributed to consolidation of hospitals, leading to less competition, as suggested to the Peter G. Petersen foundation. Additionally, a 2017 study published by the Commonwealth Fund ranked the United States U.S. last in administrative efficiency due to how much time patients and staff spend dealing with paperwork, insurance issues, and referrals.
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