Americans drive cars and most live in unwalkable places. These impart significant risks that the healthcare system, no matter how good, wouldn't impact.
Has anyone dug into this to identify whether they tried to account for built environment? Or food system?
The results are not all that different. The USA lags other rich nations, and even middle income nations like Costa Rica and Chile. https://www.oecd.org/en/publications/health-at-a-glance-2023...
Macca's in Australia has healthier food than McDonalds in the US, exercise is very common place, etc.
Speaking of Obesity - Australian PSA (1975): https://www.youtube.com/watch?v=GNjEge3Awl8
But those investments or lack thereof aren't the root cause of our obesity crisis. That's land use, urban planning, subsidies to corn, completely outside the healthcare system. If you made the healthcare system as perfect as you wanted it to be, you would be fighting an uphill battle with these problems, it's very questionable whether you'd have any real impact.
There are studies of healthcare system efficacy. Rate of diagnosis relative to likely incidents of particular illnesses. Treatment effectiveness after diagnosis. And frankly, the US does much better than most countries when you measure just the healthcare system. But people don't like that, they challenge it immediately, because it's not what they want to believe.
If public health policy was sensible it would heavily regulate high-fructose syrup, not subsidise corn, plan cities and suburbs to have plentiful free access open space and exercise areas, good public transport, walkways and cycle ways.
As happens in Australia, ideally soon to regulate high-sucrose levels in soft drinks to close up that sugar gap.
> And frankly, the US does much better than most countries when you measure just the healthcare system.
And still has lower life expectancy and cancer recovery rates than Australia. But people don't like that, they challenge it immediately, because it's not what they want to believe.
Australia and the US have nearly identical cancer survival rates according to CONCORD-3, with the US around half a percentage point ahead. CONCORD-4 isn't done yet since it's only been 7 years since the last cohort of diagnoses. What are you seeing that says something different? Is there a newer data set I'm not aware of?
About 41k people die on the road in the US per year. While this is very high, and worse than pretty much any other developed country, it’s not going to move the needle _that_ much.
Though, in Ireland, for instance, the worst parts of the country for car dependency would be close to as bad as the US. Their life expectancy is a little lower than the national one, but it’s not dramatic, and certainly not as low as the US one. There’s something else going on.
40% of Americans are obese and 75% are overweight. This is largely outside of the control of the medical system, but has a significant impact on mortality and life expectancy.
I assure you that preventative medicine does exist, even in the USA. Moreover, healthcare interventions for people with "lifestyle" diseases such as obesity have been extremely effective in reducing mortality from downstream causes such cardiovascular disease (e.g. statins).
Diet and exercise are huge health variables that doctors don't really have the tools to do anything about.
Obesity can be prevented, can be treated, and its effects on health can be managed. We are actually living through something of a miracle in the treatment of lifestyle diseases. For example, the proportion of total deaths among adults with diabetes from vascular causes (heart disease) declined from 48% in 1988–94 to 34% in 2010–15 (https://sci-hub.st/10.1016/S0140-6736(18)30314-3).
The USA is not some kind of global outlier with a uniquely unhealthy population. The problem is *very obviously* something to do with how healthcare is provided here.
It is, actually. Our obesity rates are the highest in the world at 41%. This is nearly double many European countries, and five times higher than Japan or South Korea. Only a handful of tiny Polynesian islands have us beat.
Better treatments for diabetes are great, but what's even better is not getting diabetes at all by losing weight.
Not just discussions with a patient, but advising the government, pushing for regulation on things related to obesity, working with schools, etc.
Arguably, the problem in the US isn't that these are outside the control of the medical system, but that most Americans believe they should be outside the control of the medical system.
In (some) other countries, your comment would be a real "WTF?"
[1] Throwing in questions like "Is there a firearm in your house?" and "Is there a swimming pool in your house" intermixed with "normal" medical questions.