MSNBC  [Printer-friendly version]
May 2, 2006


By the Associated Press

[Introduction: The story was also covered in the New York Times May
3, 2006.]

CHICAGO -- Middle-aged, white Americans are much sicker than their
counterparts in England, startling new research shows, despite U.S.
health care spending per person that's more than double what Britain

A higher rate of Americans tested positive for diabetes and heart
disease than the British. Americans also self-reported more diabetes,
heart attacks, strokes, lung disease and cancer.

The gap between the countries holds true for educated and uneducated,
rich and poor.

"At every point in the social hierarchy there is more illness in the
United States than in England and the differences are really
dramatic," said study co-author Dr. Michael Marmot, an epidemiologist
at University College London in England.

The study, appearing in Wednesday's Journal of the American Medical
Association, adds context to the already-known fact that the United
States spends more on health care than any other industrialized
nation, yet trails in rankings of life expectancy.

The United States spends about $5,200 per person on health care while
England spends about half that in adjusted dollars.

"Everybody should be discussing it: Why isn't the richest country in
the world the healthiest country in the world?" Marmot said.

"It's something of a mystery," said Richard Suzman of the U.S.
National Institutes of Health, which helped fund the study.

The researchers looked for answers in the data, which came from
government-sponsored health surveys. The research was supported by
grants from government agencies in both countries. A U.S. researcher
from the Rand Corp. was on the team.

Americans more obese

Smoking rates are about the same on both sides of the pond. Brits have
a higher rate of heavy drinking, but a higher percentage of Americans
are obese.

The researchers crunched numbers to create a hypothetical statistical
world in which the British had American lifestyle risk factors,
including being as fat as Americans. In that model, the researchers
found Americans still would be sicker.

Only non-Hispanic whites were included in the study to eliminate the
influence of racial disparities. The researchers looked only at people
ages 55 through 64, and the average age of the samples was the same.

Americans reported twice the rate of diabetes compared to the British:
12.5 percent versus 6 percent. For high blood pressure, it was 42
percent for Americans versus 34 percent for the British; cancer showed
up in 9.5 percent of Americans compared to 5.5 percent of Britains.

The upper crust in both countries was healthier than middle-class and
low-income people in the same country. But richer Americans' health
status resembled the health of the low-income British.

Health experts have known the U.S. population is less healthy than
that of other industrialized nations, according to several important
measurements. U.S. life expectancy, for example, ranks behind that of
about two dozen other countries, according to the World Health

Some have believed the U.S. has lagged because it has a more
ethnically diverse population than some of the higher-ranking
countries, said Suzman, who heads the National Institute on Aging's
Behavioral and Social Research Program. "Minority health in general is
worse than white health," he said.

But the new study showed that when minorities are removed from the
equation, and adjustments are made to control for education and
income, white people in England are still healthier than white people
in the United States.

"As far as I know, this is the first study showing this," said Suzman
who called the results "surprising." But some other experts said the
findings were predictable.

No financial safety net

Earlier studies have shown the United States does a poorer job than
other industrialized countries at providing primary medical care to
its citizens, particularly to those with less education and income,
said Dr. Barbara Starfield, a professor of health policy and
pediatrics at Johns Hopkins University.

"Countries oriented toward providing good primary care basically do
better in health," she said.

Marmot offered yet another explanation for the gap: Americans'
financial insecurity. Improvements in household income have eluded all
but the top fifth of Americans since the mid-1970s. Meanwhile, the
British saw their incomes improve, he said.

Robert Blendon, a professor of health policy at the Harvard School of
Public Health who was not involved in the study, said the stress of
striving for the American dream may account for Americans' lousy

"The opportunity to go both up and down the socioeconomic scale in
America may create stress," Blendon said. Americans don't have a
reliable government safety net like the English enjoy, Blendon said.

However, Britain's universal health-care system shouldn't get credit
for better health, Marmot and Blendon agreed.

Both said it might explain better health for low-income citizens, but
can't account for better health of Britain's more affluent residents.

Marmot cautioned against looking for explanations in the two
countries' health-care systems.

"It's not just how we treat people when they get ill, but why they get
ill in the first place," Marmot said.