Advantage: The Brits

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By Abigail Trafford
Tuesday, June 6, 2006

"People in London walk more," says a friend who just returned from England. But that doesn't explain the recent report that white, middle-aged Americans are sicker than their British counterparts.

"The U.S. population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease and cancer," conclude the researchers in a study published in the Journal of the American Medical Association.

How could this be? The British diet is terrible -- greasy fish and chips, globs of shepherd's pie (mashed potatoes piled on gray, ground-up meat), Yorkshire pudding (cream, eggs, flour and fat drippings). Forget vitamin D: The English rarely see the sun in a dank climate where the national dress is a raincoat. No wonder they drink more than we do! In this study of men and women aged 55 to 64, nearly 30 percent of the Brits were classified as heavy drinkers, compared with about 14 percent of Americans. Rates of smoking were about the same. So were rates of being overweight. But we were more obese: more than 30 percent of us, compared with about 23 percent of them.

Still, the obesity differential can't fully explain the transatlantic health gap. Besides, we should gain some health benefit because we drink less. Maybe the explanation is cultural: The British are stiff upper lip about illness; we tend to feel our pain, so we're more apt to detect disease?

Whatever our cultural differences, this study found that we had nearly twice the rate of diabetes. And the English even came out ahead on biological markers of risk. For example, they had more good cholesterol! They also had lower levels of C-reactive protein, considered a risk factor for heart disease and stroke. This marker has also been linked to psychosocial factors such as anger, depression and hostility.

Maybe that's it --the hostility factor! Britain is no longer the world's leading hostile empire. The broad swath of its population can relax and wallow in nostalgia. Theirs is a stress-free agenda of cricket, tourism and gossip about the Royals, while we're now occupying the imperial hot seat. National stress and anxiety are the fallout of global power and responsibility. We are infected with worry and fear -- of course we are angry and depressed with the world. But I'm suspicious: The British also live in a high-risk world, with terrorist bombings and troops in Iraq.

Maybe there is a simpler explanation -- Britain's national health program, which provides medical care to all people, rich or poor, young and old. After all, more than 40 million Americans lack health coverage.

But the study's authors caution against turning the health gap into an insurance problem. "Although access to health care is important," they point out, it cannot be the "central reason for the better health outcomes in England."

Perhaps the answer is that Americans are just too diverse while the British are more homogeneous. No, not in this case. To make the populations comparable, the new study was limited to whites in both countries.

And here's the final insult: We spend much more on medical care -- $5,274 per person in the United States, compared with $2,164 in the United Kingdom. You'd think that extra $3,000 would get us some advantage over our transatlantic cousins.

The international health gap is a puzzle with many pieces. Researchers have long made the link between health status and socioeconomic status. Poverty and lack of education are closely associated with poor health. What is most intriguing in this study is that while the U.S.-Britain health gap is more pronounced for those in the lowest tier, "high status Americans are also at a disadvantage," compared with their British peers, point out the authors. In other words, it seems that the rich and well-connected in the United States haven't been able to buy their way to good health.

How to explain this? British epidemiologist Richard Wilkinson suggests an answer may be found in the wide difference between the very rich and the very poor in the United States. The wider the gap between haves and have-nots, he argues, the poorer the health of the whole population, including those in the middle and upper tiers.

Both the U.S. and the U.K. have larger rich-poor gaps than many other countries, but Britain's is relatively smaller, which may explain why its middle-aged people are healthier than their American counterparts.

Wilkinson points out that in the United States, where life expectancy at birth is about 77, the top 10 percent earn 16 times as much as the poorest 10 percent. In the United Kingdom, where life expectancy is about a year longer, the top tier earns 14 times as much. But in Sweden and Norway, where the top 10 percent earn only six times as much as the poorest, life expectancy reaches about 80. In Japan, the richest earn 4.5 times as much, and life expectancy is 82.

The same pattern can be seen within the United States. Some states -- New Hampshire, Vermont, Wisconsin, Utah -- where income differences are smaller "have death rates as low as Britain," explains Wilkinson in an e-mail. Death rates are highest in states with the biggest income differences -- Louisiana, Mississippi, New York, Alabama, Kentucky.

Previous research has shown that people are more trusting of each other in more economically equal states. Participation in community life is greater, social supports are stronger and levels of violence are lower. "The higher violence and lower trust all suggest that social relations are poorer in more unequal societies," continues Wilkinson, author of "The Impact of Inequality: How to Make Sick Societies Healthier" (The New Press).

Could it be that our more unequal and fractured society is making us sick? The link between population health and inequality remains controversial. But it's a clue that closing the transatlantic health gap is not just about our bodies -- it's also about ourselves. ยท

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