Is US Healthcare Really Fairing That Well?

The COVID-19 pandemic has highlighted many painful realities. Many we’ve known about, such as lack of preparedness for emerging infectious diseases, and some we’ve been frankly struggling with effectively combatting, such as systemic racism and health inequalities that challenge care. Prior to COVID-19 and well after, we will still be struggling with these issues and in a landscape of a somewhat broken approach to health.

Healthcare and public health in the United States are inherently complex and frankly, not something that guarantees successful outcomes. There is an assumption though, that Americans, as a result of our expenditures in health, have better health outcomes. From longer lives to less chronic illness, how much better are the health outcomes of Americans? Moreover, what about those of privileged US citizens when we compare them to those health outcomes of average residents in other developed countries?

A team of researchers wanted to address this very question. Were the health outcomes of White US citizens living within the 1% and 5% wealthiest counties that much better than those average citizens in other developed countries? In fact, the results were what you might expect.

The authors employed a comparative effectiveness study between January 2013 and December 2015, reviewing 32 White US citizens living in 1% of the highest-income counties, and 157 living in the 5% highest income countries. Individuals were assessed for several health outcomes that were indicative of healthcare intervention capacity, such as infant and maternal mortality, colon and breast cancer, childhood acute lymphocytic leukemia, and acute myocardial infarction. Data was then compared to residents in twelve other developed countries, such as Australia, Canada, France, the Netherlands, etc.

The investigators found that infant mortality was higher in both of the highest income counties when compared to those twelve comparison countries. Moreover, the authors noted that “the 5-year survival rate for White US citizens in the 5% highest-income counties was 67.2% (95% CI, 66.7%-67.7%) for colon cancer, higher than that of average US citizens (64.9% [95% CI, 64.7%-65.1%]) and average citizens in 6 countries, comparable with that of average citizens in 4 countries, and lower than that of average citizens for 2 countries.

The 5-year survival rate for breast cancer among White US women in the 5% highest-income US counties was 92.0% (95% CI, 91.6%-92.4%), higher than in all 12 comparison countries.” When assessing the five-year survival rate for White children with acute lymphocytic leukemia, they found that it was 92.6% for those in the 5% highest income counties was mostly comparable and only exceeded one other country.

Ultimately, the authors noted that “privileged White US citizens have better health outcomes than average US citizens for 6 health outcomes but often fare worse than the mean measure of health outcomes of 12 other developed countries. These findings imply that even if all US citizens experienced the same health outcomes enjoyed by privileged White US citizens, US health indicators would still lag behind those in many other countries.”

For a country that spends more than $3.5 trillion a year on healthcare, this study emphasizes that those White US citizens living in wealthier counties will have better health outcomes, but when compared to other developed countries, the truth is that America struggles. More and more this emphasizes that health equity is a serious issue within the United States but that even those with access to the most privileged forms of healthcare are not that well off health-wise when we look abroad to those countries who prioritize health a bit differently.