We can do better―improving the health of the American people
Open accessAbstract
T he united states spends more on health care than any other nation in the world, yet it ranks poorly on nearly every measure of health status.How can this be?What explains this apparent paradox?The two-part answer is deceptively simple -first, the pathways to better health do not generally depend on better health care, and second, even in those instances in which health care is important, too many Americans do not receive it, receive it too late, or receive poor-quality care.In this lecture, I first summarize where the United States stands in international rankings of health status.Next, using the concept of determinants of premature death as a key measure of health status, I discuss pathways to improvement, emphasizing lessons learned from tobacco control and acknowledging the reality that better health (lower mortality and a higher level of functioning) cannot be achieved without paying greater attention to poor Americans.I conclude with speculations on why we have not focused on improving health in the United States and what it would take to make that happen. He a lth S tat us of the A mer ic a n Publ icAmong the 30 developed nations that make up the Organization for Economic Cooperation and Development (OECD), the United States ranks near the bottom on most standard measures of health status (Table 1).1-4 (One measure on which the United States does better is life expectancy from the age of 65 years, possibly reflecting the comprehensive health insurance provided for this segment of the population.)Among the 192 nations for which 2004 data are available, the United States ranks 46th in average life expectancy from birth and 42nd in infant mortality.5,6 It is remarkable how complacent the public and the medical profession are in their acceptance of these unfavorable comparisons, especially in light of how carefully we track health-systems measures, such as the size of the budget for the National Institutes of Health, trends in national spending on health, and the number of Americans who lack health insurance.One reason for the complacency may be the rationalization that the United States is more ethnically heterogeneous than the nations at the top of the rankings, such as Japan, Switzerland, and Iceland.It is true that within the United States there are large disparities in health status -by geographic area, race and ethnic group, and class.[7][8][9] But even when comparisons are limited to white Americans, our performance is dismal (Table 1).And even if the health status of white Americans matched that in the leading nations, it would still be incumbent on us to improve the health of the entire nation. Path wa ys t o Improv ing P opul at ion He a lthHealth is influenced by factors in five domains -genetics, social circumstances, environmental exposures, behavioral patterns, and health care (Fig. 1).10,11 When it
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Behavioral lifestyle choices are consistently reported to be the single greatest determinant of premature death, approximating all other health modulators combined.
“Behavioral lifestyle choices are consistently reported to be the single greatest determinant of premature death , approximating all other health modulators combined [161] .”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [161]
The paper says personal behavior offers the greatest opportunity to reduce premature deaths, and Figure 1 assigns behavioral patterns the largest single share, 40%. But the other four determinants total 60%, so the paper does not show behavioral patterns approximating all the others combined. The estimates concern premature death in the United States. (LLM, conf=0.88)
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Cites
Actual causes of death in the United States
McGinnis, J. M. (1993) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1993.03510180077038 · Cited by 5,480 · see citing works
Actual Causes of Death in the United States, 2000
Mokdad, A. H. (2004) · JAMA · doi:10.1001/jama.291.10.1238 · Cited by 5,211 · see citing works
Treating tobacco use and dependence-Clinical practice guideline
Mc, F. (2000) · Medical Entomology and Zoology · Cited by 3,616 · see citing works
Mortality in relation to smoking: 50 years' observations on male British doctors
Doll, R., Peto, R., Boreham, J., & Sutherland, I. (2004) · BMJ · doi:10.1136/bmj.38142.554479.ae · Cited by 2,920 · see citing works
Explaining the decrease in U.S. deaths from coronary disease, 1980–2000
Ford, E. S., Ajani, U. A., Croft, J. B., Critchley, J. A., Labarthe, D. R., Kottke, T. E., Giles, W. H., & Capewell, S. (2007) · New England Journal of Medicine · doi:10.1056/nejmsa053935 · Cited by 2,757 · see citing works
Smoking and Mental Illness: A Population-Based Prevalence Study
Lasser, K., Boyd, J. W., Woolhandler, S., Himmelstein, D. U., McCormick, D., & Bor, D. H. (2000) · JAMA · doi:10.1001/jama.284.20.2606 · Cited by 2,508 · see citing works
US Socioeconomic and Racial Differences in Health: Patterns and Explanations
Williams, D. R., & Collins, C. (1995) · Annual Review of Sociology · doi:10.1146/annurev.so.21.080195.002025 · Cited by 1,718 · see citing works
Mortality in relation to smoking: 40 years' observations on male British doctors
Doll, R., Peto, R., Wheatley, K., Gray, R., & Sutherland, I. (1994) · BMJ · doi:10.1136/bmj.309.6959.901 · Cited by 1,321 · see citing works
(2006) · Europe PMC (PubMed Central) · Cited by 1,299 · see citing works
The Case For More Active Policy Attention To Health Promotion
McGinnis, J. M., Williams-Russo, P. G., & Knickman, J. R. (2002) · Health Affairs · doi:10.1377/hlthaff.21.2.78 · Cited by 1,272 · see citing works
LIGNAC, G. O. (1951) · PubMed · Cited by 1,012 · see citing works
Murray, C. J. L., Kulkarni, S. C., Michaud, C., Tomijima, N., Bulzacchelli, M. T., Iandiorio, T. J., & Ezzati, M. (2006) · PLoS Medicine · doi:10.1371/journal.pmed.0030260 · Cited by 762 · see citing works
Actual causes of death in the United States
McGinnis, J. M. (1993) · JAMA · doi:10.1001/jama.270.18.2207 · Cited by 579 · see citing works
Getting to the Truth: Evaluating National Tobacco Countermarketing Campaigns
Farrelly, M. C., Healton, C. G., Davis, K., Messeri, P., Hersey, J., & Haviland, M. L. (2002) · American Journal of Public Health · doi:10.2105/ajph.92.6.901 · Cited by 561 · see citing works
Income dynamics and adult mortality in the United States, 1972 through 1989.
McDonough, P., Duncan, G. J., Williams, D. R., & House, J. S. (1997) · American Journal of Public Health · doi:10.2105/ajph.87.9.1476 · Cited by 413 · see citing works
Class — The Ignored Determinant of the Nation's Health
Isaacs, S. L., & Schroeder, S. A. (2004) · New England Journal of Medicine · doi:10.1056/nejmsb040329 · Cited by 384 · see citing works
Self-citationWhat to Do With a Patient Who Smokes
Schroeder, S. A. (2005) · JAMA · doi:10.1001/jama.294.4.482 · Cited by 304 · see citing works
Self-citationGradient of Disability across the Socioeconomic Spectrum in the United States
Minkler, M., Fuller‐Thomson, E., & Guralnik, J. M. (2006) · New England Journal of Medicine · doi:10.1056/nejmsa044316 · Cited by 285 · see citing works
Trends in the Black-White Life Expectancy Gap in the United States, 1983-2003
Harper, S. B., Lynch, J., Burris, S. C., & Smith, G. D. (2007) · JAMA · doi:10.1001/jama.297.11.1224 · Cited by 279 · see citing works
Woolf, S. H., Johnson, R. E., Phillips, R. L., & Philipsen, M. I. (2007) · American Journal of Public Health · doi:10.2105/ajph.2005.084848 · Cited by 277 · see citing works
Socioeconomic inequalities in health. No easy solution
Adler, N. E. (1993) · JAMA · doi:10.1001/jama.269.24.3140 · Cited by 236 · see citing works
Fiore, M. C., Croyle, R. T., Curry, S. J., Cutler, C. M., Davis, R. M., Gordon, C. R., Healton, C. G., Koh, H. K., Orleans, C. T., Richling, D. E., et al. (2004) · American Journal of Public Health · doi:10.2105/ajph.94.2.205 · Cited by 218 · see citing works
Obesity — The New Frontier of Public Health Law
Mello, M. M., Studdert, D. M., & Brennan, T. A. (2006) · New England Journal of Medicine · doi:10.1056/nejmhpr060227 · Cited by 216 · see citing works
Marmot, M. G. (2001) · New England Journal of Medicine · doi:10.1056/nejm200107123450210 · Cited by 215 · see citing works
Food Marketing and Childhood Obesity — A Matter of Policy
Nestle, M. (2006) · New England Journal of Medicine · doi:10.1056/nejmp068014 · Cited by 190 · see citing works
Maternal mortality and related concepts.
Hoyert, D. L. (2007) · PubMed · Cited by 175 · see citing works
Tobacco Control in the Wake of the 1998 Master Settlement Agreement
Schroeder, S. A. (2004) · New England Journal of Medicine · doi:10.1056/nejmsr031421 · Cited by 160 · see citing works
Self-citationHealth Spending Projections Through 2016: Modest Changes Obscure Part D's Impact
Poisal, J. A., Truffer, C. J., Smith, S. D., Sisko, A. M., Cowan, C. A., Keehan, S. P., Dickensheets, B. A., & the National Health Expenditure Accounts Projections Team (2007) · Health Affairs · doi:10.1377/hlthaff.26.2.w242 · Cited by 153 · see citing works
Law as a Tool to Facilitate Healthier Lifestyles and Prevent Obesity
Gostin, L. O. (2007) · JAMA · doi:10.1001/jama.297.1.87 · Cited by 123 · see citing works
Making Smoking History Worldwide
Koh, H. K., Joossens, L., & Connolly, G. N. (2007) · New England Journal of Medicine · doi:10.1056/nejmp068279 · Cited by 100 · see citing works
Socioeconomic inequalities in health. No easy solution.
Adler, N. E., Boyce, W., Chesney, M. A., Folkman, S., & Syme, S. L. (1993) · JAMA · doi:10.1001/jama.1993.03500240084031 · Cited by 99 · see citing works
The Medically Uninsured — Will They Always Be with Us?
Schroeder, S. A. (1996) · New England Journal of Medicine · doi:10.1056/nejm199604253341713 · Cited by 70 · see citing works
Self-citationPotential Health and Economic Consequences of Misplaced Priorities
Woolf, S. H. (2007) · JAMA · doi:10.1001/jama.297.5.523 · Cited by 63 · see citing works
A Pay-for-Population Health Performance System
Kindig, D. A. (2006) · JAMA · doi:10.1001/jama.296.21.2611 · Cited by 47 · see citing works
Does Proof Matter? Why Strong Evidence Sometimes Yields Weak Action
McGinnis, J. M. (2001) · American Journal of Health Promotion · doi:10.4278/0890-1171-15.5.391 · Cited by 43 · see citing works
Perkoff, G. T. (1985) · Journal of Chronic Diseases · doi:10.1016/0021-9681(85)90070-0 · Cited by 18 · see citing works
An Agenda To Combat Substance Abuse
Schroeder, S. A. (2005) · Health Affairs · doi:10.1377/hlthaff.24.4.1005 · Cited by 16 · see citing works
Self-citationThe way we age now: medicine has increased the ranks of the elderly. Can it make old age any easier?
Gawande, A. A. (2007) · PubMed · Cited by 14 · see citing works
Trials that Matter: Varenicline: A Designer Drug to Help Smokers Quit
Schroeder, S. A., & Sox, H. C. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-145-10-200611210-00013 · Cited by 12 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 5
- attention to health promotion. Health Aff (Millwood) 2002;21(2):78-93.
- Erra- tum, Am J Public Health 2003;93:703.]
- The New England Journal of Medicine Downloaded from nejm.org on August 29, 2023. For personal use only. No other uses without permission. Copyright © 2007 Massachusetts Medical Society. All rights reserved.
- Gawande A. Annals of medicine: the way we age now. The New Yorker. April 30, 2007:50-9.
- Woolf SH. Potential health and eco- nomic consequences of misplaced priori- ties. JAMA 2007;297:523-6. Healthy People 2010: understanding and improving health. Washington, DC: Department of Health and Human Ser- vices, 2001.
Cited by
Sorted by citations
Socioeconomic Disparities in Health in the United States: What the Patterns Tell Us
Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2010) · American Journal of Public Health · doi:10.2105/ajph.2009.166082 · Cited by 1,548 · see citing works
From ideas to efficacy: The ORBIT model for developing behavioral treatments for chronic diseases
Czajkowski, S. M., Powell, L. H., Adler, N., Naar-King, S., Reynolds, K. D., Hunter, C. M., Laraia, B., Olster, D. H., Perna, F. M., Peterson, J. C., et al. (2015) · Health Psychology · doi:10.1037/hea0000161 · Cited by 1,161 · see citing works
“…to preventable behavioral factors such as smoking, unhealthy dietary intake, and sedentary lifestyle (Mokdad, Marks, Stroup, & Gerberding, 2004; Schroeder, 2007), all of which have been linked to major chronic illnesses such as cardiovascular disease, cancer, and diabetes (Chakravarty, Hubert,…”
BackgroundGamification for health and wellbeing: A systematic review of the literature
Johnson, D., Deterding, S., Kuhn, K.-A., Staneva, A., Stoyanov, S., & Hides, L. (2016) · Internet Interventions · doi:10.1016/j.invent.2016.10.002 · Cited by 1,237 · see citing works
Cognitive neuroscience of self-regulation failure
Heatherton, T. F., & Wagner, D. D. (2011) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2010.12.005 · Cited by 1,033 · see citing works
The Mediterranean Diet, its Components, and Cardiovascular Disease
Widmer, R. J., Flammer, A. J., Lerman, L. O., & Lerman, A. (2015) · The American Journal of Medicine · doi:10.1016/j.amjmed.2014.10.014 · Cited by 963 · see citing works
Financial Incentive–Based Approaches for Weight Loss: A Randomized Trial
Volpp, K. G., John, L. K., Troxel, A. B., Norton, L., Fassbender, J., & Loewenstein, G. (2008) · JAMA · doi:10.1001/jama.2008.804 · Cited by 923 · see citing works
A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation
Volpp, K. G., Troxel, A. B., Pauly, M. V., Glick, H. A., Puig, A., Asch, D. A., Galvin, R., Zhu, J., Wan, F., DeGuzman, J., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmsa0806819 · Cited by 836 · see citing works
Health Disparities Beginning in Childhood: A Life-Course Perspective
Braveman, P., & Barclay, C. (2009) · Pediatrics · doi:10.1542/peds.2009-1100d · Cited by 653 · see citing works
Confronting The Growing Burden Of Chronic Disease: Can The U.S. Health Care Workforce Do The Job?
Bodenheimer, T., Chen, E., & Bennett, H. D. (2009) · Health Affairs · doi:10.1377/hlthaff.28.1.64 · Cited by 544 · see citing works
Patrick, H., & Williams, G. C. (2012) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-9-18 · Cited by 481 · see citing works
Nielsen, L., Riddle, M., King, J. W., Aklin, W. M., Chen, W., Clark, D., Collier, E., Czajkowski, S., Esposito, L., Ferrer, R., et al. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.07.002 · Cited by 446 · see citing works
Mindfulness and Behavior Change
Schuman-Olivier, Z., Trombka, M., Lovas, D. A., Brewer, J. A., Vago, D. R., Gawande, R., Dunne, J. P., Lazar, S. W., Loucks, E. B., & Fulwiler, C. (2020) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000277 · Cited by 435 · see citing works
Rung, J. M., & Madden, G. J. (2018) · Journal of Experimental Psychology: General · doi:10.1037/xge0000462 · Cited by 358 · see citing works
Schroeder, S. A., & Morris, C. D. (2010) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.012809.103701 · Cited by 349 · see citing works
Self-citationAssociation between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis
Hood, K. K., Peterson, C. M., Rohan, J. M., & Drotar, D. (2009) · Pediatrics · doi:10.1542/peds.2009-0207 · Cited by 347 · see citing works
Tektonidis, T. G., Åkesson, A., Gigante, B., Wolk, A., & Larsson, S. C. (2015) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2015.08.039 · Cited by 216 · see citing works
Poverty, racism, and the public health crisis in America
Beech, B. M., Ford, C., Thorpe, R. J., Bruce, M. A., & Norris, K. C. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.699049 · Cited by 220 · see citing works
Big data hurdles in precision medicine and precision public health
Prosperi, M., Min, J. S., Bian, J., & Modave, F. (2018) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-018-0719-2 · Cited by 200 · see citing works
Trait mindfulness and health behaviours: a meta-analysis
Sala, M., Rochefort, C., Lui, P. P., & Baldwin, A. S. (2020) · Health Psychology Review · doi:10.1080/17437199.2019.1650290 · Cited by 199 · see citing works
Clair, C., Chiolero, A., Faeh, D., Cornuz, J., Marques-Vidal, P., Paccaud, F., Mooser, V., Waeber, G., & Vollenweider, P. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-23 · Cited by 177 · see citing works
Page-Reeves, J., Kaufman, W., Bleecker, M., Norris, J., McCalmont, K., Ianakieva, V., Ianakieva, D., & Kaufman, A. (2016) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2016.03.150272 · Cited by 172 · see citing works
P4P4P: An Agenda For Research On Pay-For-Performance For Patients
Volpp, K. G., Pauly, M. V., Loewenstein, G., & Bangsberg, D. (2009) · Health Affairs · doi:10.1377/hlthaff.28.1.206 · Cited by 136 · see citing works
Otto, M. W., Eastman, A., Lo, S., Hearon, B. A., Bickel, W. K., Zvolensky, M., Smits, J. A. J., & Doan, S. N. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.07.003 · Cited by 136 · see citing works
Huffman, J. C., DuBois, C. M., Millstein, R. A., Celano, C. M., & Wexler, D. (2015) · Journal of Diabetes Research · doi:10.1155/2015/428349 · Cited by 127 · see citing works
Effective strategies for encouraging behavior change in people with diabetes
Hood, K. K., Hilliard, M., Piatt, G., & Ievers-Landis, C. E. (2015) · Diabetes Management · doi:10.2217/dmt.15.43 · Cited by 122 · see citing works
Franklin, B. A., Eijsvogels, T. M. H., Pandey, A., Quindry, J., & Toth, P. P. (2022) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2022.100425 · Cited by 121 · see citing works
“their destiny relative to wellness and health promotion [161].”
Ong, J. C. L., Seng, B. J. J., Law, J. Z. F., Low, L. L., Kwa, A. L. H., Giacomini, K. M., & Ting, D. S. W. (2024) · Cell Reports Medicine · doi:10.1016/j.xcrm.2023.101356 · Cited by 111 · see citing works
Creating Exercise Habits Using Incentives: The Trade-off Between Flexibility and Routinization
Beshears, J., Lee, H. N., Milkman, K. L., Mislavsky, R., & Wisdom, J. (2021) · Management Science · doi:10.1287/mnsc.2020.3706 · Cited by 58 · see citing works
Johnson, J. L., Moffat, B. M., & Malchy, L. A. (2010) · International Journal of Mental Health Systems · doi:10.1186/1752-4458-4-23 · Cited by 53 · see citing works
Health Policy Training: A Review of the Literature
Heiman, H., Smith, L., McKool, M., Mitchell, D., & Roth Bayer, C. (2015) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph13010020 · Cited by 49 · see citing works
Purposiveness and Leisure-Time Physical Activity in Women in Early Midlife
Holahan, C. K., Holahan, C. J., Velasquez, K. E., Jung, S., North, R. J., & Pahl, S. A. (2011) · Women & Health · doi:10.1080/03630242.2011.617811 · Cited by 43 · see citing works
Improving diabetes care: the model for health care reform
Kahn, R., & Anderson, J. E. (2009) · Diabetes Care · doi:10.2337/dc09-0184 · Cited by 35 · see citing works
Current Status and Prospects of Health-Related Sensing Technology in Wearable Devices
Cho, J. (2019) · Journal of Healthcare Engineering · doi:10.1155/2019/3924508 · Cited by 33 · see citing works
Nilsen, W. J., & Pavel, M. (2013) · IEEE Pulse · doi:10.1109/mpul.2013.2271682 · Cited by 24 · see citing works
The developing vision of primary care.
Barnes, K. A., Kroening-Roche, J. C., & Comfort, B. W. (2012) · New England Journal of Medicine · doi:10.1056/nejmp1204487 · Cited by 21 · see citing works
Virtual Reality and Other Realities
Botella, C., Baños, R. M., García-Palacios, A., & Quero, S. (2017) · The Science of Cognitive Behavioral Therapy · doi:10.1016/b978-0-12-803457-6.00022-2 · Cited by 16 · see citing works
Gojanovic, B., Fourchet, F., & Gremeaux, V. (2022) · Annals of Physical and Rehabilitation Medicine · doi:10.1016/j.rehab.2021.101551 · Cited by 15 · see citing works
- Authors
- Schroeder, S. A.
- Affiliations
- University of California, San Francisco (US)
- Corresponding author
- Schroeder, Steven A.
- ORCID
- Schroeder, Steven A.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2007-09-20
- Volume
- 357
- Issue
- 12
- Pages
- 1221-1228
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2154051039
- Cited by
- 1,065
- References
- 39
- Citations by year
- 2026: 25 · 2025: 39 · 2024: 41 · 2023: 47 · 2022: 59 · 2021: 75 · 2020: 131 · 2019: 64 · 2018: 69 · 2017: 72 · 2016: 69 · 2015: 64 · 2014: 56 · 2013: 42 · 2012: 45
- FWCI
- 87.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- health care spending, tobacco control, health disparities, health improvement, quality of care, health insurance, life expectancy, infant mortality, racial and ethnic disparities, socioeconomic disparities, health policy priorities, health care reform
- MeSH terms
- Smoking Prevention, Delivery of Health Care, Health, Health Promotion, Health Status, Humans, Mortality, Obesity, Quality of Health Care, Smoking, United States, Health Behavior
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