Epic fail: The verdict on the US healthcare system

“The United States spends more on health care than does any other country, but its health outcomes are generally worse than those of other wealthy nations.   People in the United States experience higher rates of disease and injury and die earlier than people in other high-income countries”.  ‘Nuff said.  But what are the reasons?

US healthcare system examines itself

The quote above comes from a JAMA article commenting on a recent US National Research Council/Institute of Medicine (NRC/IOM) report entitled Shorter Lives, Poorer Health.  The report doesn’t examine the costs of the US healthcare system itself, instead focusing on what it terms the ‘health disadvantage’ suffered by north Americans.

The ‘health disadvantage’

The US health disadvantage is a many-tentacled beast.  Most strikingly, US citizens have shorter life expectancies than people in most of the wealthy countries selected for comparison (Figure 1; see relative positions of red dots for US, and grey dots for 21 other countries).  Compared with other wealthy countries, US adolescents have higher rates of motor vehicle fatalities and homicide deaths.  Infant mortality is higher in the US than in any other high-income country.  US rates of diabetes and obesity are the worst among the comparison group, while the US fares below average in terms of chronic lung disease, heart disease and disability rates.

The report even notes that, “The nation’s large population of recent immigrants is generally in better health than native-born Americans” – a fact pointed out by our colleagues at ANH-USA already.  And unfortunately, President Obama’s recent healthcare reforms are likely to make things even worse.

        a) Male

         b) Female

Figure 1. Male (a) and female (b) US life expectancy (red dots), 1980–2006, compared with life expectancy in Australia, Austria, Belgium, Canada, Denmark, Finland, France, Iceland, Ireland, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, the United Kingdom and West Germany (grey dots). Taken from the National Research Council/Institute of Medicine (NRC/IOM) report Shorter Lives, Poorer Health

Fortunately, the authors did identify a plus side for US citizens, specifically: “Higher survival after age 75...higher rates of cancer screening and survival, better control of blood pressure and cholesterol levels, lower stroke mortality, lower rates of current smoking, and higher average household income. In addition, U.S. suicide rates do not exceed the international average”.

So what’s the problem?

The authors have put considerable effort into trying to analyse the reasons for the US health disadvantage.  They identified problems with the healthcare system itself – fragmentation, limited public health and primary care resources and a large uninsured population – along with individual behaviours and, “The physical and social environment in US communities”.  The latter includes such factors as towns and cities being built for vehicles instead of people, thereby discouraging physical activity, and the influence of industry, marketing and other factors on food choices.

Tinkering at the edges

As solutions, the report proposes more comprehensive and better-coordinated research, along with a national public conversation about the issues and urgent efforts to implement policies such as Healthy People 2020 and the recommendations of the National Prevention Council.

So, in a nutshell, while the NRC/IOM report is admirably forthright about the poor outcomes of the US healthcare system, its solutions amount to more of the same and more power for the government and healthcare system.  For example, the Dietary Guidelines for Americans mentioned in the National Prevention Strategy currently amount to the MyPlate recommendations – which are themselves part of the problem, rather than part of the solution.  And while it would be wonderful if the US could implement the physical activity goals of Healthy People 2020 or the National Prevention Strategy, it’s hard to see how such an almighty turnaround might occur, all things being equal.

Important factors overlooked

But there are even more elephants in this particular room.  For one, the US is the society most thoroughly penetrated by genetically modified (GM) foods and their litany of documented adverse health effects.  The NRC/IOM, for example, makes no mention of the environmental chemical, ‘electrosmog’ or GM burden to which US citizens are being exposed.  There may be insufficient data, but there are plenty of plausible mechanisms, especially when such factors are considered together.  And nowhere does the report even consider that the current model upon which the US healthcare system is built might be fundamentally flawed, despite correctly prescribed pharmaceutical drugs being one of the leading causes of death.

Improving health outcomes – naturally

Problems of poor health outcomes associated with national health systems and orthodox medical interventions are not limited to the USA.  For us, a rational healthcare system – one based on addressing genuine needs and creating useful jobs – would be based on the following principles:

• Health promotion/disease prevention achieved through diet and lifestyle education, encouraging people to take control of their own health
• Nature-based therapies as first-line interventions to restore homeostasis when problems occur, using nutritional, herbal and other modalities that work with the body’s innate healing capacity
• Reserve the use of new-to-nature drugs, if they are required at all, as well as surgery primarily for emergency situations
• A radical restructuring of the medical curriculum to emphasise prevention, and of hospitals to change from houses of sickness to ‘wellness centres’
• Thorough risk–benefit evaluation of all interventions, regardless of modality – this being something of a specialism at the ANH!
• Integration of insights from the systems biology approach to genetics and nutrition
• Increased use of functional testing of health and wellbeing to provide objective markers of health status and resilience
• A cultural ethos of whole-body healthcare, rather than the reliance on specialised and compartmentalised healthcare delivery as is the norm in contemporary Western healthcare
• A focus on sustainability at all levels of the healthcare system, including in terms of its impact on the natural environment

It’s your call

The NRC/IOM report has one clear message for US citizens: live an average American lifestyle and eat an average American diet, and your health outcomes will be somewhere near the bottom of the pile of industrialised countries.

Conversely, doing things relatively few Americans do will greatly improve your chances of a long, healthy life. Here’s our top 6 tips, all of them backed by solid evidence!

• Don’t smoke
• Minimise alcohol consumption
• Eat plenty of fresh, unprocessed fruit and vegetables
• Engage in 6–12 hours’ moderate to intense physical activity each week
• Avoid taking medications if you can adjust your diet and lifestyle to resolve a health problem.  Seek guidance from a qualified and experienced nutritional, functional medicine, naturopathic or other integrative practitioner if required
• Take responsibility for your own health.  Don’t hand this power to someone else – it could kill you!

Updated: 27 Feb 2013