Despite spending more than 2.5 times as much on health care as in peer nations,1 there is a consistent and pervasive pattern of higher mortality and inferior health in the United States.2 This commentary, based on a symposium at the 2014 Pediatric Academic Societies meeting in Vancouver, highlights factors that may be responsible for these differences, comments on implications for policy, practice, and research, and proposes a call to action.
The US Health Disadvantage
A report by the National Research Council and the Institute of Medicine (IOM), Shorter Lives, Poorer Health (hereafter called the IOM report), describes major health disadvantages between the United States and 16 comparable, high-income “peer” countries.2 All of these nations have sufficient national wealth to support a variety of health and social services policies and programs to address the health needs of their populations. Yet the IOM report, along with other reports, revealed significantly poorer outcomes for the US population, beginning at birth, and affecting all age groups.2–4 The substantially higher US rates of infant mortality, low birth weight, and preterm birth weight have been well known. What is perhaps less well known is that this disadvantage continues throughout childhood and adolescence. Indeed, the probability of children dying before age 5 (8 per 1000) is highest in the United States and US adolescents have higher all-cause mortality, including mortality from injuries and violence.2 Compared with peer countries, the prevalence of obesity among US adolescents is more than twice other national means, and the US prevalence of diabetes is in the top third.
Reasons for the US Disadvantage
What is behind this paradox of spending more and achieving less? Although the reasons undoubtedly include our fragmented health care system and large uninsured population, the pervasive nature of low US rankings suggests something more profound: a fundamental difference between policies …
Address correspondence to Gerry Fairbrother, PhD, AcademyHealth, 1150 17th St NW, Suite 600, Washington, DC 20036. E-mail: