In recent years, I have asserted that both scandal and mismanagement by the Catholic hierarchy have led to the loss of influence for Catholic Social Teaching. Thus one of the great sources of public wisdom in our culture ends up getting ignored or even dismissed. But no matter how badly the custodians of this tradition perform their duties, we American Catholics ignore that wisdom at our peril.
Now comes evidence that ignoring the lessons of Catholic Social Teaching is costing people their lives. A recently released study by the National Research Council and the Institute of Medicine (U.S. Health in International Perspectives: Shorter Lives, Poorer Health ) attempts to determine why the U.S. ranks last in life expectancy among all wealthy nations. (see http://www.nap.edu/openbook.php?record_id=13497&page=1)
The Gospel of John makes it clear that Christian faith and a full life are closely linked, when Jesus says, “I came that they may have life, and have it abundantly.”Catholic Social Teaching includes “Health Care” (one key to a full life) on its list of human rights. As one commentator explained: “Human fulfillment requires health, work, education, access, leisure, resources, security and many other things, which we define as human rights.”
But this massive study expands the reality behind these principles. Part 1 begins with this basic fact:
The United States ranks at or near the bottom on multiple measures of mortality and morbidity, in all age groups up to age 75, in males and females alike, and in virtually all other subgroups of the population.
Then Part 2 it asks why. And Part 3 explores ideas for changing our course.
Last week’s wide media coverage of the report focused on its account of firearms deaths--the most newsworthy item, of course, in the wake of the Newtown tragedy.
But this 424-page study is bigger than that. It is a landmark that offers for the first time a comprehensive answer to why Americans suffer a health disadvantage. For Catholics who believe good public health is a human right, this analysis touches not only on social justice, but on life and death.
The evidence shows that the U.S. health disadvantage is pervasive across people’s lifespan, gender, class, and even race: “Americans face shorter lives and greater illness at all ages.” In a word, we are sicker and we die sooner--even if we don’t know it.
The breadth of our health inferiority is stunning:
When compared with the average for other high-income countries, the United States fares worse in nine health domains: adverse birth outcomes; injuries, accidents, and homicides; adolescent pregnancy and sexually transmitted infections; HIV and AIDS; drug-related mortality; obesity and diabetes; heart disease; chronic lung disease; and disability.
Think a good medical care system is enough to guarantee “healthcare”? Think again! This pervasive disadvantage is determined by far more than our Medical Care System. The study outlines four more key areas that affect our health:
Life-styles and behaviors, social and economic circumstances, environmental influences, and public policies can also play key roles in shaping individual and community health. And a number of these factors may be critical to understanding why some high income countries experience significantly better health outcomes than the United States.
When all five are added up, the tally is bleak. This raises the question of whether our “American way of life” is killing us.
It is true that “ObamaCare” should expand the number of insured Americans, but its broad impact is to be determined.
As for personal behaviors, the study finds that 40% of all U.S. deaths are linked to tobacco, diet, inactivity, or drinking. I wonder: why are these behaviors more dangerous in the U.S. than elsewhere?
Certain important unhealthy or injurious behaviors are more common in the United States than peer countries, including high-caloric intake, drug misuse, unsafe driving practices, high-risk sex, and the use of firearms. Poverty, unemployment, and income inequality are more prevalent than in comparable countries, education has not kept pace with other countries, and social mobility is more limited.
On firearms, the data is appalling.
There is little evidence, the study says, that violent acts a more frequent here than elsewhere. Yet they cause more deaths. 48% of violent U.S. deaths (homicide, accidents, suicide) involve firearms. US citizens own 35 to 50% of all the civilian owned firearms in the world--four times as many semiautomatic and automatic weapons as the U.S. Army! Globally, 80% of the firearms deaths occur in the U.S. The U.S. homicide rate is 20 times higher than our peer countries, and 43 times higher for people aged 15-24. (Note: that’s not 20 % and 43% higher, it’s 2000% and 4300% higher).
The U.S. firearms suicide rate is 5.8 times higher than elsewhere and unintentional firearm deaths are 5.2 times higher. All these grim numbers produce a chilling conclusion:
The prevalence of firearms in the United States looms large as an explanation for higher death rates from violence, suicidal impulses, and accidental shootings.
As for social factors in the U.S. health inferiority, the study collected data on income and wealth, on education, on the occupation, and on racial and ethnic identity. Observing that, relative to other wealthy countries, the U.S. possesses a “weak social safety net,” the study finds that our decline in health and life expectancy since 1975 coincides with a 40-year decline in social conditions, and concludes we need to explain the connection:
Life expectancy and other health outcomes…in the United States began to lose pace with other high-income countries in the late 1970s, a trend that has continued to the present. During this same time…there has been a potentially important co-occurrence of worsening social conditions in the United States, notably a rise in income inequality, poverty, child poverty, single-parent households, divorce, and incarceration--all more pronounced than other rich nations.
These unsettling trends present a potentially important explanation for the U.S. Health disadvantage… An examination of these underlying causes can shed light on why the United States appears to be losing ground.
On policy, the study reviewed the nine key health factors from Part One and concluded that each factor has policy implications:
Policy is also relevant to the unfavorable social, economic, an environmental conditions identified of this report as potential contributors to the U.S. Health disadvantage. A variety of policies can contribute to high poverty rates, unemployment call-up, inadequate educational achievement, lost social mobility, and the absence of safety net programs to protect children and families from the consequences of these problems. However, identifying and implementing policy solutions is a formidable challenge.
This means that policy reform is key to longer life for Americans. Not just government policy, but also the policies of corporations and communities and nonprofit agencies and even churches. Those peer countries are ahead of us for a reason: they have instituted social systems aimed at the common good--aimed at a longer, healthier life for all their people. And they are succeeding:
In countries with the most favorable health outcomes, resource investments and infrastructure often reflect a strong societal commitment to the health and welfare of the entire population…Choices about political governance structures, and the social and economic conditions they reflect and shape, matter to overall levels of health.
The sad truth is that our health inferiority does not mean we have failed to achieve what they have achieved. Rather, the truth is this: we have not even tried! The study is clear about the consequences of doing nothing:
The consequences of not attending to the growing U.S. health disadvantage and reversing current trends are predictable: the United States will probably continue to fall further behind comparable countries on health outcomes and mortality. In addition to the personal toll this will take, the drain on life and health may ultimately affect the economy and the prosperity of the United States as other countries reap the benefits of healthier populations and more productive workforces. With so much at stake, especially for America’s youth, the United States cannot afford to ignore its growing health disadvantage.
We Catholics claim to serve life. We inherit a moral tradition that requires an option to promote the common good. We belong to an institution that believes we all have a human right to the best health and fullest life possible.
From this viewpoint, too many of us have allowed this basic right of ours to be violated by inaction at all levels. Worse than that: we haven’t even noticed it happening. As if we were victims of mass anesthesia, we have slept through the decline in our health and our lifespan, dreaming that all was well. This study sounds a loud alarm that offers no snoozing. It is time we wake up and face the nation that is allowing its people to die before their time--before our time.
© Bernard F. Swain PhD 2013
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