Two separate and new OECD reports, updating health and the global economic outlook, raise two issues that are inter-related: that gains in longevity are stalling, with chronic illnesses and mental ill health affecting more people; and, as wealth grows more concentrated among the wealthy, the economic outlook around most of the world is also slowing.

First, we’ll mine the Health at a Glance 2019 annual report covering data on population health, health system performance, and medical spending across OECD countries.

The first chart arrays the x-y data points of life expectancy versus health spending for each of the OECD countries studied. The USA as an outlier is very clear, found in the lower right quadrant: America is far to the right with greatest spending on healthcare, and below the median for life expectancy just north of Poland, Turkey, and Slovakia — three of the lowest-spending countries in the group.

Several key data points under this macro finding tell the more granular story about low ROI in health spending in the U.S.:

  • Relatively high levels of obesity are literally weighing down Americans’ health status, contributing to higher rates of diabetes, raising risks for many cancers, and reversing gains made in heart disease. The 2017 U.S. prevalence rate of Type 1 and Type 2 diabetes of 10.8% of the adult population was the highest in the world except for Turkey (12.1%) and Mexico (13.1%). For context, the OECD 36 nation median was 6.4%.
  • Nearly three in four U.S. adults are overweight or obese, and 4 in 10 kids are, as well. This has driven diabetes prevalence to its apex, underpinned by unhealthy diets and low physical activity across Americans, young and older.
  • Unhealthy behaviors like lack of exercise contributes to a growing burden of chronic disease in the U.S., starting at younger ages. For example, less than two-thirds of adults consume fruit every day (fewer men than women).
  • In addition to a relatively high level of avoidable mortality in America, the U.S. also has the lowest level of universal coverage for a core set of health care services compared with the 35 other OECD countries. That core set of services covers consultations with doctors, tests and examinations, along with inpatient hospital care. In the U.S., Americans have relatively less access to a doctor when care is needed, the OECD report revealed. [The primary care “backbone” in the U.S. isn’t as comprehensive as in other developed countries, which is one of the major differences between American health care delivery and organization versus other countries that spend less on medical care and achieve much better outcomes, which I’ve discussed here in Health Populi]. 

The segue from the Health at a Glance report to the OECD Economic Outlook is the organization’s analysis of out-of-pocket health care costs published in April 2019, Access to care and financial protection. “In the United States, access problems due to underinsurance is more common in low-income groups…delayed or avoided care due to co-payments was more than twice as common among insured adults with an income below 200% of the federal poverty line, compared to those above the same income level,” the report noted.

Now, to OECD data on wealth and income — the root of the root of social determinants of good or ill health. This bar chart comes from OECD’s report on Society at a Glance published earlier this year, calling out growing wealth concentration with the U.S. top of the OECD country roster in terms of the proportion of wealth the top 10% of a nation’s citizens owns. In America, that’s 79% compared to, for example, Japan where the top 10% of citizens own 41% of the wealth.

The new report on the 2019 Economic Outlook published yesterday projected that the global economy is slowing after this recent historic long economic expansion. Tariffs and trade tensions are key factors in the world’s economic slowdown. OECD calculated in this research that U.S. tariffs with China may lower American GDP by 0.5% point by 2021.

While the labor market has seen new job creation, the rise of real wages has not been homogeneous across different workers, particularly in the U.S. where workers have traded off wage growth for health care cost growth in companies that have covered health insurance.

Job growth in the expanding gig economy has been, statistically, impressive — but those jobs largely aren’t accompanied by benefit packages and, especially, health insurance coverage.

The U.S. is also running large budget deficits which are expected to grow to nearly 7% of GDP in 2021.

Here’s a uniquely American observation called out in this report: “Efforts to reduce opioid addiction appear to be bearing fruit, which will likely reduce death rates and support higher labour force participation,” which was good news in this otherwise sobering report.

Still, “risks abound around projected slowing economic growth,” OECD warns.

Health Populi’s Hot Points:  This last chart compares gains in life expectancy (longevity) between two periods, 2002-2007 and 2012-2017. Look all the way to the left of the chart, and see that in the U.S. life expectancy gained in the earlier period, 2002-2007, ranked relatively high with OECD countries like the UK, Australia, Canada, Hungary, Italy, New Zealand, and others.

But in the latter five-year period, 2012-2017, life expectancy gains in the U.S. ranked the lowest among OECD nations — in fact, losing life-years on average, the only country to experience that sad mortality outcome.

The Economist special report, Poverty in America, included essays addressing poverty, how to measure it, and American poverty’s impact on children and people of color.

Research has shown that government programs have done more to help poor Americans than “is widely acknowledged,” The Economist concluded. The best way to move forward from this reversal in life expectancy shown in the last chart is to focus on children a section in the special report explains subtitled, “The kids are not alright.”

Poverty’s impact on children is long-lasting, which is a fact that’s incontrovertible. 13 million kids in America are now poor. When they reach 18, they probably, based on the data, become poor adults.

“This American tragedy is an ignored one,” The Economist asserts. Poor kids who grow up to be poor adults have shorter lives and a higher risk of criminality, the report continues.

It is appropriate, then, that the cover of the 2019 Economic Outlook report features a young person, whose hands bear the phrase, “our future…in your hands.”

Emily Sokol wrote an insightful column on the role of value-based health care for the benefit of children’s health this week in HealthPayer Intelligence. She quotes Nemours Health System’s CEO Dr. Larry Moss who said, “Children’s health is the most powerful lever we have to influence the health of the next generation, and, ultimately, to influence the economy of this country.”

Moss explained the devastating impact of adverse childhood events (ACEs) which negatively impact a young person through their life, setting the stage in terms of risk factors for lower educational attainment, lower incomes, overall lower socioeconomic status, and greater healthcare system demands and earlier risk of mortality.

“Compared to those with no ACEs, those with four or more ACEs were twice as likely to smoke, seven times as likely to be alcoholics, six times as likely to have had sex before age 15, and twice as likely to have cancer or heart disease by the time they became adults,” Moss described.

He made the case for value-based care that address the whole person accounting for social determinants of health and holistic health integrating physical, mental, social and financial health.

A healthcare system can’t do this alone, we know — partnering with other social organizations helped to promote a community-wide investment towards bettering childhood, Sokol further explained.

As Moss recommended, “Partnerships are absolutely critical. We’re not experts in education, poverty, and all the social issues that are major components of health. We can’t do this stuff.”