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Dr. Jeff Kane: Why aren’t we healthier?


There’s a disturbing gap between American healthcare and its goal, our health.

Our system is arguably the best in the world for those who can afford it, but our general health lags behind. One dismal statistic from the World Health Organization finds the U.S. ranking 36th in life expectancy, behind Slovenia, Costa Rica, Canada, Japan, and all the rich countries of Europe.

Much of our lag comes from widespread income inequities and uneven healthcare access. Still, few of us, regardless of race or income, enjoy health commensurate with the immense sums we spend on care. Research published in the Journal of the American Medical Association found that although Whites with higher incomes enjoy better than average health domestically, even they fare worse in several health categories than the average in other developed countries.

Why should this be?

Consider that this level of health is exactly what we want. After all, our policies and behaviors ultimately emanate from traditional American values: faith in the free market, individual freedom, self-reliance, and distrust of government. Whatever their benefits, these values don’t always augment our health.

Wary of over-regulating commerce, for example, we allow industries to pollute our air, land, water, and food. Diesel-powered trucks still dominate our highways, even though the California Air Resources Board has established that 70% of our cancer risk comes from diesel exhaust particles. We fume at the unconscionable cost of prescription medicines, yet perennially allow Pharma’s piracy. School boards still give passes to vending machines peddling junk food. Then we wonder why disorders like obesity, diabetes, hypertension, lung disease, and cancer are so common.

One of our individual freedoms is the right to bear arms, and indeed, we bear plenty. Whatever security they seem to confer, they famously threaten it as well. The U.S. rate of firearm homicide is almost twenty times higher than the average for 22 other countries. Last year, for the first time, firearm deaths outnumbered vehicle fatalities, and are now the leading cause of teenage deaths. Such tragedies erode our health statistics to the point that the American Medical Association has designated firearm casualties a public health problem.

Prizing self-reliance and hard work, we (via our representatives) consistently limit employees’ vacations, paid parental leave, and job-related counseling. The consequent stresses, of course, degrade health metrics. In contrast, French law specifies a 35-hour work week and at least four weeks of annual paid vacation.

Distrust of government has always been a thread in our national tapestry, but the COVID pandemic luridly broadened it. Suddenly everyone and no one was an expert, rendering our response late, piecemeal, and confused. It’s resulted in one million COVID deaths (highest in the world, and close to the total number of deaths in all our wars), yet another source of lower American life expectancy.

The critic H.L. Mencken observed, “Democracy is that form of government where the people get what they want — good and hard.” Is what we have now what we really want?

Jeff Kane is a physician and writer in Nevada City

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