berkman-healthdivide - feature article lisa f. berkman the...

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contexts fall 2004 38 Contexts, Vol. 3, Issue 4, pp. 38-43, ISSN 1536-5042, electronic ISSN 1537-6052. © 2004 by the American Sociological Association. All rights reserved. Please direct all requests for permission to photocopy or reproduce article content through the University of California Press's Rights and Permissions website, at the health divide feature article lisa f. berkman The United States is one of the world’s wealthiest nations, yet the health of average Americans lags behind that of citizens in other developed countries. The huge amounts we spend on health care are not buying our population good health. The rea- son is a widening gap between the health of rich and poor Americans. The United States spends more on health care than any other nation in the world, both in absolute dollars and as a proportion of the national economy. Yet it ranks in the bottom half of industrialized countries in life expectancy. Overall, Americans’ health is worse than that of people in Japan, Sweden and France, as well as less affluent countries like Spain, Italy and Cyprus. While the richest and best-educated Americans are as healthy as their counterparts in other rich nations, poor and less-educated Americans have a life expectancy comparable to adults in many Third World coun- tries. A recent study found that African-American men in Harlem were less likely to live to age 65 than were men in Bangladesh. The vast sums we spend on health care do not buy most Americans good health. Americans’ health has improved considerably over the past century. But the health gap between rich and poor persists and may have even increased over the past two decades. The gap encompasses men and women, blacks and whites, recent immigrants and those who have been here for many genera- tions. Improving the health of the worst-off Americans remains a major challenge. Meeting that challenge depends on understanding the causes of poor health in people who are socially and economically disadvantaged and on our ability to do something about those causes. understanding americans’ ill health One possible explanation for why the United States lags so noticeably behind other developed countries in health is that many Americans lack access to quality medical care. Some researchers believe that if all Americans received top-notch treatment, the United States would rank near the top in citizens’ health. But the evidence does not support this hope. While good health care for all Americans should remain a high priori- ty for many reasons, studies in Great Britain have found that bet- ter access to care does not necessarily reduce health disparities between the rich and poor. By the 1980s, British citizens had 30 years of experience with free and universal access through the National Health Service. But according to Mel Bartley, during the 1980s the gap in death rates between rich and poor had actu- ally increased—in step with rising economic inequality. Over a longer period, 1930 to 1990, the death rate for
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berkman-healthdivide - feature article lisa f. berkman the...

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