Why Americans live sicker and die earlier than people in rich counties

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Why Americans live sicker and die earlier than people in rich counties

Well: What We Need to Talk About When We Talk About Health by Sandro Galea, Oxford University Press, US $24.95, Pp 304, May 2019, ISBN 978-0190916831

Most Americans at least instinctively know that something is wrong with the American health system even if they don’t know where the problem is. The health and medical statistics also show that there is a lot of room for improvements in America’s health system. The statistics tell us that the American health system is worse than that of any other rich county. Child mortality in the United States is about 7 per 1,000, in Finland, it’s 2 per 1,000. The life in expectancy in America is about 79 years while it is 84 years in Japan. This is in spite of the fact that the Americans spend twice as much as Japan does on health per capita. In Well, Sandro Galea shows that this has not been always like that. Sandro Galea argues that this is not because Americans care less about health than do people in other rich countries. The United States spent $3.3 billion in 2016 on health. Much of Americans’ health expenditures go toward doctors and medicines. The inefficiency of this approach shines a light on how Americans historically conflate the concept of health with the practice of medicine and how our national health conversation is dominated by a belief that treating illness is somehow easier or better than preventing that illness in the first place.

Sandro Galea argues that American health is not defined by things like seeing doctors or taking medicines or getting in our 5,000 steps a day. He writes, “Rather, it is defined by the full spectrum of our life circumstances, from the families we come from to the neighborhoods where we live to the people we see and the choices we make. And unless we understand those forces, our health is never going to improve.” He goes on to argue that all this happens because we think about health in the wrong way. We think that improving health is an individual enterprise focused on the individual. We think that lifestyle will amount to living longer as long as we can afford all the medicines we need to keep going. But study after study shows that our country’s health output per dollar is worse than any of our peer counties, and study after study also shows that efforts to change our lifestyle generally fall short just a few months after we make these efforts. This means that we have been spending our money on ineffectual, finger-wagging efforts to modify behaviors, then later on medicine to help us after we get sick. Based on the evidence, that appears to be the wrong approach.

Well is about the forces around us that shape health, most of which we do not think about. Sandro Galea says that these forces are typically not in the health discussion — but should be. In other words, Well is about factors that have to align with the goal of creating the healthiest possible people if we are to reap the benefits of our investment in health. He says that the forces around us are what throws us in the river. They are our past, money, power, love and hate, compassion, the choices we make, luck, fairness and justice, and our values.

Well is an important addition to the existing literature on public health in the United States. Well is packed with heartfelt and passionate arguments. Sandro Galea successfully shows that non-medical forces are negatively affecting Americans’ health although Americans spend more money on doctors and medicines than any other rich county. Well is an indictment of America’s public health system. Sandro Galea gives a revolutionary perspective on the state of public health in the United States and tells us how it can be fixed. Sandro Galea is a powerful voice in American public health debate. Every American particularly policy-makers must read Well.

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