Americans like to think their health care is the best in the world. But it isn’t, according to a study published in today’s issue of the Journal of the American Medical Association. From diabetes to heart disease to cancer, middle-age white Americans are significantly less healthy than their British counterparts. U.S. rates of diabetes, for example, are twice as high as the British.
The big question is why, especially since Americans spend about $5,200 per person each year on health care — more than twice as much as the British.
“It leaves us with something of a mystery,’’ said Richard Suzman, director of the behavioral and social research program at the National Institute on Aging, which helped fund the study.
The study still found health gaps even after accounting for the most obvious factors, such as smoking and obesity. Great Britain also has universal health care, but that didn’t seem to make the difference either, said James P. Smith, a co-author of the study and senior economist at the RAND Corp.
Some 94 percent of Americans in the study had health insurance, and the health gap persisted at different income levels. Even the health of the wealthiest, best-educated Americans was so poor that their rates of diabetes and heart disease were similar to the poorest, least-educated Britons.
About 15 percent of Americans reported having heart disease, compared to less than 10 percent of Britons; 9.5 percent of Americans said they had cancer, compared to 5.5 percent in Britain; more than 42 percent in the United States said they have high blood pressure, compared to less than 34 percent in Britain.
The results “shocked and stunned’’ the researchers, who set out to study differences in health between education and income level, rather than compare overall health. “We didn’t go in anticipating there would be big health differences,’’ Smith said. “We said, 'This can’t be right.’ ”
Maybe Americans are just more likely to report their illnesses than the famously stoic, “stiff upper lip’’ Brits, researchers thought. But when they looked at data on concrete measures, such as blood tests, the differences remained.
Not everyone was surprised.
“Americans eat too much,’’ said Sacha Bradley, floor manager at the Horse & Jockey British Pub in South Pasadena. “Their portions are bigger than English restaurant food.’’
Bradley, 33, moved to the United States 10 years ago. Here, she says, buying fresh produce and healthy groceries seems more expensive, while fast food and heaping restaurant servings are more convenient.
Even though researchers found the gap persisted regardless of weight, England is, in fact, a leaner country than the United States. Some kind of link is plausible, scientists said. The study measured only people’s current weight, not their past history.
In Great Britain, people are becoming more overweight, but the trend lags behind the United States. In Britain, the obesity rate rose from 7 to 23 percent between 1980 and 2003. In the United States, it increased from 15 to 31 percent.
“It may really matter whether you’ve been obese for 20 years or five years,’’ Smith said.
The study shows the need to stress healthy lifestyles and choices to American children, said Thomas Mason, epidemiology professor at the University of South Florida.
“The message is very simple: Start early,’’ Mason said. “You don’t want to wait until a person is in their 50s or 60s to argue, 'It’s time to change your lifestyle.’ ”
The study compared people in two large national health surveys: 4,386 Americans ages 55 to 64 and 3,681 Britons. Because there are greater health disparities among minorities, the comparison included only non-Hispanic whites. Researchers also analyzed two other studies that measured cholesterol, blood pressure and other markers. Because Americans get more screenings for cancer, that might influence why that rate is higher, researchers said.
But they said that couldn’t fully account for the difference.
The results likely say more about lifestyles and preventive care than the quality of health care if you’re sick, Suzman said. “The U.S. does better than the U.K. for treating some diseases, such as breast cancer.’’
The study didn’t compare exercise levels, because that data wasn’t in the original surveys. Researchers and local expatriates alike pointed to activity as a key difference.
“We walk more,’’ said Clearwater resident Tania Reed, owner of Britan’s Yogurt in Tampa. “Americans always want to park in the closest spot. You don’t see as many people on bicycles.’’
“Down here, you basically can’t get around without a car,’’ Mason said. “It’s a very different environment.’’ Then there’s stress.
“Americans work much harder than the English do,’’ Smith said. “And they work harder longer.’’
Americans celebrate Starbucks and take their caffeine to go. The English take a break for tea.
“My brother always says, 'In America, you’re always going, going, going,’ ’’ Reed said. “There, in the afternoon, it’s like, 'It’s 3:30, time to put the kettle on.’ ’’
And that’s another possibility, she said.