Academic Articles International Health Care Systems

Sick optimistic Americans vs. healthy pessimistic English

A recent NBER working paper by Banks, Marmot, Oldfield and Smith looks at the health outcomes and Socio-Economic Status (SES) of white males between the ages of 55 and 64 in the U.S. and in England. The authors use data from the American Health and Retirement Study (HRS), Assets and Health Dynamics of the Oldest Old (AHEAD), the National Health and Nutrition Examination Survey (NHANES), the Children of the Depression Age (CODA) and the War-Babies Cohort. In the UK, the data used are the English Longitudinal Survey of Aging (ELSA)–which is similar to the HRS–and the Health Survey for England (HSE).

The authors find the following conclusions:

  1. SES is highly correlated with disease incidence. This finding is robust to when SES is measured both by income and education categorizations.
  2. The English are healthier than the Americans when one looks at nearly all disease incidence rates.
  3. Despite the fact that Americans are less healthy than the British, self-reported health status is superior for Americans than the British. This is true in aggregate as well as when the researchers conditioned on actual health status.

Below are some statistics demonstrating the differences in disease incidence rates:

England U.S.
Diabetes 7.1% 14.4%
Hypertension 34.4% 46.8%
All Heart Disease 12.6% 17.9%
Heart Attack 6.3% 8.0%
Stroke 3.0% 4.0%
Lung Disease 5.8% 6.8%
Cancer 3.6% 7.3%

The prevalence of important risk factors in the U.S. and England are similar. Smoking rates in both countries are about 20%. Heavy drinking is more common in England, but obesity is more prevalent in the U.S.

One problem with the study is that it assumes that mortality rates for each disease are similar across countries. If the U.S. was able to keep alive more individuals with serious diseases, while the same people would be less likely to survive in England, this phenomenon could explain the results shown above. However, the health outcome differentials are so large that this one issue is unlikely to explain the entire difference between the two countries.

It has been widely noted that the U.S. spends a higher percentage of its GDP than any other country in the world, yet does not have superior health outcomes compared to other OECD countries. According to Reinhardt, et al. (Health Affairs 2004), in 2001 the U.S. spent 13.9% of GDP on medical care while the UK spent only 7.6% of GDP.

Banks; Marmot; Oldfield; Smith (2006) “The SES health gradient on both sides of the Atlantic” NBER Working Paper No. 12674.

Reinhardt; Hussey; Anderson; (2004) “U.S. health care spending in an international contextHealth Affairs, vol 23(3) pp. 10-25.