Brits Healthier Than Americans, Study Says

Brian Handwerk
for National Geographic News

Updated May 4, 2006

Health-conscious Americans may want to reach for a plate of fish and chips or a pint of ale after digesting the results of a new study.

Older British citizens are far healthier than their U.S. counterparts—even though twice as much is spent on health care per person in the United States annually. That's according to a study published today in the Journal of the American Medical Association.

(Related story: "British Have Changed Little Since Ice Age, Gene Study Says.")

The study's authors are unable to explain the heath gap.

"Everybody should be discussing it: Why isn't the richest country in the world the healthiest country in the world?" co-author Michael Marmot asked in an interview with the Associated Press. Marmot is an epidemiologist at University College London.

Marmot and colleagues found that middle-aged to older Americans were twice as likely to have diabetes and 10 percent more likely to be afflicted by hypertension than their British counterparts. Americans also displayed higher rates of heart disease, heart attack, stroke, lung disease, and cancer.

Experts have known for years that the U.S. lags behind other developed countries in some key health indicators.

The World Health Organization examined the 23 countries that spent the most money per capita on health care in 2001. While the U.S. outspent everyone, only the Czech Republic had a lower "healthy life expectancy"—that is, total average life expectancy minus the average number of years of illness.

But this new study reveals that even those Americans receiving the nation's best care fall short of British health standards. (See Britain maps and facts.)

Wealth, Education Not Factors

Marmot's team compared whites aged 55 to 64. The researchers did not examine minorities, who tend to have poorer overall health, but did survey people of varied income and education levels.

"This is the first time, to my knowledge, that anyone has shown this is true even for upper-income people—which means that it's not money that makes the difference," said Barbara Starfield, University Distinguished Professor at Johns Hopkins University in Baltimore, Maryland. Starfield is not affiliated with the new study.

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."

Free Email News Updates
Sign up for our Inside National Geographic newsletter. Every two weeks we'll send you our top stories and pictures (see sample).