There was a man with tongue of wood

Last time we looked at the findings of the consensus report of the Institute of Medicine that concludes that we face shorter lives and poorer health compared to other advanced countries.

The report includes a comparison of deaths among both men and women under 50. I included the chart for men last time, but overlooked the chart for women. My bad.

The top three causes of mortality for men were 1. Non-intentional injuries, 2. Non-communicable diseases, excluding cardio-vascular, and 3. Intentional injuries.

The top three causes of mortality for women were 1. Non-communicable diseases, excluding cardiovascular, 2. Non-intentional injuries, and 3. Perinatal conditions.

Since there is a separate category of maternal conditions for women, the perinatal conditions, which appears for both men and women, obviously refers to risks while being born rather than giving birth.

But the report goes beyond those findings to suggest possible sources of the problem and recommendations for further study.

It is not a simple discussion but a complicated one, filled with the kind of nuance and qualification common to academic work, and conspicuously missing in public discussion.

The Table of Contents gives a taste of the complexity, which suggests that remediation will be equally complex and multi-modal–not as simple as the public and their political representatives might prefer:

4 Public Health and Medical Care Systems, 106
Defining Systems of Care, 107

1. Question 1: Do Public Health and Medical Care Systems
   Affect Health Outcomes?, 109
2. Question 2: Are U.S. Health Systems Worse Than
   Those in Other High-Income Countries?, 110
3. Question 3: Do U.S. Health Systems Explain the
   U.S. Health Disadvantage?, 132
4. What U.S. Health Systems Cannot Explain, 133
5. Conclusions, 135

5 Individual Behaviors 138

1. Tobacco Use, 140
2. Diet, 144
3. Physical Inactivity, 147
4. Alcohol and Other Drug Use, 149
5. Sexual Practices, 152
6. Injurious Behaviors, 154
7. Conclusions, 159

6 Social Factors 161

1. Question 1: Do Social Factors Matter to Health?, 163
2. Question 2: Are Adverse Social Factors More
   Prevalent in the United States Than in Other High-Income
   Countries?, 170
3. Question 3: Do Differences in Social Factors Explain the
   U.S. Health Disadvantage?, 185
4. Conclusions, 190

7 Physical and Social Environmental Factors 192

1. Question 1: Do Environmental Factors Matter to Health?, 193
2. Question 2: Are Environmental Factors Worse in the
   United States Than in Other High-Income Countries?, 199
3. Question 3: Do Environmental Factors Explain the
   U.S. Health Disadvantage?, 203
4. Conclusions, 205

8 Policies and Social Values 207

1. The Role of Public- and Private-Sector Policies, 209
2. The Role of Institutional Arrangements on
   Policies and Programs, 211
3. Societal Values, 219
4. Policies for Children and Families, 225
5. Spending Priorities, 233
6. Conclusions, 236

The report notes:
It will also be important for Americans to engage in a thoughtful discussion about what investments and compromises they are willing to make to keep pace with health advances other countries are achieving. Before this can occur, the public must first be informed about the country’s growing health disadvantage, a problem that may come as a surprise to many Americans.

The report summarizes the costs of inaction: