Pass the Bangers and Mash (The Hidden Krugman)

Paul Krugman comments on the story from earlier this week about a Journal of the American Medical Association study that found that "white, middle-aged Americans--even those who are rich--are far less healthy than their peers in England" (via the WaPo).

"I knew we were less healthy, but I didn't know the magnitude of the disparities," said Gerard Anderson, an expert in chronic disease and international health at Johns Hopkins University who had no role in the research.

Just why the United States fared so miserably wasn't clear. Answers ranging from too little exercise to too little money and too much stress were offered.

Even the U.S. obesity epidemic couldn't solve the mystery. The researchers crunched numbers to create a hypothetical statistical world in which the English had American lifestyle risk factors, including being as fat as Americans. In that model, Americans were still sicker.

And here's an interesting graphic from that story:



But back to Mr. Krugman's Friday column, Our Sick Society (fully available to Times Select subscribers):

The authors of the study compared the prevalence of such diseases as diabetes and hypertension in Americans 55 to 64 years old with the prevalence of the same diseases in a comparable group in England. Comparing us with the English isn't a choice designed to highlight American problems: Britain spends only about 40 percent as much per person on health care as the United States, and its health care system is generally considered inferior to those of neighboring countries, especially France. Moreover, England isn't noted either for healthy eating or for a healthy lifestyle.

Nonetheless, the study concludes that "Americans are much sicker than the English." For example, middle-age Americans are twice as likely to suffer from diabetes as their English counterparts. That's a striking finding in itself.

What's even more striking is that being American seems to damage your health regardless of your race and social class.

That's not to say that class is irrelevant. (The researchers excluded racial effects by restricting the study to non-Hispanic whites.) In fact, there's a strong correlation within each country between wealth and health. But Americans are so much sicker that the richest third of Americans is in worse health than the poorest third of the English.

So what's going on? Lack of health insurance is surely a factor in the poor health of lower-income Americans, who are often uninsured, while everyone in England receives health care from the government. But almost all upper-income Americans have insurance.

What about bad habits, which the study calls "behavioral risk factors"? The stereotypes are true: the English are much more likely to be heavy drinkers, and Americans much more likely to be obese. But a statistical analysis suggests that bad habits are only a fraction of the story.

In the end, the study's authors seem baffled by the poor health of even relatively well-off Americans. But let me suggest a couple of possible explanations.

One is that having health insurance doesn't ensure good health care. For example, a New York Times report on diabetes pointed out that insurance companies are generally unwilling to pay for care that might head off the disease, even though they are willing to pay for the extreme measures, like amputations, that become necessary when prevention fails. It's possible that Britain's National Health Service, in spite of its limited budget, actually provides better all-around medical care than our system because it takes a broader, longer-term view than private insurance companies.

The other possibility is that Americans work too hard and experience too much stress. Full-time American workers work, on average, about 46 weeks per year; full-time British, French and German workers work only 41 weeks a year. I've pointed out in the past that our workaholic economy is actually more destructive of the "family values" we claim to honor than the European economies in which regulations and union power have led to shorter working hours.

Time to get out to the garden on this beautifully sunny Seattle Friday... after I write a guide to buying backpacking tents... and writing up some descriptions on watches that wirelessly synchronize with atomic time...