I have recently spoken a lot with reporters in my capacity as chair of the National Research Council-Institute of Medicine panel, which in January released its recent report on the U.S. health disadvantage. The report, The U.S. Health Disadvantage in International Perspective: Shorter Lives, Poorer Health, delivered some stunning news: Americans at all ages up to age 75 have shorter life expectancy and greater rates of disease and injury than people in other high-income countries. The problem is pervasive, and the sheer gravity of the problem—claiming the lives of babies, adolescents, and older adults—has sparked palpable interest in the news media.

The report was covered in major U.S. newspapers, such as the New York Times, the Wall Street Journal, the Los Angeles Times, the Washington Post, U.S. News & World Report, USA Today, and The Atlantic, as well as by overseas newspapers like The Guardian (United Kingdom), Mobiles Republic (France), and Nyheder (Denmark). Wire services joined in, such as the Associated Press, Reuters, and Bloomberg News. The report was featured on CNN, NBC News, and National Public Radio’s All Things Considered, C-SPAN, and podcast interviews by the British Medical Journal and the Healthcare Policy Podcast.

Almost all reporters exhibited the same curiosity that consumed our panel. They asked me to explain what is responsible for the U.S. health disadvantage. My answer, as stated in our report, is that the problem is almost certainly multifactorial and involves some combination of problems in health care, individual behaviors, social factors, the physical and social environment, and the policies and values that shape those conditions.

The answer to our health problems points to the very issues that are the focus of our work at the VCU Center on Human Needs, especially our research on the social determinants of health.  The National Research Council-Institute of Medicine report showed that the U.S. is lagging behind other rich countries on many measures of social and economic wellbeing. We are the richest economy in the world, but we also have the highest levels of income inequality and child poverty among high-income countries. We pride ourselves on being a land of opportunity, but we also have one of the lowest levels of social mobility—the ability of poor people to climb the economic ladder and earn more than their parents. Our older adults are the best educated in the world, but we are slipping behind other high-income countries and some emerging economies in the education of young people.

The U.S. health disadvantage may require our nation to make different choices, but a major contributor may be place-based factors in our neighborhoods, such as residential segregation, inequities in the distribution of social and health-related assets, and the organization of our cities and transportation systems. Congressman Tip O’Neill famously said that “all politics is local,” and the same may be true for public health. Many of the solutions to the U.S. health disadvantage require decisions by communities, even neighborhoods, across America.

Steven H. Woolf, MD, MPH

Director, VCU Center on Human Needs