Skip to main content

America flunks its health exam

By Aaron Carroll, Special to CNN
updated 2:38 PM EST, Fri January 11, 2013
A report finds that Americans have
A report finds that Americans have "shorter lives and poorer health," coming in last in key areas behind 16 other rich nations
STORY HIGHLIGHTS
  • Aaron Carroll: New study shows U.S. health and lifespan worst of 17 rich countries
  • He says it's because of personal choices, systemic woes. Poverty high, health care uneven
  • He says this particularly affects youth, plagued by sickness, violence, high mortality
  • Carroll: Don't make it political. The richest country in the world must improve public health

Editor's note: Dr. Aaron E. Carroll is an associate professor of pediatrics at the Indiana University School of Medicine and the director of the university's Center for Health Policy and Professionalism Research. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

(CNN) -- A just-released report from the Institute of Medicine and National Research Council is making news by clearly illustrating that Americans have "shorter lives and poorer health." This is somewhat shocking, given how much we spend on health care each year — more than any of the 16 other rich countries surveyed in the study. What's even more upsetting is that this report focused quite heavily on people who are young. In the United States, even that group fared poorly.

Aaron Carroll
Aaron Carroll

Why is this?

Some of the reasons involve choices make at a personal level. We eat too much, abuse drugs too often, wear seat belts too rarely and commit violence against each other to often.

Systemic issues are also to blame. We have higher levels of poverty than comparable countries, and our safety net programs are less capable of catching people when they fall. And too many also have too much trouble accessing the health care system, resulting in inefficient, ineffective and often absent care.

It's far too easy to let these dreadful statistics become obscured in a politically charged argument. Let's avoid that. This report is so stark that it's going to take a concerted effort on the part of the government, the media, the health care system and everyday citizens to turn things around. Our personal choices are bad. Our safety nets are bad. Our health care system is bad. It's all bad. How bad?

When compared with peer countries, the United States was the absolute worst with respect to still births, infant mortality and low birth weight. Some have tried to blame this on "coding" differences. In other words, they will claim that other countries will refuse to define a premature birth as we do, resulting in artificially high numbers in the United States. But when this report recalculated the rates to exclude such births equally in all countries, we still ranked last.

Become a fan of CNNOpinion
Stay up to date on the latest opinion, analysis and conversations through social media. Join us at Facebook/CNNOpinion and follow us @CNNOpinion on Twitter. We welcome your ideas and comments.



Things don't get better after birth. The chance that a child in the United States will die before age 5 is higher than in any of the other 16 peer countries. Injuries are the most common cause of death, but the United States also has the highest rate of deaths caused by negligence or abuse.

And violence is decidedly an American problem. Homicide is the third most common cause of death in children age 1-4.

From age 5-19, the trend continues. Kids this age in the United States have the worst health ranking of the 17 studied countries. More than one-third of U.S. children age 5-17 are obese or overweight, the highest of any peer country. The adolescent pregnancy rate in the United States is about 3.5 times the average of others. Additionally, the rates of sexually transmitted infections, including syphilis, gonorrhea and chlamydia are the worst compared to peer countries.

Nor are these children exempt from death. Injury deaths are more common in 15- to 19-year-olds in the United States than in any other studied country. Homicide claims the second highest number of lives in 15- to -24-year-olds, and 4 in 5 of those deaths involve guns. Males between the ages of 15 and 19 are five times as likely to die from violence in the United States than in other countries.

Obamacare: What's next?
The NRA, guns and health care
Chicago gang members reflect on violence
Teens work to save Chicago's south side

Even as young adults, ages 25-34, mortality remains consistently upsetting and preventable. Unintentional injuries remain the No. 1 cause of death. The risk of dying by violence remains seven times higher for males in the United States ages 20-24 than in other countries.

We have to work together to make these numbers better. Some of them can be improved with public health measures. We need to help Americans be less obese, to have fewer accidents and to commit less violence. There are lots of local studies and initiatives that propose ways to fix these things, but our public health system is woefully underfunded, and translating any promising findings to meaningful societal change poses a huge challenge.

We also need to improve our safety nets to help children at the lowest end of the socioeconomic ladder do better, even before they are born. Pregnant women, babies and children suffer from hunger and malnutrition far too often in the richest country in the world. Yet we still debate the merits of the federally funded WIC (Womens, Infants and Children) program, school lunches and food assistance to needy families.

Finally, we need to find a way to improve access to the health care system. The Medicaid program covers one in every three births and one in every three children in the United States, and it's still not enough. As some states balk at expanding Medicaid to cover many of the poorest uninsured, some are still talking about reducing funding to the already stretched program. There's no question that we have the capability, the knowledge and the resources to care for people. It's just a matter of doing it better.

There will be some who deny these results. Others will try to use them for political gain. That would be a mistake. We have to accept these findings and begin to work holistically to improve them. Being last just isn't the American way.

Follow us on Twitter @CNNOpinion.

Join us on Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Aaron Carroll.

ADVERTISEMENT
Part of complete coverage on
updated 8:42 AM EDT, Mon August 18, 2014
The former U.K. prime minister and current U.N. envoy says there are 500 days left to fulfill the Millennium Goals' promise to children.
updated 9:10 AM EDT, Mon August 18, 2014
Julian Zelizer says the left mistrusts Clinton but there are ways she can win support from liberals in 2016
updated 7:49 AM EDT, Tue August 19, 2014
Peter Bergen says the terror group is a huge threat in Iraq but only a potential one in the U.S.
updated 1:34 PM EDT, Sat August 16, 2014
Mark O'Mara says the way cops, media, politicians and protesters have behaved since Michael Brown's shooting shows not all the right people have learned the right lessons
updated 11:23 AM EDT, Sun August 17, 2014
Retired Lt. Gen. Mark Hertling says the American military advisers in Iraq are sizing up what needs to be done and recommending accordingly
updated 3:41 PM EDT, Fri August 15, 2014
Marc Lamont Hill says the President's comments on the Michael Brown shooting ignored its racial implications
updated 5:46 PM EDT, Fri August 15, 2014
Joe Stork says the catastrophe in northern Iraq continues, even though many religious minorities have fled to safety: ISIS forces -- intent on purging them -- still control the area where they lived
updated 6:26 PM EDT, Thu August 14, 2014
Tim Lynch says Pentagon's policy of doling out military weapons to police forces is misguided and dangerous.
updated 9:15 AM EDT, Fri August 15, 2014
S.E. Cupp says millennials want big ideas and rapid change; she talks to one of their number who serves in Congress
updated 7:57 PM EDT, Thu August 14, 2014
Dorothy Brown says the power structure is dominated by whites in a town that is 68% black. Elected officials who sat by silently as chaos erupted after Michael Brown shooting should be voted out of office
updated 7:49 AM EDT, Thu August 14, 2014
Bill Schmitz says the media and other adults should never explain suicide as a means of escaping pain. Robin Williams' tragic death offers a chance to educate about prevention
updated 11:05 AM EDT, Fri August 15, 2014
Nafees Syed says President Obama should renew the quest to eliminate bias in the criminal justice system
updated 4:24 PM EDT, Thu August 14, 2014
Eric Liu says what's unfolded in the Missouri town is a shocking violation of American constitutional rights and should be a wake-up call to all
updated 3:22 PM EDT, Wed August 13, 2014
Neal Gabler says Lauren Bacall, a talent in her own right, will be defined by her marriage with the great actor Humphrey Bogart
updated 6:56 AM EDT, Fri August 15, 2014
Bob Butler says the arrest of two journalists covering the Ferguson story is alarming
updated 4:35 PM EDT, Wed August 13, 2014
Mark O'Mara says we all need to work together to make sure the tension between police and African-Americans doesn't result in more tragedies
updated 4:06 PM EDT, Mon August 18, 2014
Pepper Schwartz asks why young women are so entranced with Kardashian, who's putting together a 352-page book of selfies
updated 7:08 PM EDT, Wed August 13, 2014
Michael Friedman says depression does not discriminate, cannot be bargained with and shows no mercy.
updated 8:51 AM EDT, Tue August 12, 2014
Mary Allen says because of new research and her own therapy, she no longer carries around the fear of her mother, which had turned into a generalized fear of everything
updated 3:59 PM EDT, Tue August 12, 2014
Gilbert Gottfried says the comedian was most at home on the comedy club stage, where he was generous to his fellow stand-up performers
updated 4:54 PM EDT, Tue August 12, 2014
Iris Baez, whose son was killed by an illegal police chokehold, says there must be zero tolerance for police who fatally shoot or otherwise kill unarmed people such as Michael Brown
updated 8:46 AM EDT, Tue August 12, 2014
Maria Cardona says as he seeks a path to the presidency, the Kentucky Senator is running from his past stated positions. But voters are not stupid--and they know how to use the internet
updated 10:19 PM EDT, Tue August 12, 2014
Gene Seymour says the shock at the actor and comedian's death comes from its utter implausibility. For many of us over the last 40 years or so, Robin Williams was an irresistible force of nature that nothing could stop.
updated 3:51 PM EDT, Tue August 12, 2014
Soledad O'Brien says the story of two veterans told in a documentary airing on CNN shows the challenges resulting from post-traumatic stress
updated 11:25 AM EDT, Tue August 12, 2014
LZ Granderson says we must not surrender to apathy about the injustice faced by African Americans
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT