The State of US Health, 1990-2010

Abstract

The United States spends the most per capita on health care across all countries,^1,2 lacks universal health coverage, and lags behind other high-income countries for life expectancy³ and many other health outcome measures.⁴ High costs with mediocre population health outcomes at the national level are compounded by marked disparities across communities, socioeconomic groups, and race and ethnicity groups.^5,6 Although overall life expectancy has slowly risen, the increase has been slower than for many other high-income countries.³ In addition, in some US counties, life expectancy has decreased in the past 2 decades, particularly for women.^7,8 Decades of health policy and legislative initiatives have been directed at these challenges; a recent example is the Patient Protection and Affordable Care Act, which is intended to address issues of access, efficiency, and quality of care and to bring greater emphasis to population health outcomes.⁹ There have also been calls for initiatives to address determinants of poor health outside the health sector including enhanced tobacco control initiatives,^10-12 the food supply,^13-15 physical environment,^16,17 and socioeconomic inequalities.¹⁸