Body politic building
Jack Lalanne might still be able to tow a row of yachts across a lake, and 50ish Sly Stallone is definitely holding up his burly end of the deal, but the rest of us Yanks are not doing so hot. At least that's what a recent World Health Organization report indicates. The United States finished well behind most other industrialized nations in a WHO study of "healthy living."
"Basically, you die earlier and spend more time disabled if you're an American rather than a member of most other advanced countries."
Unlike studies of longevity that simply measure mortality rates, the WHO study uses a new indicator, the Disability Adjusted Life Expectancy (DALE). DALE summarizes the expected number of years to be lived in what might be termed the equivalent of "full health." The U.S. scored behind nations such as Japan, Canada, Britain, Germany, Sweden, and sweating-to-the-oldies powerhouses like San Marino. The clean-living, fish-eating Japanese have the longest healthy life expectancy of 74.5 years among 191 countries, versus less than 26 years for the lowest-ranking country—Sierra Leone.
The rest of the top 10 nations—with "scores" ranging from 73.2 years to 72.3—are Australia, France, Sweden, Spain, Italy, Greece, Switzerland, Monaco, and Andorra. Low scorers on the DALE scale included Uganda, Botswana, Zambia, Malawi, and Niger. None of these African nations—tormented by some combination of war, disease, and abject poverty—had a healthy life expectancy higher than 32.7 years. The U.S. finished 24th with 70, only slightly better than the dreaded evil island empire of Cuba—with 68.4—and less prosperous nations such as Dominica, Ireland, and Portugal.
WHO officials said they were somewhat perplexed by the poor showing of the Americans. After all, the U.S. spends more than twice as much per capita on health care than our industrialized brethren's average.
"The position of the United States is one of the major surprises of the new rating system," says Dr. Christopher Murray, director of WHO's Global Program on Evidence for Health Policy. "Basically, you die earlier and spend more time disabled if you're an American rather than a member of most other advanced countries."
WHO blames the low rank of the U.S. on a number of familiar cultural ills—high rates of smoking-related cancers and heart disease, high rates of violence and homicide, and the impact of HIV/AIDS on total life expectancy. They suggest one other cause, however, in the extremely high rates of poverty within specific U.S. communities—Native Americans, rural African Americans, and inner-city poor—who have "extremely poor health, more characteristic of a poor developing country rather than a rich industrialized one."
A lot of Americans may be surprised to discover the Third World thus appearing on the nation's collective doorstep, but students of globalization have long observed that the so-called developing world is less a geographic place than a cultural and class experience. The First and Third Worlds freely intermingle within societies around the world that allow stark inequities in wealth, privilege, and opportunity to persist.
In the U.S., those inequities become apparent in measures of income, health, and longevity. There are "demographics" within the U.S. that have a life expectancy not much better than some of the world's poorest nations.
It is a painful irony that during a time of historic prosperity, the capacity of Americans to articulate and support a vision of a common good that includes all the members of its society has perhaps never been weaker. Political analysts can talk about the effect of poverty on a community, sacrificing a perspective of U.S. society that sees only how poverty affects all Americans as one community.
As President Clinton is wont to say, "We can do better."
And who knows? Perhaps improving this domestic vision of a common good to include all our "local" brothers and sisters will make it easier to peer across our borders to see those other brothers and sisters struggling for a "healthy living" at that most unforgivably wretched end of the WHO survey.
Kevin Clarke is managing editor of online products at Claretian Publications in Chicago.All active news articles