Short and sweet

August 16, 2007

Economists like to say that the United States is the richest country in the world, and Americans like to believe it. But how is wealth measured? If you look at the well-being of the American population, you begin to see how things are coming up short this side of the Atlantic -- and the Pacific.

The United States now ranks 42nd in the world in life expectancy. Twenty years ago it was 11th. It has been surpassed by most of the countries of Europe, by Japan, by Guam, by Jordan. This is a serious and troubling outcome, especially considering that the United States spends more on health care than any other nation.

Some say the deterioration has to do with access to health insurance. Others think it's because of Americans' unhealthful habits, beginning with what they eat. Both are probably right.

Of course there are skeptics, some of whom point out that the murder rate is far higher here than elsewhere -- but that's not a determining factor, nor is it a very reassuring argument. Life expectancy for white Americans is closer to the European norm -- but this is a fairly powerful sign of the ways in which inequality in the United States is growing. Infant mortality is much higher here, as well -- higher than in Cuba, among many other places -- and, yes, this drags the U.S. averages down, but it's also a direct indictment of American health care.

This slippage is not surprising, because for decades the United States has also been falling behind in the height rankings. Americans were at the top in the years after World War II, but the Japanese have caught up with us, and the Dutch, Norwegians and Belgians have long since outstripped us. Public health researchers agree that height is, more than anything else, a reflection of childhood care and nutrition. American society doesn't treat its children as well as European societies do, and Americans are shorter as a result.

Unhealthful food, an unhealthful environment, a lack of physical activity, and a medical system that neglects the chronic complaints of the millions of uninsured and that forces nearly everyone else to navigate a nonsensical labyrinth of providers and insurers -- all this makes Americans what they are today.

Forty-second best.

And it's not as though no one knows how to address the problem. Most of the rest of the industrialized world has already done that.

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