First published on ZNet on January 12, 2013. Ten years and three months ago, in a Senate speech in support of authorizing George W. Bush to invade Iraq if he wanted to, the right-wing U.S. Senator Kay Bailey Hutchinson (R-Texas) proclaimed the United States of America “the beacon to the world of the way life should be.” Her statement expressed more brazenly than usual a widespread, doctrinally shared sentiment in the homilies of the nation’s political class: the “exceptional,” God-blessed USA is the best country in the world, the homeland and headquarters of freedom, prosperity, and good living.
Here is a question for Hutchinson and the rest of her American-exceptionalist ilk: is life at its best supposed to be long and healthy or short and illness- and injury-ridden?
I pose this query in the wake of the release last week of an authoritative study by some of the nation’s leading medical and public health experts. Commissioned by the National Institute of Health, the federal government’s top medical research agency, and carried out by experts appointed by the National Research Council (NRC) and the Institute of Medicine (IOM), two units of the prestigious National Academy of Science, the report provides the first comparative analysis of the burden imposed by multiple diseases and injuries in the United States and 16 other “affluent democracies: 13 Western European countries plus Australia, Canada and Japan.
The study’s findings are not well matched to the standard national narcissism of U.S. political discourse. On average, the NRC-IOM report shows, Americans experience higher rates of disease and injury and die sooner – yes, die sooner – than people in other high-income countries. The findings hold for “all ages between birth and 75” and even, the researchers found, “for…well-off Americans who mistakenly think that top-tier medical care ensures that they will remain in good health.”
The NRC and IOM panel was “struck by the gravity of its findings. For many years,” the panel noted, “Americans have been dying at younger ages than people in almost all other high income countries. This disadvantage has been getting worse for three decades, especially among women. Not only are their lives shorter, but Americans also have a longstanding pattern of poorer health that is strikingly consistent and pervasive over the life course—at birth, during childhood and adolescence, for young and middle-aged adults, and for older adults.”
“For decades,” panel chairman Dr. Steven Woolf notes, “we [the United States] have been slipping behind.”
How badly does the U.S. compare with its global peers? For male lifespan, the U.S. is dead last – 17 of 17. For female lifespan it is next to last.
The American disadvantage is especially pronounced in nine key health areas: infant mortality and low birth weight, injuries and homicides, adolescent pregnancy and sexually transmitted infections, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease, and disability, “Many of these conditions,” the panel notes, depressingly enough, “have a particularly profound effect on young people, reducing the odds that Americans will live to age 50. And for those who reach age 50, these conditions contribute to poorer health and greater illness later in life.
What’s it all about? The NRC-IOM panel finds five factors behind the exceptionally bad (within the “advanced” rich nations) health experience of the United States’ population:
“Health systems. Unlike its peer countries, the United States has a relatively large uninsured population and more limited access to primary care. Americans are more likely to find their health care inaccessible or unaffordable and to report lapses in the quality and safety of care outside of hospitals.
“Health behaviors. Although Americans are currently less likely to smoke and may drink alcohol less heavily than people in peer countries, they consume the most calories per person, have higher rates of drug abuse, are less likely to use seat belts, are involved in more traffic accidents that involve alcohol, and are more likely to use firearms in acts of violence.
“Social and economic conditions. Although the income of Americans is higher on average than in other countries, the United States also has higher levels of poverty (especially child poverty) and income inequality and lower rates of social mobility. Other countries are outpacing the United States in the education of young people, which also affects health. And Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages.
“Physical environments. U.S. communities and the built environment are more likely than those in peer countries to be designed around automobiles, and this may discourage physical activity and contribute to obesity.”
All of these causes are highly important, of course, but if one is looking for a historical key as to why the U.S. has been “slipping behind the rest” of the advanced nations specifically over “the last three decades,” then inequality would appear to be the biggest contributing factor. The comparative deterioration noted by the NRC and IOM panel is matched precisely to the rise of America’s Second Gilded Age – the United States’ distinctive and pronounced shift to remarkable socioeconomic inequality and plutocracy during the long “neoliberal” era from the late 1970s through the ongoing Age of Obama. Along with rampant, savage disparity – so great now that the richest 400 Americans now possess a greater net worth than the bottom 50 percent of Americans – comes rampant, health-wrecking stress and insecurity for untold tens of millions of everyday Americans, including many that might seem comfortably placed but who are in fact vulnerable to stunning downward mobility and even destitution in a nation that combines epic taxpayer bailouts and subsidies for its very wealthy Few with the weakest social safety net in the “advanced” world.
Do not look for the NRC-IOM findings to receive much if any attention in avowed American exceptionalist Barack Obama’s forthcoming Second Inaugural and State of the Union Addresses. The depressing facts do not fit well with the president’s longstanding and persistently cozy relationship with the nation’s economic super-elite (notwithstanding many Wall Street financiers’ defection to Romney in 2012), with his repeated references across his national political career to the United States’ so-called “free market” system as “our greatest asset” and the source of “the greatest prosperity the world has ever seen,” with his neoliberal commitment to “deficit reduction,” with his repeated campaign boasts about cutting federal domestic discretionary spending to its lowest level since the Eisenhower years (consistent with his recent reference to his domestic policies as consistent with those advanced by “liberal Republicans” in past years), or with the limited and conservative nature of his anti-public health care reform, aptly described by the progressive journalist and author Matt Taibbi as “a massive giveaway to private, profit-making corporations.”
For what its worth, Obama has never been terribly interested in how the U.S. stacks up against its true global peers when it came to public and social health. The president’s bestselling campaign book The Audacity of Hope waxed eloquent on “just how good” even “our poor…have it” compared to more truly miserable counterparts in Africa and Latin America. Obama revealingly ignored considerably less favorable contrasts with Western Europe, Canada, Australia, and Japan, the most relevant comparisons, where dominant norms and social policies created considerable slighter levels of poverty and inequality (and longer and healthier lives, we might add, in light of the NRC and IOM’s report) than what is found in the militantly hierarchical U.S. Given his desire to raise money and win approval from the top 1 percent that owned more than half the United States’ financial wealth, it made sense that he preferred to compare the U.S. poor with the desperately impoverished masses of Nairobi, Jakarta and Bogota than with the relatively well-off lower classes of Oslo, Paris and Toronto.
In the summer of 1966, by contrast, Obma’s supposed role model Dr. Martin Luther King, Jr., was most struck by the greater poverty that existed in the U.S compared to its real global peers: other First World states. “Maybe something is wrong with our economic system,” King told an interviewer and observing that (in historian David Garrow’s words) “in democratic socialist societies such as Sweden there was no poverty, no unemployment and no slums.”
A generation later and for some time now, it is clear that Swedes and other Europeans, along with Australians, Canadians, and Japanese, experience not just less poverty but also and by no mere coincidence longer and healthier lives than do residents of “the beacon to the world of the way life should be.” That’s something for America’s purportedly patriotic politicians, plutocrats, presidents, and pundits to put in their exceptionalist pipes to puff on.
Paul Street (email@example.com) is the author of many books and essays. His next book They Rule: The 1%’s War on Democracy and the Future – and What We Can Do About it Before it’s Too Late will be published next summer if his health holds out.
1. England, France, Germany, Italy, Spain, Netherlands, Sweden, Denmark, Norway, Austria, Portugal, Switzerland, Finland.