From riches to rags - the US health story

The United States of America has gone from health to sickness in the space of 25 years, according to new analysis of US health data.

However, a team of public health researchers led by Fuse Associate Director Professor Clare Bambra say it doesn’t have to be doom and gloom for the richest country in the world.

Tall and healthy

The data, analysed by Durham University academics, show that Americans are expected to live shorter lives on average than their counterparts in other wealthy countries and the US fares worse in a number of key health outcomes such as infant mortality rates, obesity and diet, and teenage pregnancies.

But it is only since the 1980s that the US started slipping down the health league tables after being the healthiest and tallest of the rich democracies for many years.

Today, Americans live three years less than their counterparts in France or Sweden. They are considerably shorter than Europeans. The US has the highest obesity rates and average daily calorie intake in the world. It also has the lowest life expectancy amongst the world’s 19 wealthiest countries.

Government policies

The researchers say the health of different places is determined both by the make-up of the people and by the environment in which people live. Crucially, they say, it can be changed and improved dramatically by government decisions such as regulating fast food outlets, restricting access to cigarettes or reducing unemployment.

Clare Bambra, professor of public health geography at Durham University and lead of the Fuse Health Inequalities research programme, said: “There is a clear US health disadvantage where we see high poverty rates, a healthcare system that leaves a lot to desire, and overall a less generous welfare state than other similar countries. 

“Societies in which there is a stronger social safety net almost always do better in health terms so the US government can do a lot to make its society healthier.

“Regulation imposed by governments can play a major part in keeping people healthy. Increasing the price of, or restricting access to, cigarettes and alcohol can reduce consumption. In the same way, reducing the number of fast food outlets could see a big drop in obesity levels. A further review of the healthcare system with more expenditure going on patient care rather than on regulating the healthcare market would also make a difference.

“Where you live can kill you and comparing the health statistics of the US with their wealthy counterparts clearly shows this.”

South-North divide

The analysis of data is part of a new book, called “Health Divides: where you live can kill you”. It highlights stark health inequalities between the US and other rich countries but also within the US, such as how men in the affluent leafy suburbs of Maryland in the capital Washington DC are expected to live 20 years longer than those in the low income inner city neighbourhoods. There is a similar stark contrast in New Orleans where there is a 25 year gap in life expectancy between residents of the Iberville and Naverre suburbs although they are just three miles apart.

A clear south-north divide, with the northern states outperforming those in the south is also noted in the book particularly for obesity rates.

Mets or Royals

Another way of looking at these health divides within the United States is to use baseball teams and the areas they are in as metaphors for comparing health. Who would win the World Series crown if the result was based on how healthy the area around the stadium is?

In 2015, Kansas City Royals were crowned the winners after beating the New York Mets. However, if the result had been decided on life expectancy of men in the two cities, New York Mets, where men are expected to live on average to 79 years, would have walked away with the title beating Kansas City Royals by five years (where the life expectancy of men is 73.9 years). In lowest performing Baltimore City County where the Orioles play, the life expectancy for men is only 68.9 years, equivalent to that of significantly less wealthy countries like Nepal and Indonesia. In contrast, men living in Orange County - where the LA Dodgers play – can expect to live to 80 years.

This illustrates the huge health inequalities that exist between US cities.

Where you live matters

Professor Bambra added: “The health of places is influenced by the people who live there and in what type of environment they live. However, politics also matter in determining which strategies those in power pursue to narrow the gap, or whether they even care at all.

“What is clear from the research is that societies in which there is a stronger social safety net almost always do better in health terms and within those countries the poorest and most vulnerable groups are far healthier and live longer than their peers in less supportive societies such as in the UK or the US. 

“So, where you live matters for how long you live, and changing how we live could reduce health inequalities.”

Adapted with thanks from Durham University.

Read the accompanying Fuse blog post by Professor Clare Bambra: Where you live can kill you


Photo attribution: “House for sale, New Orleans” by K.G. Schneider via, copyright © 2006:

Last modified: Fri, 14 Oct 2016 10:42:54 BST