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A Reportcard on the Health of Americans

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The amount of money the United States spends on healthcare is staggering, surpassing every other nation at a total of $2.2 trillion, or $7,421 per person per year. Despite this, the country lags behind others in terms of life expectancy, ranking twenty-third for men and twenty-fifth for women. Hong Kong's men top the charts at 79 years while Japanese women lead at 85.6 years. On the opposite end of the scale, the Russian Federation has the lowest life expectancy for both men and women.

Nevertheless, Americans are living longer. In 2007, life expectancy at birth reached a record high of 78.1 years, up from 75.4 years in 1975. It represents a 3.6-year increase for men and a 1.9-year increase for women. The gender gap in longevity has narrowed from 7 years in 1990 to 5.3 years in 2007, and the racial longevity gap has decreased from 7 years to 4.9 years.

Learn More

Learn more about the state of health in America with our PDF An Invitation to Health.

The US Centers for Disease Control and Prevention (CDC) has released the latest findings on Americans' health and health behaviors. The report shows that over the last 30 years, only one in three adults over 18 has increased their physical activity levels. Additionally, only a fifth of adults do strength-training exercises. The percentage of obese adults has more than doubled in the last 40 years, rising from 13 percent to 34 percent. Meanwhile, about 21 percent of adults currently smoke cigarettes, and more men smoke than women. One-fifth of all adults over 18 reported having five or more drinks on at least one day in the last year, and 9 percent reported five or more drinks on at least 12 days last year. Six percent of all adults over 12 used marijuana in the last month, and 3 percent reported nonmedical use of prescription drugs.

The report also delves into health conditions. The percentage of Americans who describe their health as fair or poor increases with age, from 6 percent of those between 18 and 44 to 28 percent of those older than 75. African Americans and Hispanics report poor health more than white Americans. Many conditions, including hypertension and high cholesterol, increase with age. While the incidence of vaccine-preventable diseases like measles has declined, the rate of infections such as Chlamydia has increased. Approximately 3 percent of adults report serious psychological distress, and those living in poverty have four times the rate of mental problems as others.

The CDC report also highlights the massive number of visits to doctors' offices, hospital emergency rooms, and outpatient care departments every year, reaching a total of 1.1 billion. More than eight in ten of the population visited a physician or hospital at least once. Roughly half of Americans received at least one drug prescription in the last month, and 20 percent received three or more. Yet, some 17 percent of people under age 65 did not have health insurance coverage at some point, including 10 percent of children under age 18. More than a third of Hispanics, American Indians, and Alaska Natives were uninsured at some time, compared with less than a fifth of those in other racial and ethnic groups.

Finally, the CDC report touches on mortality rates. Heart disease deaths have declined 38 percent overall since 1990, while cancer deaths are down 16 percent. Although mortality rates for African Americans have dropped, they remain significantly higher than those of whites, particularly for stroke, heart disease, diabetes, and HIV/AIDS. Homicide continues to be the leading cause of death for young African American men between the ages of 18 and 44.

The Healthy People Project

The federal Healthy People project has been setting science-based, 10-year national objectives for promoting health and preventing disease since 1979. The program's most recent initiative, Healthy People 2010, aimed to increase the quality and quantity of years of healthy life and to eliminate health disparities. As seen in the previous section, Americans live longer, but there is still much work to be done to meet specific focus area goals. For example, the percentage of obese Americans remains at 34 percent, more than twice the target goal of 15 percent.

Despite public education campaigns, only three in ten Americans exercise regularly, far below the target objective of 50 percent. Smoking rates also remain high, with 21 percent of Americans smoking rather than the targeted 12 percent. However, progress is being made on other fronts, and the lessons learned from Healthy People 2010 may help achieve greater success in meeting the objectives of Healthy People 2020.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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