I became a published author in 1972 with the first trekking guidebook to Nepal now in its 8th edition. This and his other books noted below have sold close to half a million copies worldwide and been translated into five languages.
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Americans pay almost half the world's health care bill -- a well-documented fact. What is equally well-documented and even less well-known is that, despite that huge outlay of cash, we die at a younger age than citizens in close to 50 other countries, including all the other rich nations and some poorer ones as well.
Americans will spend almost any amount of money to extend life for a few months or years. Much of the medical care dollars in this country are paid out for what is called “end-of-life-care.” More people in the USA go bankrupt because of medical expenses than for any other single reason. We are desperate to live as long as possible. But those of us privileged to live in the most powerful nation on earth do not live as long as we should, and we are completely unaware of our abominable standing in the world. Worse still, the way we spend money will never do what it should do -- it will never produce good health.
America: Dying Too Young divulges the deadly truth that health in the United States is a travesty when compared to the length of life enjoyed in other countries. Studies published in leading journals, analyses produced by our National Academy of Sciences, our Institute of Medicine, and other leading research centers in this country all concur that our health as people living in this nation is not that good when compared to those in close to fifty other nations.
Why are we dying so prematurely? Hard as it might be to believe, there is ample evidence that our early deaths have little to do with individual behaviors such as smoking and bad diets. Many longer-lived countries have a higher proportion of smokers than the U.S. does. Many emulate the American fast-food diet and have similar rates of obesity but their populations still live longer. Our relatively high homicide rates are also not to blame, although they are higher than in the healthier countries. If we consider years of life left to live at 50, or at retirement at age 65, when the chances of being killed in a shoot-out are much less, Americans still don’t live as long as people in many other countries. Nor is our lauded medical care system the culprit. We have the most advanced medical technology and sophisticated treatments anywhere in the world; people from many countries (or at least those who have enough money) come here to be treated. But health care is not what produces a healthy nation.
Half a century ago or more, Americans had better health than people in most other nations. In the early 1950s, for example, we could claim the best outcomes world-wide for mothers in avoiding death in childbirth. Today forty nations avert maternal deaths better than we do despite our technologically advanced medicines. We could similarly boast of averting mortality in childhood or having the best survival for advanced age in the late 1940s, but today our health status is a disgrace.
Should we boast of living much longer than people in Afghanistan, or Sierra Leone? Countries with similar health outcomes to ours, measured by rates of deaths, include: Algeria, Armenia, Barbados, Latvia, Lithuania, Macedonia, Maldives, Malta, Peru, Poland, and Slovakia. None of them are rich developed nations who all enjoy longer lives. Is that level of health good enough for us? If our mortality levels had been those of the healthiest nations over the last century, over 66 million more Americans would have been alive in 2000.
The United States can take pride in many accomplishments. We are home to nearly half of all the billionaires in the world. We have the most Nobel Prize winners, the best higher education, the greatest choice in products and unbelievable military might. We have the best entertainment system, and the most opportunities. We were first to do mail order commerce. We produced the first computer and developed the Internet. We are the only country to send humans to the moon.
But shouldn’t Americans also have the right to a life that is significantly longer than that of Algerians?
The Russian’s launch of Sputnik in 1957 was a wake-up call for this country in scientific progress. Russia’s accomplishment pointed out how far behind we were, but in 1969 we became the only nation to land a human in space. We rise to challenges; we just have to set useful goals and make a commitment to them. The health of a nation is not as easily discernable as an object in space that beeped signals incessantly, but the well-documented better health of Japan, Canada, France and Sweden’s compared to our own should be our wake-up call today.
America: Dying Too Young details the awareness and effort that will be needed at the societal level if the US is to achieve a longer average life span. Research over the last thirty years documents that societies with a smaller gap between rich and poor have better overall health. Humans are social creatures, so when confronted by inequality the comparisons they make are harmful to everyone. Societal inequality is at the heart of factors that produce worse health outcomes for all. Healthier nations not limited by great inequality have structures and policies in place that make better health happen without people having to think constantly about doing the right thing to be healthy.
One of the basic principles in the study of the determinants of health is an understanding that early life impacts a lifetime. Half of our health as adults is programmed in early life, from around conception until we start school. Given the importance of early life, national policies in healthier countries guarantee, for example, that pregnant women can take paid leave from work. Once a baby is born, parents have paid time off to do their child rearing work, which turns out to be the most critical period for producing health. When societies have a large income or economic gap, those who are well off can afford the luxury of time off and have no interest in supporting those lower down the hierarchy to enjoy the same if they can't pay for it on their own. Policies in more equal societies tend to care for everyone.
The economic gap between the very rich and the rest of us in the United States lies at the heart of our declining health status relative to other nations. One third of deaths in the US are attributed to our record-setting income gap.
The inevitable conclusion to this story is that greater economic fairness will be the best medicine for our health as a nation. In fact, policies that were promoted a scant half-century ago are what we need today to begin our health improvements. Both Republican and Democratic presidents and other national leaders have in the past espoused the steps necessary for producing health by proposing policies that would lead to fairer outcomes, but their efforts were not successful. Attempts to avert the current global economic crisis are not producing steps that will lead to better health either.
The focus of attention for a longer-lived society must be on creating conditions in early life so that parents can produce healthy adults, and supporting social and economic equity for the population at large. Health begins in the home, but requires a health-promoting community and national policies to support longer lives.
Our health as a nation, compared to others, needs to be tracked closely and displayed the way business indices, or sports team standings are tracked. If we monitor our health ranking among nations, and see it rising rather than dropping, we will enjoy healthier, longer lives as well as improvements in our wellbeing. The prescription that will make us all healthier will be attractive for everyone.
