Section XVII: US Health in a Global Perspective

What is the major finding of international comparisons of U.S. health?

The U.S. has the worst health outcomes among high-income countries across most metrics (life expectancy, infant/maternal mortality, DALYs) despite the highest healthcare spending.

When did the U.S. begin falling behind peer nations in life expectancy?

Around 1980, when U.S. improvements slowed relative to other wealthy nations.

What metrics are used in international health comparisons?

Life expectancy, infant/maternal mortality, DALYs, cause-specific mortality, morbidity prevalence.

Why is life expectancy NOT a prediction?

It summarizes current age-specific death rates; it does not forecast an individual’s actual lifespan.

What is one area where U.S. outcomes are relatively strong?

Cancer mortality — the U.S. performs better than many peers.

Which age group does NOT show a U.S. disadvantage?

Adults ages ~75 and older.

Why doesn’t high U.S. healthcare spending translate into better population health?

Many determinants of health are upstream (social and economic factors), not in clinical care.

Why can’t healthcare alone explain the U.S. health disadvantage?

Healthcare is downstream; major health differences arise from structural conditions and social context.

How does the U.S. compare on healthcare access?

The U.S. ranks last among peer nations due to patchy insurance coverage and affordability issues.

Does healthcare quality explain the U.S. health disadvantage?

No — quality is not consistently lower, and cannot account for the broad health gaps.

Which health behavior contributes most to the U.S. disadvantage?

Obesity — the U.S. has the highest obesity prevalence among high-income nations.

How does the U.S. compare in smoking rates?

U.S. smoking rates are relatively low and do not explain poor population health.

Why are opioids and firearms important in international comparisons?

They contribute heavily to injury mortality, which is much higher in the U.S.

What type of determinants are health behaviors?

Downstream determinants influenced by environment, social context, and policy.

What are upstream determinants?

Social, economic, and policy factors that shape environments and downstream behaviors.

How does U.S. income inequality compare to peers?

It is among the highest (high Gini index).

Why are ecologic studies linking inequality and mortality controversial?

Inequality correlates with poverty, making mechanisms difficult to separate.

What do U.S. regional mortality differences suggest?

State-level policy and economic context strongly shape population health.

What regional pattern is seen in the U.S.?

Pacific/New England = best outcomes; South/Southeast = worst outcomes.

Does the U.S. have worse environmental quality than peers?

No — air and water quality are generally similar to peer nations.

What type of spending is unusually low in the U.S.?

Social program spending (housing, childcare, unemployment, labor protections).

Why might low social spending harm population health?

It weakens upstream supports like housing stability, childcare, and income security.

What overall pattern characterizes U.S. health outcomes?

Broad disadvantages across many ages and causes, not limited to one disease.

What question does the lecture raise about access?

How much lack of insurance contributes to the disadvantage — and why it’s hard to estimate.

True or False: Better healthcare access alone would eliminate the U.S. disadvantage.

False — upstream determinants drive many differences.

If two countries have similar smoking and environment but one has higher obesity and injury mortality, what explains the gap?

Obesity and injury-related causes (opioids, firearms).

A country spends heavily on healthcare but little on social welfare. What outcomes are expected?

Poor population health despite strong clinical care.

Why might the U.S. have worse maternal mortality despite high spending?

Structural inequities, racism, and poor access to prenatal/OB care.

High infant mortality despite advanced medical technology suggests what?

Upstream determinants like poverty, stress, racism, and access issues.

Why does the U.S. disadvantage begin around 1980?

Rising inequality and divergent social/economic policy slowed health improvement.