Chicago The English are known by several stereotypes that suggest poor health, including pallid complexions, bad teeth, terrible food and an affinity for pubs.
Well, so much for stereotypes.
Startling new research shows that white, middle-aged Americans - even those who are rich - are far less healthy than their peers in England, a finding that flummoxed some experts.
Americans had higher rates of diabetes, heart disease, strokes, lung disease and cancer, findings that held true no matter what income or education level. And that's despite the fact that U.S. health care spending is double what England spends on each of its citizens. "Everybody should be discussing it: Why isn't the richest country in the world the healthiest country in the world?" asks study co-author Dr. Michael Marmot, an epidemiologist at University College London in England.
The study, based on government statistics in both countries, adds context to the already-known fact that the United States spends more on health care than any other industrialized nation, yet trails in rankings of life expectancy.
The United States spends about $5,200 a person on health care while England spends about half that in adjusted dollars.
Reasons are unclear
Even experts familiar with the weaknesses in the U.S. health system seemed stunned by the study's conclusions.
"I knew we were less healthy, but I didn't know the magnitude of the disparities," said Gerard Anderson, an expert in chronic disease and international health at Johns Hopkins University who had no role in the research.
Just why the United States fared so miserably wasn't clear. Answers ranging from too little exercise to too little money and too much stress were offered.
Even the U.S. obesity epidemic couldn't solve the mystery. The researchers crunched numbers to create a hypothetical statistical world in which the English had American lifestyle risk factors, including being as fat as Americans. In that model, Americans were still sicker.
Smoking rates are about the same on both sides of the pond. The English have a higher rate of heavy drinking.
Only non-Hispanic whites were included in the study to eliminate the influence of racial disparities. The researchers looked only at people ages 55 through 64, and the average age of the samples was the same.
Higher disease rates
Americans reported twice the rate of diabetes compared to the English, 12.5 percent versus 6 percent. For high blood pressure, it was 42 percent for Americans versus 34 percent for the English; cancer showed up in 9.5 percent of Americans compared to 5.5 percent of the English.
The upper crust in both countries was healthier than middle-class and low-income people in the same country. But richer Americans' health status resembled the health of the low-income English.
"It's something of a mystery," said Richard Suzman of the U.S. National Institutes of Health, which helped fund the study.
Health experts have known the U.S. population is less healthy than that of other industrialized nations, according to several important measurements, including life expectancy. The U.S. ranks behind about two dozen other countries, according to the World Health Organization.
Some have believed the United States has lagged because it is more ethnically diverse, said Suzman, who heads the National Institute on Aging's Behavioral and Social Research Program. "Minority health in general is worse than white health," he said.
But the new study showed that when minorities are removed from the equation, and adjustments are made to control for education and income, white people in England are still healthier than white people in the United States.
"As far as I know, this is the first study showing this," said Suzman. The study, supported by grants from government agencies in both countries, was published in Wednesday's Journal of the American Medical Association.
Other studies have measured the United States against other countries in terms of health care spending, use of medical care and availability of health care services. But this is the first to focus on prevalence of chronic conditions, said Anderson, the Johns Hopkins professor.
Exercise, financial insecurity
Differences in exercise might partly explain the gap, he suggested. One of the study's authors, Jim Smith, said the English exercise somewhat more than Americans. But physical activity differences won't fully explain the study's results, he added.
Marmot offered a different explanation for the gap: Americans' financial insecurity. Improvements in household income have eluded all but the top fifth of Americans since the mid-1970s. Meanwhile, the English saw their incomes improve, he said.
Robert Blendon, a professor of health policy at the Harvard School of Public Health who was not involved in the study, said the stress of striving for the American dream may account for Americans' lousy health.
"The opportunity to go both up and down the socioeconomic scale in America may create stress," Blendon said. Americans don't have a reliable government safety net like the English enjoy, Blendon said.
However, England's universal health-care system shouldn't get credit for better health, Marmot and Blendon agreed.
Both said it might explain better health for low-income citizens, but can't account for better health of England's more affluent residents.
Marmot cautioned against looking for explanations in the two countries' health-care systems.
"It's not just how we treat people when they get ill, but why they get ill in the first place," Marmot said.