Health Care US vs UK (Gladwell)

U.S. versus U.K.

Last week, in his New York Times column , Paul Krugman wrote about a study from the Journal of the American Medical Association , and the study is fascinating enough that it’s worth a second look. It was conducted by a group of epidemiologists at University College London (my parent’s alma mater!). The point was to compare the health of the United States and the United Kingdom. It’s an interesting question for a number of reasons, but principally because the United States spends $5274 per person, per year, on health care and the United Kingdom spends $2164, or substantially less than half as much. The question is—what do we get, in terms of health, that for extra $3100 a year?

Comparisons between countries are pretty tricky. So the study takes a number of precautions. Obviously the United States has a much larger percentage of immigrants, particularly Latino, and a large and (relatively poor) black population. So the comparison is limited to non-Hispanic whites in both countries. Health also differs, dramatically, by socio-economic status, so that everyone in the study was broken up into one of three groups by income and education. It was also limited to men and women between the ages of 55-64, and the age distribution of the two countries was identical.

So what do they find?

The first conclusion is that Americans are really, really sick compared to the British. In every socio-economic group, for instance, the prevalence of diabetes is roughly double in the United States than it is in the United Kingdom. Rates of hypertension, heart disease, heart attacks, stroke, lung disease and cancer are also all higher in the United States. And not just a little big higher. Much higher. So, for example, 2.3 percent of the English have had a stroke, versus 3.8 percent of the Americans.

Is that because Americans have unhealthier lifestyles? Not really. Levels of smoking, in the two countries, are pretty similar. Americans are much more likely to be obese (31.3 versus 23 percent). But then 30 percent of the British were heavy drinkers, versus 14.4 percent of Americans. (One of the curious facts in the study: in both the United States and the United Kingdom, the more money you make and the more education you have, the more you drink. There are roughly twice as many heavy drinkers in the best educated English cohort as there are in the least educated English cohort. So much for class assumptions about alcohol.) The study’s author did a statistical exercise, where they assumed that the British group had exactly the same lifestyle risk factors as their American counterparts. The result? Nothing much changes. Americans were still far sicker than the British.

Krugman argues that this is evidence of how much more stressful living in America is than living in England. I think that's absolutely right. I would simply add that it is one more nail in the coffin of the notion that good health is something that can be purchased through fancy, high-tech drugs and doctors and hospitals,.I know the idea that health care is just another consumer good is pretty popular at the moment. But its very hard to read the JAMA study, see what our $5274 actually buys us--and still believe in that notion. Our health is in reality a function of the broader society in which we live--the pressures and conditions and environments in which we find ourselves. The next time we have a debate about, say, how much to tax the rich, or how to structure old age pensions, it would be nice if someone in Washington had the courage to make this point.