What do we know about social determinants of
health in the U.S. and comparable countries?
Peterson-Kaiser Health System Tracker
The U.S. is an outlier for health spending, but when combined
with other social services, spending is similar to other countries
Total social spending (including health and other social services) as
percent of GDP, 2011
Total health consumption as percent of GDP, 2011
United States
16%
France
11%
Germany
11%
Switzerland
11%
Sweden
11%
Average
11%
Netherlands
11%
Canada
10%
Belgium
France
31%
United States
29%
Belgium
27%
United Kingdom
26%
Netherlands
26%
Japan
26%
Germany
25%
10%
Average
25%
Japan
10%
Sweden
25%
Austria
10%
Austria
24%
Australia
9%
Canada
United Kingdom
9%
Australia
0%
5%
10%
15%
20%
21%
20%
0%
10%
20%
30%
40%
Source: Kaiser Family Foundation analysis of data from OECD (2016), "Health expenditure and financing: Health expenditure indicators", OECD Health
Statistics (database). doi: http://dx.doi.org/10.1787/data-00349-en (Accessed on 08 February 2016); and OECD (2016), Social spending (indicator). doi:
10.1787/7497563b-en (Accessed on 08 February 2016) Note: Social spending includes cash assistance. Total net social spending data unavailable for
Switzerland.
Peterson-Kaiser Health System Tracker
Though the U.S. population is aging, it has a younger average age
and smaller elderly population than comparable countries
Median age, 2015 estimates
Percent of population over age 65, 2014
Japan
46.5
Japan
Germany
46.5
Germany
Austria
43.6
26%
21%
Sweden
20%
Netherlands
42.3
France
19%
Switzerland
42.1
Austria
19%
Average
42.3
Average
18%
Canada
41.8
Belgium
18%
Belgium
41.4
Switzerland
18%
Sweden
41.2
Netherlands
18%
France
41.1
United Kingdom
17%
United Kingdom
40.4
Canada
16%
Australia
38.4
Australia
15%
United States
37.8
United States
14%
0
10
20
30
40
50
0%
10%
20%
30%
Source: Data on median age from the CIA World Fact Book , available at https://www.cia.gov/library/publications/the-world-factbook/fields/2177.html;
data on the percent of population over age 65 from the World Bank, available at http://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS.
Peterson-Kaiser Health System Tracker
The U.S. has the shortest life expectancy among
comparable countries
Life expectancy at birth in years, 2013
Japan
83.4
Switzerland
82.9
France
82.3
Australia
82.2
Sweden
82.0
Comparable Country Average
81.8
Canada
81.5
Netherlands
81.4
Austria
81.2
United Kingdom
81.1
Germany
80.9
Belgium
80.7
United States
78.8
76.0
77.0
78.0
79.0
80.0
81.0
82.0
83.0
Source: Kaiser Family Foundation analysis of data from OECD (2016), Life expectancy at birth (indicator). doi: 10.1787/27e0fc9d-en (Accessed on 12
January 2016). Note: Data for Canada are from 2011.
Peterson-Kaiser Health System Tracker
84.0
In the U.S., both blacks and whites have shorter average life
expectancies than the average of comparable countries
Life expectancy at birth in years, 2006 and 2013
2006
2013
85
80
75
78
79
80
82
81
78
82
79
75
73
70
65
60
55
50
United States:
Non-Hispanic Black
United States:
Non-Hispanic White
United States:
Hispanic
United States:
All Races
Comparable Countries:
Average
Source: Data by race are from the Centers for Disease Control, available at: http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf (Accessed on 12
January 2016); comparable country data are from OECD (2016), Life expectancy at birth (indicator). doi: 10.1787/27e0fc9d-en (Accessed on 12 January
2016).
Peterson-Kaiser Health System Tracker
The U.S. has a higher degree of income inequality than
comparably wealthy countries
Gini coefficient, 2010
United States
40.5
Australia
34.9
United Kingdom
34.8
France
33.8
Canada
33.7
Switzerland
32.7
Comparable Country Average
31.5
Germany
31.1
Austria
30.3
Netherlands
28.7
Belgium
28.5
Sweden
26.8
0
5
10
15
20
25
30
35
40
Source: Kaiser Family Foundation Analysis of data from The World Bank, World Development Indicators (database). Available at
http://data.worldbank.org/indicator/SI.POV.GINI/countries?cid=DEC_SS_WBGDataEmail_EXT&display=default (Accessed on December 16, 2015).
Note: Data for Japan are unavailable.
Peterson-Kaiser Health System Tracker
45
Americans with lower incomes are less likely to report
being in good health than those with high incomes
Percent of population age 15+ reporting good health, by income quintile, 2013
100%
96%
90%
80%
73%
70%
60%
50%
40%
30%
20%
10%
0%
Lowest Income
Highest Income
Source: OECD (2015), Perceived health status by income level, 2013 (or nearest year), in Health at a Glance 2015, OECD Publishing, Paris.
DOI: http://dx.doi.org/10.1787/health_glance-2015-graph33-en
Peterson-Kaiser Health System Tracker
The U.S. has the lowest insured rate of comparable
countries
Percent of total population covered by private and/or public health insurance in 2013 (comparable countries) or 2014 (United States)
United Kingdom
100.0%
Switzerland
100.0%
Sweden
100.0%
Japan
100.0%
Canada
100.0%
Australia
100.0%
France
99.9%
Comparable Country Average
99.9%
Austria
99.9%
Netherlands
99.8%
Germany
99.8%
Belgium
99.0%
89.6%
United States
84%
86%
88%
90%
92%
94%
96%
98%
100%
Source: Kaiser Family Foundation analysis of 2014 U.S. Census data, available here
https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-253.pdf; and data from OECD (2015), “OECD Health Data: Social
Protection”, OECD Health Statistics (database). (Accessed on September 16, 2015). Note: Data for Japan were unavailable for 2013, so data from the
previous year are shown.
Peterson-Kaiser Health System Tracker
Uninsured adults are much more likely to go without
needed medical care due to costs
Barriers to health care among nonelderly adults by insurance status, 2014
Uninsured
Medicaid/Other Public
Employer/Other Private
52%
No usual source of care
10%
12%
32%
Postponed seeking care due to cost
12%
8%
27%
Went without needed care due to cost
10%
5%
19%
Could not afford prescription drug
13%
4%
0%
10%
20%
30%
40%
50%
60%
Source: Kaiser Family Foundation analysis of National Health Interview Survey. Report available here: http://kff.org/uninsured/fact-sheet/key-factsabout-the-uninsured-population/
Peterson-Kaiser Health System Tracker
Per capita cigarette consumption is lower in the United
States than in comparably wealthy countries
Number of cigarettes smoked per capita per year, age 15+, 2014
Belgium
2,353
Austria
1,988
Japan
1,713
Switzerland
1,634
Germany
1,480
Netherlands
1,396
Comparable Country Average
1,393
Canada
1,154
United States
1,083
France
993
Australia
956
Sweden
831
United Kingdom
827
0
500
1000
1500
2000
2500
Source: World Lung Foundation and the American Cancer Society. The Tobacco Atlas. Available at: http://www.tobaccoatlas.org/topic/cigarette-useglobally/ (Accessed on January 5, 2016).
Peterson-Kaiser Health System Tracker
The U.S. has higher than average disease burden from
lung cancer
Lung, tracheal, and bronchus cancer age-standardized disability adjusted life years (DALY) rate per 100,000 population, 2013
Netherlands
873
Belgium
823
United States
795
France
795
Canada
773
United Kingdom
663
Comparable Country Average
646
Germany
641
Austria
601
Switzerland
537
Australia
531
Sweden
442
Japan
425
0
100
200
300
400
500
600
700
800
900
Source: Kaiser Family Foundation analysis of data from the University of Washington Institute for Health Metrics and Evaluation. Available at:
http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads (Accessed on November 22, 2015).
Peterson-Kaiser Health System Tracker
1000
The U.S. has the highest prevalence of obesity among
comparable countries
Prevalence of obesity, BMI ≥ 30, age-standardized estimates, 2012 or nearest year
United States
35.3%
Australia
28.3%
Comparable Country Average
21.2%
Canada
25.8%
United Kingdom
24.7%
Germany
23.6%
Japan
3.6%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Source: Kaiser Family Foundation analysis of data from OECD (2016), "Non-medical determinants of health", OECD Health Statistics (database).
DOI: http://dx.doi.org/10.1787/data-00546-en (Accessed on 21 January 2016). Note: Comparable countries here include Australia, Canada, Germany,
Japan, and the United Kingdom. Data for Australia are for 2011 and data for Canada are for 2013.
Peterson-Kaiser Health System Tracker
More adults in the U.S. have a sedentary lifestyle than
in most comparable countries
Prevalence of insufficient physical activity among adults aged 18+ years, age-standardized estimate, 2010
United Kingdom
37.3%
Japan
33.8%
Belgium
33.2%
United States
32.4%
Sweden
28.7%
Comparable Country Average
26.4%
France
23.8%
Austria
23.8%
Australia
23.8%
Canada
23.2%
Germany
21.1%
Netherlands
15.5%
0%
5%
10%
15%
20%
25%
30%
Source: Kaiser Family Foundation analysis of data from the World Health Organization. Available at:
http://apps.who.int/gho/data/view.main.2463?lang=en (Accessed on November 22, 2015). Note: Data not available for Switzerland.
Peterson-Kaiser Health System Tracker
35%
40%
The U.S. has a higher than average disease burden
caused by cardiovascular diseases
Age-standardized Disability adjusted life years (DALY) rate per 100,000 population, 2013
United States
3,261
Germany
2,778
Sweden
2,702
Austria
2,651
United Kingdom
2,462
Belgium
2,399
Comparable Country Average
2,288
Netherlands
2,278
Canada
2,185
Australia
2,076
France
1,908
Switzerland
1,865
Japan
1,862
0
500
1000
1500
2000
2500
3000
Source: Kaiser Family Foundation analysis of data from the University of Washington Institute for Health Metrics and Evaluation. Available at:
http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads (Accessed on November 23, 2015).
Peterson-Kaiser Health System Tracker
3500
In the U.S., whites, blacks, and Hispanics all have higher
prevalence of obesity than the average of comparable countries
Prevalence of obesity for adults age 20+ by race/ethnicity and gender, age-adjusted, 2012
Males
Females
70%
57.5%
60%
50%
40%
46.3%
40.2%
34.4%
38.1%
34.6%
32.3%
35.9%
30%
21.2%
21.2%
20%
10%
0%
United States:
Non-Hispanic White
United States:
Hispanic
United States:
Non-Hispanic Black
United States:
All Races
Comparable Countries:
Average
Source: Data by race are from CDC/National Center for Health Statistics, “Health, United States, 2014: With Special Feature on Adults Aged 55–64,”
available at http://www.cdc.gov/nchs/hus.htm; comparable country data are from OECD (2016), "Non-medical determinants of health", OECD Health
Statistics (database). DOI: http://dx.doi.org/10.1787/data-00546-en (Accessed on 21 January 2016). Note: Comparable countries here include Australia,
Canada, Germany, Japan, and the United Kingdom. Data for Australia are for 2011 and data for Canada are for 2013.
Peterson-Kaiser Health System Tracker
Income level may contribute to the higher prevalence of
obesity in the United States than in similar countries
Prevalence of obesity for adults age 20+ by poverty level in the U.S. and on average in comparable countries, age-adjusted, 2012
45%
40%
38.3%
40.1%
37.0%
35.3%
35%
30.2%
30%
25%
21.2%
20%
15%
10%
5%
0%
United States:
Below 100% FPL
United States:
100%-199% FPL
United States:
200%-399% FPL
United States: 400% United States: All
FPL or more
income levels
Comparable
Countries: Average
Source: Data by poverty level are from CDC/National Center for Health Statistics, “Health, United States, 2014: With Special Feature on Adults Aged 55–
64,” available at http://www.cdc.gov/nchs/hus.htm; comparable country data are from OECD (2016), "Non-medical determinants of health", OECD Health
Statistics (database). DOI: http://dx.doi.org/10.1787/data-00546-en (Accessed on 21 January 2016). Note: Comparable countries here include Australia,
Canada, Germany, Japan, and the United Kingdom. Data for Australia are for 2011 and data for Canada are for 2013.
Peterson-Kaiser Health System Tracker
The U.S. has consistently had lower average alcohol
consumption than most comparable countries
Liters per capita, age 15+, 1980-2012
United States
Comparable Country Average
25
20
15
10
5
Source: Kaiser Family Foundation analysis of data from OECD (2015), "OECD Health Data: Non-Medical Determinants of Health", OECD Health
Statistics (database). doi: 10.1787/data-00546-en (Accessed September 29, 2015). Note: Data for Austria were unavailable for 2012, so data from the
previous year are shown.
Peterson-Kaiser Health System Tracker
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
0
Disease burden from alcohol use disorders is higher
than average in the U.S.
Age-standardized Disability adjusted life years (DALY) rate per 100,000 population, 2013
France
348
Germany
304
Sweden
261
Austria
259
United States
238
Belgium
219
Comparable Country Average
208
United Kingdom
188
Canada
169
Switzerland
158
Australia
143
Netherlands
136
Japan
110
0
50
100
150
200
250
300
350
Source: Kaiser Family Foundation analysis of data from the University of Washington Institute for Health Metrics and Evaluation. Available at:
http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads (Accessed on November 23, 2015).
Peterson-Kaiser Health System Tracker
400
The U.S. has higher than average disease burden caused
by liver conditions due to alcohol use
Liver cancer due to alcohol use, age-standardized Disability adjusted
life years (DALY) rate per 100,000 population, 2013
France
Austria
35
Japan
86
United Kingdom
20
Belgium
18
Average
Switzerland
18
Canada
Canada
96
Belgium
21
Average
103
France
27
United States
116
Germany
28
Austria
131
United States
31
Germany
Liver cirrhosis due to alcohol use, age-standardized Disability adjusted
life years (DALY) rate per 100,000 population, 2013
14
82
70
67
Australia
45
United Kingdom
13
Switzerland
43
Sweden
13
Sweden
43
Netherlands
41
Japan
39
Australia
11
Netherlands
9
0
10
20
30
40
0
50
100
150
Source: Kaiser Family Foundation analysis of data from the University of Washington Institute for Health Metrics and Evaluation. Available at:
http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads (Accessed on November 23, 2015). Note: “Average” is the simple
average of the comparable countries shown above. Comparable countries are defined as those with above median GDP and above median GDP per capita in
at least one of the past ten years.
Peterson-Kaiser Health System Tracker
The U.S. has the highest environmental burden of
disease compared to other high-income countries
Total environment attributable DALYs per 100,000 capita, 2004
United States
1,861
Belgium
1,818
United Kingdom
1,764
France
1,677
Germany
1,665
Comparable Country Average
1,590
Australia
1,568
Austria
1,547
Netherlands
1,543
Sweden
1,538
Canada
1,520
Japan
1,456
Switzerland
1,393
0
200
400
600
800
1,000
1,200
1,400
Source: Kaiser Family Foundation analysis of data from the WHO Global Health Observatory Data Repository. Available at:
http://apps.who.int/gho/data/node.main.162?lang=en (Accessed on November 23, 2015).
Peterson-Kaiser Health System Tracker
1,600
1,800
2,000
Poisonings, car accidents, and falls are the leading
causes of accidental death in the United States
Mortality rate per 100,000 population, by cause of death, 2013
14
12.3
12
11.2
9.6
10
8
6
4
2
1.1
0.9
0.5
0.3
0.2
Other land
transport
accidents
Accidental
discharge of
firearms
0
Accidental Motor vehicle
poisoning and
accidents
exposure to
noxious
substances
Falls
Accidental
drowning and
submersion
Accidental
Water, air,
exposure to
space, and
smoke, fire, other transport
flames
accidents
Source: CDC (2013). Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf
Peterson-Kaiser Health System Tracker
Accidental poisonings lead to more than twice the years
of disability in the U.S. than in comparable countries
Age-standardized Disability adjusted life years (DALY) rate per 100,000 population, 2013
United States
27
Belgium
17
Canada
13
Japan
13
Australia
12
United Kingdom
12
France
12
Comparable Country Average
10
Switzerland
9
Sweden
8
Austria
7
Netherlands
6
Germany
5
0
5
10
15
20
25
Source: Kaiser Family Foundation analysis of data from the University of Washington Institute for Health Metrics and Evaluation. Available at:
http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads (Accessed on November 23, 2015).
Peterson-Kaiser Health System Tracker
30
Relative to comparable countries, the U.S. has higher rates of
death from accidental poisonings, such as drug overdoses
Standardized mortality rate for accidental poisonings per 100,000 population, 2000-2010
United States
Comparable Country Average
12
10
8
6
4
2
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Source: Kaiser Family Foundation analysis of 2013 OECD data: OECD Health Statistics (database). doi: 10.1787/data-00540-en (Accessed on December 15,
2015). Notes: Where data were unavailable (United Kingdom in 2000 and Australia for 2005), the previous year’s data were used. Data for Switzerland
omitted. Break in series for Austria in 2002, Canada and France in 2000, and the United Kingdom in 2001.
Peterson-Kaiser Health System Tracker
Disease burden from drug abuse disorders is higher in
the U.S. than in comparable countries
Age-standardized Disability adjusted life years (DALY) rate per 100,000 population, 2013
Opioid use disorders
Other drug use disorders
Amphetamine use disorders
Cannabis use disorders
Cocaine use disorders
300
250
245
241
200
144
150
110
100
57
50
34
14
28
33
9
0
United States
Comparable Country Average
Source: Kaiser Family Foundation analysis of data from the University of Washington Institute for Health Metrics and Evaluation. Available at:
http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads (Accessed on November 23, 2015).
Peterson-Kaiser Health System Tracker
56 percent of people in the U.S. report having a
personal connection to prescription painkiller abuse
Percent of nationally representative sample who say they personally know anyone who has…
Themselves
Family Member
Close Friend
Ever taken a prescription painkiller not prescribed to them
6%
Ever been addicted to prescription painkillers
Acquaintance/Someone else
14%
15%
13%
10%
12%
12%
2%
Died from a prescription painkiller overdose
4% 5%
7%
Percent who say yes to any of the above
56%
0%
10%
20%
30%
40%
50%
60%
Source: Kaiser Family Foundation. Kaiser Health Tracking Poll: November 2015. Available at: http://kff.org/health-reform/poll-finding/kaiser-healthtracking-poll-november-2015/
Peterson-Kaiser Health System Tracker
The U.S. has the highest disease burden from motor
vehicle road injuries
Age-standardized Disability adjusted life years (DALY) rate per 100,000 population, 2013
United States
462
Belgium
373
Canada
291
Australia
278
France
251
Austria
216
Comparable Country Average
214
Switzerland
188
Sweden
185
Germany
173
Netherlands
163
United Kingdom
135
Japan
96
0
50
100
150
200
250
300
350
400
450
Source: Kaiser Family Foundation analysis of data from the University of Washington Institute for Health Metrics and Evaluation. Available at:
http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads (Accessed on November 23, 2015).
Peterson-Kaiser Health System Tracker
500
The U.S. has the highest rate of years of life lost to
disability and premature death due to firearm assaults
Age-standardized Disability adjusted life years (DALY) rate per 100,000 population, 2013
United States
206
Canada
29
Belgium
25
France
21
Netherlands
14
Australia
14
Comparable Country Average
13
Sweden
11
Switzerland
9
Austria
8
Germany
7
United Kingdom
5
Japan
2
0
50
100
150
200
Source: Kaiser Family Foundation analysis of data from the University of Washington Institute for Health Metrics and Evaluation. Available at:
http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads (Accessed on November 23, 2015).
Peterson-Kaiser Health System Tracker
250