Not surprisingly, prosperous and educated people in both Britain and the U.S. are considerably healthier than the poor.
But the study concluded that "differences in socioeconomic groups between the two countries were so great that those in the top education and income level in the U.S. had similar rates of diabetes and heart disease as those in the bottom education and income level in England," according to a JAMA press release. The study also accounted for lifestyle differences.
The Americans tended to be overweight and the Brits too fond of alcohol, the researchers say. But the study concluded that they did not cause the disparity in overall health.
"I'm arguing that it's due to the differences in the circumstances in which people live," Michael Marmot told the New York Times.
"Work, job insecurity, the nature of communities, residential communities, et cetera—I think that's the place we should try to look."
Johns Hopkins University's Starfield suggests another explanation.
"In the U.S. we have a very specialty-oriented health system, and many studies have shown that, in general, countries [such as Britain] with stronger primary care and less emphasis on specialists do better," she said.
John Abramson, a clinical instructor at Harvard Medical School and the author of Overdosed America, believes that the United States' doctors need to examine their sources of information. "Id say that the information that comes to doctors, even in their best journals, is not focused on [what] will best improve health outcomes," Abramson said.
"Far too often that information is coming directly or indirectly from commercial sources [such as pharamceutical companies], and their primary goal is meeting their [financial] responsibilities to their investors," he said. Abramson cites the example of heart disease, an ailment for which the U.S. has a more than 50 percent higher incidence than the U.K. This is despite the fact that Americans are twice as likely to use cholesterol-reducing drugs, or statins, and receive three times as many cardiac surgeries or angioplasties, according to Abramson.
"What it points to is that the real way to prevent heart disease is to exercise routinely, eat a Mediterranean-style diet, dont smoke, drink in moderation, and reduce chronic stress, he explained.
For some people, the sixth thing would be to take a statin to reduce their risk of heart disease, he said.
"But because most of the information that comes to doctors and patients about reducing the risk of heart disease is coming directly or indirectly from the drug companies, whats happening is most of our attention on preventing heart disease is focused on lowering cholesterol [often with statins] instead of the lifestyle interventions that are each more effective."
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