Steven H. Woolf and Laudan Aron (eds.): U.S. Health in International Perspective: Shorter Lives, Poorer Health

the health and longevity of the uS population improved at an unprecedented pace over the past century.uS life expectancy at birth (both sexes combined) increased from 47.7 years in 1900 to 68.4 years in 1950 and 78.2 years in 2010.although the rise of nearly ten years in longevity between 1950 and 2010 was substantial, other countries have performed better and americans now live shorter lives and experience more illnesses and injuries than people in most other high-income countries.this is the case even though the uS is among the wealthiest nations in the world and spends more per capita on health care than any other country.a growing body of research is calling attention to these trends and searching for explanations.the national Research council (nRc), the research arm of the national academy of Sciences, has been in the forefront of this effort.in 2011 the nRc published a report entitled Explaining Divergent Levels of Longevity in High-Income Countries, which examined the determinants of mortality at older ages (crimmins, Preston, and cohen 2011-reviewed by Graziella caselli in PDR 37, no.4).among its key conclusions was that much of the difference between the uS and other countries can be attributed to relatively high uS levels of mortality from smoking and obesity.Given the importance of the topic, the nRc in 2011 appointed a second expert panel, chaired by Steven h. woolf, with an overlapping but expanded mandate: to examine not just mortality but also international levels and determinants of health and to study the young as well as the old. the present nRc report summarizes the findings of this follow-up effort.the evidence for a health disadvantage of the uS compared to 16 peer countries* is pervasive.in 2007 female life expectancy ranged from 86.0 years in Japan to 80.5 years in denmark, with the uS ranking next to last at 80.7 years.among male populations, Swiss males had the highest life expectancy (79.3 years) and uS males the lowest (75.6 years).this means that the uS has fallen decades behind its peers.the present report examines a range of international health indicators and documents a uS disadvantage in nine domains: 1) adverse birth outcomes (e.g., low birth weight, infant mortality), 2) injuries and homicides (e.g., motor vehicle deaths and murders), 3) adolescent pregnancy and sexually transmitted infections, 4) hiv and aidS, 5) drug-related mortality, 6) obesity and diabetes, 7) heart disease, 8) chronic lung disease, and 9) disability (e.g., arthritis and other activity limitations).the first half of this list mostly affects the young.while only a relatively small proportion of all deaths occur below age 50, such deaths account for a third of the difference in life expectancy between the uS and countries with the highest life expectancy.the