Why more Americans perish as Aussies live longer

SYDNEY, Australia — Universal, affordable health care may be expensive, but the world’s first comprehensive adult mortality study provides hard evidence of how well it works to preserve lives.

While the risk of dying young in Australia has fallen dramatically over the past 40 years, the United States has failed dismally to improve its record, according to the University of Washington study of premature deaths in 187 countries published in the Lancet. 

The study, which estimated the probability that an individual who has just turned 15 will die before reaching age 60, considered premature, showed that the U.S. — despite being one of the richest countries in the world — had fallen significantly behind other countries in reducing deaths. 

In 1990, the U.S. ranked 34th in the world in female mortality and 41st in male mortality, but by 2010 it had dropped in the rankings to 49th for women and 45th for men, putting it behind all of western Europe and some lower-income countries such as Albania.

Australia, meantime, was one of the best performers, having shot up from 36th spot for females and 44th for males in 1970 to enter the top 10 countries in adult death prevention for both genders.

Health experts say one of the main factors explaining the stark contrast between Australia and the U.S., is the fact that, unlike Australia, only people with money can afford proper health care in the U.S.

On top of that, smoking rates have declined much faster in Australia due to better public health campaigns, than in the U.S. and obesity levels have soared in America — Australia is catching up but that won’t show for another decade.

Health reform pioneer John Deeble, one of the original architects of Australia’s publicly funded Medicare system, said America’s primary care system is ‘‘very weak’’ compared with Australia and there is too much reliance on expensive specialists rather than general doctors.

‘‘The Americans do not have anything that is the equivalent of the Australian and British GP [general practitioner],’’ said Deeble, an emeritus fellow at the Australian National University.

‘‘Fifteen percent of the population doesn’t have any health insurance at all. They may have a bigger underclass [than Australia],’’ he said.

The Public Health Association of Australia president, Mike Daube, said the results were unsurprising.

‘‘Smoking has declined rapidly here and obesity has been increasing dramatically in the U.S. America has been an incredibly affluent country over that period so they’ve been quicker to be affected by the diseases of affluence [cardiovascular diseases],’’ Daube said.

‘‘The really big overarching difference here is that we not only have health care that is pretty much as good as you can find in the U.S. but it’s almost universally accessible.’’

‘‘In the U.S., they’ve had access essentially only if they’d had money.’’

The survey of 187 countries is the most comprehensive assessment to date of global adult mortality and showed a massive rise in global inequalities. 

The study, by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, also showed that global inequality in adult mortality has grown to the point where adult men in Swaziland — the country with the worst mortality rate — now have a probability of premature death that is nine times the mortality rate of the best country, Cyprus.

The lowest mortality risks overall are recorded in Iceland, which has a risk of premature death for males of 65 per 1,000, and in Cyprus, where the risk for females is 38 per 1,000.

The study shows the gap in mortality rates between men and women is growing globally, with women’s health improving faster than men’s.

In the 40 years between 1970 and 2010, adult mortality fell by 34 percent in women and 19 percent in men globally. The gap between adult male and female mortality widened by 27 percent in that period.

The prevention of premature adult death is just as important for global health policy as the improvement of child survival, its authors said.

Yet, while the prospects of child survival have improved markedly due to campaigns in the 1980s and 1990s, little attention has been paid to adult mortality rates.

“However, adult mortality has received little policy attention, resources or monitoring efforts,” the study said.

One of the authors of the study, the University of Washington’s Christopher Murray said while maternal and child mortality rates had seen major progress since 1970, this was not the case in adult mortality rates.

“We are seeing this massive spread between the best and the worst off,” Murray said.

The researchers point to a range of factors for the widening disparities. AIDS sharply reversed positive trends in mortality in the 1990s in Africa. Increased incomes in some countries appear to be increasing the prevalence of risk factors for disease, such as high blood pressure and obesity. Smoking also continues to play a large role throughout the world.

Alan Lopez, head of the School of Population Health at the University of Queensland and one of the paper’s co-authors, said “we have been remarkably ignorant around adult mortality.”

“We need to apply the same passion that surrounds keeping children alive to keeping young adults alive,” Lopez said.

Other key findings include:

• The lowest risk of death in adults was recorded in Iceland (men) and Cyprus (women).
• Mortality rates for men and women in 37 countries are higher in 2010 than they were in 1990.
• Eastern Europe has seen one of the largest public health reversals of modern times. Russia has fallen from a rank of 43rd place for female mortality in 1970 to 121st.
• Since 2005, sub-Saharan Africa has seen strong mortality declines, a possible result of efforts to prevent new HIV infections and to treat AIDS patients with antiretroviral drugs.
• South Asia, and India in particular, had the highest female mortality in the world in 1970. Both the region and the country have seen major declines.
• The list of countries with the lowest adult mortality has changed greatly. Only three — Sweden, the Netherlands and Norway — remained in the top 10 for male mortality between 1970 and 2010.

Top 10 countries in adult death prevention:

MALE 1970

1. Greece
2. Sweden
3. Cuba
4. Andorra
5. Paraguay
6. Cyprus

MALE 2010
1. Iceland
2. Sweden
3. Malta
4. Netherlands
5. Switzerland
6. Australia

FEMALE 1970
1. Andorra
2. Norway
3. Greece
4. Sweden
5. Netherlands
6. Switzerland

FEMALE 2010
1. Cyprus
2. South Korea
3. Japan
4. Greece
5. Italy
6. Spain