Our Sick Society - New York Times
The New York Times

May 5, 2006
Op-Ed Columnist

Our Sick Society
By
PAUL KRUGMAN

Is being an American bad for your health? That's the apparent implication of
a study just published in The Journal of the American Medical Association.

It's not news that something is very wrong with the state of America's
health. International comparisons show that the United States has achieved a
sort
of inverse miracle: we spend much more per person on health care than any
other nation, yet we have lower life expectancy and higher infant mortality
than
Canada, Japan and most of Europe.

But it isn't clear exactly what causes this stunningly poor performance. How
much of America's poor health is the result of our failure, unique among
wealthy
nations, to guarantee health insurance to all? How much is the result of
racial and class divisions? How much is the result of other aspects of the
American
way of life?

The new study, "Disease and Disadvantage in the United States and in
England," doesn't resolve all of these questions. Yet it offers strong
evidence that
there's something about American society that makes us sicker than we should
be.

The authors of the study compared the prevalence of such diseases as
diabetes and hypertension in Americans 55 to 64 years old with the
prevalence of the
same diseases in a comparable group in England. Comparing us with the
English isn't a choice designed to highlight American problems: Britain
spends only
about 40 percent as much per person on health care as the United States, and
its health care system is generally considered inferior to those of
neighboring
countries, especially France. Moreover, England isn't noted either for
healthy eating or for a healthy lifestyle.

Nonetheless, the study concludes that "Americans are much sicker than the
English." For example, middle-age Americans are twice as likely to suffer
from
diabetes as their English counterparts. That's a striking finding in itself.

What's even more striking is that being American seems to damage your health
regardless of your race and social class.

That's not to say that class is irrelevant. (The researchers excluded racial
effects by restricting the study to non-Hispanic whites.) In fact, there's
a strong correlation within each country between wealth and health. But
Americans are so much sicker that the richest third of Americans is in worse
health
than the poorest third of the English.

So what's going on? Lack of health insurance is surely a factor in the poor
health of lower-income Americans, who are often uninsured, while everyone in
England receives health care from the government. But almost all
upper-income Americans have insurance.

What about bad habits, which the study calls "behavioral risk factors"? The
stereotypes are true: the English are much more likely to be heavy drinkers,
and Americans much more likely to be obese. But a statistical analysis
suggests that bad habits are only a fraction of the story.

In the end, the study's authors seem baffled by the poor health of even
relatively well-off Americans. But let me suggest a couple of possible
explanations.

One is that having health insurance doesn't ensure good health care. For
example, a New York Times report on diabetes pointed out that insurance
companies
are generally unwilling to pay for care that might head off the disease,
even though they are willing to pay for the extreme measures, like
amputations,
that become necessary when prevention fails. It's possible that Britain's
National Health Service, in spite of its limited budget, actually provides
better
all-around medical care than our system because it takes a broader,
longer-term view than private insurance companies.

The other possibility is that Americans work too hard and experience too
much stress. Full-time American workers work, on average, about 46 weeks per
year;
full-time British, French and German workers work only 41 weeks a year. I've
pointed out in the past that our workaholic economy is actually more
destructive
of the "family values" we claim to honor than the European economies in
which regulations and union power have led to shorter working hours.

Maybe overwork, together with the stress of living in an economy with a
minimal social safety net, damages our health as well as our families. These
are
just suggestions. What we know for sure is that although the American way of
life may be, as Ari Fleischer famously proclaimed back in 2001, "a blessed
one," there's something about that way of life that is seriously bad for our
health.

POsted by Miriam V.