A Search for Answers to Continuing Health and Mortality Disparities in the United States: Why did the United States suffer a reversal in gains in life expectancy and why do we linger at the bottom for high-income countries?
Year: 2014
Type: article
Abstract: Why did the United States suffer a reversal in gains in life expectancy and why do we linger at the bottom for high-income countries?Over the past twenty years or so, patterns of mortality and health conditions in the U.S. population have developed two strong, disturbing traits. First, compared to other high-income countries, U.S. mortality and health status rank as one of the worst. Second, mortality and health status disparities by race, income, and education, far from weakening over time, remained invariant or increased. In this article, we describe the nature and possible causes of the U.S. mortality disadvantage in later life (older than age 50) and review the most recent findings regarding health and mortality disparities by race and education. We argue that disparities by race and education are puzzling because they are remarkably persistent in all modern societies, and particularly acute in the United States, despite advances in medical technology and healthcare.The Growing Gap in Mortality in High-Income CountriesTwo recent reports issued by the National Academy of Sciences argue convincingly that Americans experience higher mortality and worse health than their peers in developed countries (National Research Council, 2011a, 2011b, 2013). Americans face shorter lives than individuals in other developed, high-income countries. As of 2012, U.S. life expectancy at birth among females ranks last or next to last in a set of about seventeen high-income countries, trailing top performing countries by more than four years (National Research Council, 2013). Conditions among males are slightly better, as they rank slightly below the middle of the group of the seventeen countries and trail the top performers by 3.6 years. Empirical evidence reveals that the U.S. disadvantage is visible both in mortality between ages 0 and 50 and at ages older than 50. But Americans may fare a bit better if they survive to older ages: at least in the most recent life tables, life expectancies at ages 65 to 70 are closer to the average of peer countries, and at very old ages (75 years and older), the United States experiences an advantage (Palloni and Yonker, 2013). Aside from this regularity at very old ages, Americans simply do not live as long as their peers in other wealthy nations.The U.S. disadvantage also is visible in a broad array of health status measures, including pediatrics outcomes (birth weight and length of gestation), adolescent and adult mental health, child and adult obesity, diabetes, teenage pregnancy, and accidents and injuries (National Research Council, 2013). The lower ranking of the United States is sustained over a long arch of the life span, from birth to late adulthood. This suggests that the U.S. mortality and health disadvantage is a symptom of a generalized malaise that affects individuals at all stages of their life cycle, not the product of particularly bad conditions in one of them.Intriguingly, the United States did not always experience the life expectancy (or health) disadvantage we see today. In the 1950s and 1960s, U.S. life expectancy at birth, and at ages older than forty-five, was above the average value of the seventeen countries referred to above (the pooled benchmark), infant mortality ranked among the five lowest, and the very old already enjoyed the same advantage they experience today, albeit starting at somewhat younger ages (around age 70 rather than 75). However, sometime during the late 1970s and early 1980s, the pace of U.S. gains in life expectancy slowed abruptly, infant mortality stood out as an egregious outlier among the seventeen countries, and female mortality performed worse than male mortality and began falling behind more rapidly. From that point on, peer countries pulled away from the United States and have done so uninterruptedly for nearly thirty years.What caused this reversal? Is the U.S. disadvantage in mortality the same at all ages? …
Source: PubMed
Authors: Alberto Palloni, James Yonker
Institution: University of Wisconsin–Madison
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W902353276