A few weeks ago we posted about this medical journal article, which found that Americans are significantly sicker than their British counterparts. Controlling for factors such as race and income, the study found, Americans have far higher levels of chronic illnesses such as diabetes, heart disease, hypertension, lung disease, and cancer.
Not so fast, says reporter Gina Kolata in yesterday’s New York Times. According to Kolata, Americans aren’t necessarily sicker; they’re just over-diagnosed. US medical culture, she claims, tends to look for illness that British doctors prefer to overlook. (Stiff upper lip and all that, I suppose.) And US doctors & patients are much more likely to go on medical “fishing expeditions,” searching for illnesses that pose little actual risk to people’s quality of life. She relates a telling (though possibly apocryphal) anecdote:
One day…a doctor-in-training was asked by his professor to define a well person. The resident thought for a moment. A well person, he said, is “someone who has not been completely worked up.”
Perhaps more to the point, Kolata points to life expectancy rates in the US and UK—which she calls “almost identical”—as a sign that Americans’ relative sickliness isn’t actually making them any sicker. Life expectancy tends to reflect the overall health of a population, so similar life expectancy should mean similar health.
Kolata raises some interesting points. But consider me unconvinced.
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Now, I do think that differences in diagnostic practice between the US and UK could be part of the story here. Take prostate cancer. Many men die with prostate cancer, rather than of it—that is, they have prostate cancer but it never spreads, and never really affects their health. Unlike the US, where prostate screening has become commonplace (at least for people with good health insurance), the UK rarely screens asymptomatic men for prostate cancer—which suggests that higher prostate cancer rates in the US are more a function of screening than the underlying incidence of cancer.
Ok, that’s prostate cancer; and the same thing may be true for some other medical conditions that the US tests for regularly, but the UK tests for only rarely.
But this doesn’t do anyting to explain differences in disease incidence—such as diabetes—that both US and UK doctors test for, or that are derived from sources other than self-reports. Higher incidence of diabetes, apparently, isn’t simply an artifact of diagnostic practice, or a propensity for American doctors to label their patients as “sick.” Same goes for strokes—which apparently are much more common in the US than the UK (see here for Malcolm Gladwell’s take on this).
Which brings me to a second point: the US and UK apparently may not be as close in their health records as Ms. Kolata claims. For example, according to the UN Human Development Report, UK citizens live about a year longer than their US counterparts, about twice the difference that Kolata cites.
Still, a one-year difference is pretty close. Among independent nations, the US ranks 28th among in life expectancy, and the UK 22nd. But as good an indicator as life expectancy may be, it fails to capture quality of life distinctions—in particular the amount of our lives that we spend in poor health. Based on WHO data (see, e.g., this spreadsheet), UK residents could expect about 2 extra years of healthy life than Americans as of 2001.
Maybe differences of that magnitude don’t matter much. But consider this: much of the nation’s medical spending can be attributed to the last few months of life, when doctors often make heroic efforts to keep people alive for just a little bit longer. Extending lifespans, sometimes by just a few months, seems to be a major economic cost—and a reflection of the high value we place on our own lives. The fact that the UK spends far less per capita on health care than the US, but still gets 2 extra years of healthy life, should give us all reason to think that America’s poor health isn’t simply an illusion created by an overmedicated culture, but a real (though largely unexplained) difference in the underlying health of the citizenry.