Thursday, May 04, 2006

The National Health 

We were aware that the World Health Organization, in a 2000 survey, ranked the U.S. healthcare system 37th-best in the world, despite the fact that America spends vastly more on medical care per capita than any other country. We naturally assumed, however, that the 46 million citizens who lack health insurance were dragging down the national average, and that top-flight care would always be available to those Americans who could afford to buy it.

A new study throws that assumption into question. Based on a number of indicators, the poorest people in Great Britain (#18 in the WHO survey) are just as healthy as the richest in America:
Middle-aged English people are “much healthier” than their American counterparts, even though the US spends far more on medical care than the UK, according to a large international study published on Tuesday in the Journal of the American Medical Association.

Americans have significantly higher rates of diabetes, heart disease, stroke, lung disease and cancer than English people in the 55 to 64 age group . . . .

The researchers who were funded by several US and UK government agencies, set out to look at the social and economic factors affecting health but shifted emphasis when large differences emerged between the two countries. The study looked both at the way people reported their own health and – to guard against any bias from self-reporting – at objective biological markers of disease from blood tests. Altogether there were about 15,000 participants.

Samples in both countries were limited to whites and excluded recent immigrants, so as to control for racial and ethnic factors . . . .

As expected, people with higher socio-economic status, as measured by their income and education levels, tended to enjoy better health. But because the national differences were so great, those at the top of the education and income scale in the US suffered diabetes and heart disease at a similar rate to those at the bottom of the scale in England . . . .

Different health systems may also be part of the story. The researchers note that the US spends $5,274 per head on medical care while the UK spends $2,164, adjusted for purchasing power. But Britain’s National Health Service provides publicly funded medicine for everyone, while Americans under the age of 65 have to rely on private insurance.

Prof Marmot suggested that, while the healthcare provided by the British state health service was not superior to the private US system, it provided important psychological reassurance.

As the researchers say in the journal paper: “To a much greater extent England has set up programmes whose goal is to isolate individuals from the economic consequences of poor health in terms of their medical expenditure and especially earnings and wealth reduction.”

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