ALTHOUGH THE UNITED STATES spends more on health care than any other country, US residents live shorter and less healthy lives than do people in other developed nations, according to a new report (http: //tinyurl.com/a4yzn3o) from the National Research Council and the Institute of Medicine. Moreover, the report found that the mortality gap is growing, in large part because of a disproportionately higher rate of early deaths among individuals in the United States before their 50th birthday. The report compares US health outcomes and mortalitydatawith data from 16 peer countries, including Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, and Japan. The panel that drafted the report found that the life expectancy of residents of the United States was shorter than that of residents of almost all the peer countries. They also found that the health disparities persisted across health conditions and extended to highincome and highly educated groups. These results suggest that health disparities between lower-income US individuals and minorities and higherincomeandwhite individualsdonot fully explain the US mortality gap. The United States did, however, fare better than other countries on longevity after age 75 years. Much of the differences in longevity were related to early deaths. For example, the United States had the highest infant mortality rate, and disproportionately fewer US children live until their fifth birthday. Violence and injuries are large contributors to deaths among children, adolescents, and young adults in the United States. Steven H. Woolf, MD, MPH, chair of the panel and professor of family medicine at Virginia Commonwealth University, noted that US individuals were 7 times more likely to die as a result of violence and 20 times more likely to be killed by a gun than people living in peer countries. Residents of the United States were also less healthy than many of their counterparts in other countries on several measures. For example, US teens had the highest pregnancy rate and they are more likely to develop a sexually transmitted disease. People l iv ing in the United States also had the second highest rate of HIV infection and the highest rate of AIDS. The United States also had the highest rates of obesity across age groups and the highest rate of diabetes among adults aged 20 years and older. Older adults in the United States are also more likely to report physical activity limitations. Woolf said that cultural and social differences in the countries may account for some of the disparity in longevity. He noted that although the United States spends more on health care than other countries, many peer countries spend much more than the United States on various social programs that may contribute to good health and longevity. “Social policies are probably to blame for part of this problem,” he said. Y in Y an g/ iS to ck ph ot o. co m news@JAMA From JAMA’s Daily News Site