A recent paper just appeared on the American Journal of Epidemiology makes the case for England being “healthier”, or scoring better for many health parameters, than US.(Martinson et al, 2011) The study performed by researchers at the Office of Population Research, Princeton US, systematically compared health indicators in the United States and England from childhood through old age. Results showed that individuals in the United States have higher rates of most chronic diseases and markers of disease than their counterparts across the Atlantic. The study also shows that differences at young ages are as large as those at older ages for most conditions, including obesity, diabetes, asthma, heart attack or angina. Similar patterns were observed when the sample was restricted to whites, the insured, nonobese, nonsmoking nondrinkers, and specific income categories, and also when stratified by normal weight, overweight, and obese weight categories.
In another recent paper, Desai and coauthors apply the metaphor by George Bernard Shaw to the context of health care, when they define the UK and the US as “Two countries divided by a common language” (Desai et al, 2010). Cancer care costs money, and deciding how to allocate resources to treat cancer is inevitably a moral as well as a political act. As the rationing of oncologic care is necessary, it is important to reflect on the decision making process about the allocation of resources, ie to address the questions “Who decides? And on what basis?”. As outlined in the review by Desaid and coauthors, the US and British systems of healthcare both have strengths and weaknesses in relation to cancer care. While the USA achieves better outcomes than the UK among older people with cancer, outcomes among young people with chronic diseases are much worse in the USA than the UK, and the racial differences in outcome for cancer and other chronic diseases in the USA are very wide. Also, the USA spends three times as much per person on healthcare than does the UK, and even allowing for the higher transaction costs arising from multiple payers, the absence of pharmaceutical cost controls and the higher cost of malpractice insurance, the USA should be expected to achieve much better outcomes from treatable conditions than the UK, but it does not. The findings by Desai for cancer are in line with those by Martinson for other health parameters. The review by Desai and coauthors suggests two policy recommendations: a) for the UK: rather than seeking to preserve current levels of expenditure on the NHS, there is an argument for increasing them further; b) for the US: many commentators have condemned the healthcare reforms in the USA for creating something that might resemble the British NHS, but it is precisely those elements of the American health system that most resemble the NHS which seem to achieve the best results.
As reported by Michelle Roberts for BBC news, it is not clear from the study by Martinson why health status differs so dramatically between the US and England. According to the researchers, the difference is an “unresolved puzzle” for two countries which share much in terms of “history and culture”. But do they, really? I would not be so sure. What do you think? Please cast your views!
Desai M, Rachet B, Coleman MP, Two countries divided by a common language: health systems in the UK and USA. J R Soc Med. 2010 Jul;103(7):283-7
Martinson ML, Teitler JO, and Reichman NE. Health Across the Life Span in the United States and England Am. J. Epidemiol. 2011 doi:10.1093/aje/kwq325
Roberts, M. England ‘healthier than the US’, BBC news, March 9, 2011