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Despite spending more per person on health care than any other country, Americans are getting sicker and dying younger than our international peers -- a problem persisting across all ages and both genders, according to a new report.

In 2011, the National Research Council found life expectancy in the United States was increasing at a slower rate than in other high-income democracies. Shortly after, the NRC and Institute Of Medicine convened a panel of experts to investigate why.

The panel was given 18 months to review recent health studies from 16 "peer countries": Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands and the United Kingdom.

The panel released its report, titled "U.S. Health in International Perspective: Shorter Lives, Poorer Health," on Wednesday.

"Our panel was unprepared for the gravity of the finding we uncovered," chair Steven Woolf wrote in the report's preface. "We hope that others will take notice."

This is not a new problem, Woolf noted on a conference call about the report. "It's been going on since 1980 and it's getting progressively worse."

Data from 2007 show Americans' life expectancy is 3.7 years shorter for men and 5.2 years shorter for women than in the leading nations -- Switzerland for men and Japan for women.

As of 2011, 27 countries had higher life expectancies at birth than the United States.

"The tragedy is not that the United States is losing a contest with other countries," the report states, "but that Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary."

The report outlines nine health areas where the United States lags behind other rich nations, including infant mortality, homicides, teen pregnancy, drug-related deaths, obesity and disabilities.

Americans have the highest prevalence of AIDS in the group. Seniors are at a greater risk of developing and dying from heart disease. And our children are less likely than children in peer countries to reach their fifth birthday.

It's easy to point a finger at our health care system, which unlike comparison countries' does not provide universal coverage. As a result, lower income and less educated people often receive poorer care.

"The U.S. health system is highly fragmented, with limited public health and primary care resources and a large uninsured population," the authors wrote. "Compared with people in other countries, Americans are more likely to find care inaccessible or unaffordable."

But the panel says that's not all that's to blame. Studies show even white, insured, college-educated Americans are sicker than their peers in Europe.

The experts gave three other possible causes for the country's growing health disadvantage:

Though Americans know what's "good" for them, few act on it. Although we are less likely to smoke and drink heavily than our peers, we consume more calories, have higher rates of drug abuse, are less likely to use seat belts and are more likely to use guns in acts of violence, according to the report.

Most high-income countries report income and education disparities in their health care system. But the panel said Americans benefit much less from social programs that could negate the effects of poverty.

"In countries with the most favorable health outcomes, resource investments and infrastructure often reflect a strong societal commitment to the health and welfare of the entire population," the report states.

Our environment is also a big contributor to Americans' poor health, the panel said. U.S. communities are built around automobiles, discouraging physical activity and increasing traffic accidents. Contraceptives are only available by prescription, instead of over the counter. Even stress could play a role -- adding to our waistlines, substance abuse and criminal behavior.
More, and recommendations, at http://www.cnn.com/2013/01/09/health/international-health-report/index
.html?hpt=hp_bn12

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A study in the Journal of Trauma and Acute Care Surgery found that the gun murder rate in the U.S. is almost 20 times higher than the next 22 richest and most populous nations combined.

Among the world’s 23 wealthiest countries, 80 percent of all gun deaths are American deaths and 87 percent of all kids killed by guns are American kids. http://abcnews.go.com/blogs/headlines/2012/07/gun-deaths-a-familiar-am
erican-experience/

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Dr. Matthew Sleeth is a former emergency room physician. He's also the author of "24/6: A Prescription for a Healthier, Happier Life."

CNN: You begin your book by writing about a store owner who vowed to close his store on Sundays, so his employees and their families, as well as his customers, could take the day off. But it didn't stay that way for long. What happened?

Sleeth: For almost 2,000 years, Western culture stopped -- primarily on Sunday -- for about 24 hours. Even when I was a child, you couldn't buy gasoline, you couldn't buy milk. The drugstores weren't open. The only thing that was open was a hospital. Even in dairy farming country, we would milk cows, but we wouldn't bring in hay.

And so society just had a day where they put it in park. (That) was Sunday... until the last 30 years or so.

CNN: Why do you think taking one day off a week is so important?

Sleeth: We go 24/7 now, and I think it's having health consequences. I think more and more, there's a consensus that it leads to depression and anxiety.

It's interesting, when a doctor sits down and does a primary intake with a new patient, they ask about smoking, exercise and diet, but they don't ask how much you're working. They don't get any sense of if you're working seven days a week, or if you have time set aside -- like people have always had -- for rest.

CNN: You write about incorporating a "stop day" into your weekly schedule. How do you think that can extend and enrich your life?

Sleeth: A "stop day" is a day you really cease from your labors. This really comes in Western cultures from the Ten Commandments. The fourth commandment tells us to remember the Sabbath. The word "Sabbath" simply means "to cease" -- to cease from your labors.

CNN: You go as far as to say that going full-throttle 24/7 is an illness. How do you recognize the signs?

Sleeth: I find that there's a growing epidemic, really, of depression. We're the most depressed country in the world.

The World Health Organization says somewhere between one in nine and one in 10 Americans are being treated for depression. We tend to work more hours than any other country in the world; Japan is second closest.

When we're constantly going, we pour out chemicals to try to meet those stresses. We have short-term stress hormones like adrenaline, and longer-term hormones like the steroids that we pour out. Those chemicals constantly being "on" are bad for us, and they lead to anxiety and depression and to, I think, diabetes and being obese.

It's interesting that if I took somebody in the emergency department and gave them a big slug of adrenaline, you'll find that an hour later they're just wiped out, and that'll really persist throughout the day. I think that's what we're doing to ourselves. We're constantly bringing stress into our life, and the idea of having one day a week that I can count on to stop is very reassuring.

Even if on Monday I'm very, very busy -- and that proceeds throughout the week -- if you know you have a habit of a weekly day of rest, of stopping, then you always know that's out in front of you. A lot of people "go" and never know when it is that they're going to come to rest. More at

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A recent measurement found that a Japanese worker has approximately two hours overtime a day on average (generally unpaid). The problem with unpaid overtime in companies is that the overtime is simply not recorded in many cases. Labor regulations limit the amount of overtime, so in order not to contradict labor regulations, workers are being told not to record the overtime, as it would be considered an illegal action from the side of the company.

In general, overtime is something that is accepted as part of work, and protest against it is rare, as the reaction of colleagues, superiors and even family and friends is feared. It is not uncommon for many Japanese employees to work late hours until 2-3 am in the morning, and being expected to be in the office again at 9am. In some cases (especially in subsidiaries of big listed companies that have to cope with the pressure of parent companies, who generate margins through exploitation of daughter companies) employees have been reported to have worked 300 hours of overtime in one single month. These statistics are in almost all cases not official, and most employees would always refrain from making such statements to authorities or the press, nor would they agree to be named.

In 2008, karoshi made headlines: a death back in 2006 of a key Toyota engineer who averaged over 80 hours overtime each month was ruled as a result of overwork.Wiki, Karoshi

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The number of people who committed suicide indicating "failure to get jobs" rose to 424, up 20 percent from the year before and more than doubling from 180 in 2007. About one-third were in their 20s, including new graduates seeking jobs.

Hardly a week passes without news of an executive jumping in front of a train or hanging himself in a hotel room. The corporate warrior ethos still pervades the Japanese workplace--and warriors don't show their pain. Ageism is a factor, too. It is very hard to relaunch a career after 45 or so. And finally there is a cultural reluctance in Japan--and in the rest of Asia, for that matter--to seek help for depression and other forms of mental illness. Japanese, says Kitagawa, the Life Phone counselor, "tend to have a prejudice against mental-health problems, especially men."

As in most countries, it is men who are the most likely to kill themselves. Most suicides involve midlevel executives or Japan's new jobless. More at http://www.businessweek.com/stories/2002-06-02/business-suicides-japan
s-death-trap

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I take note of the fact that a lot of Americans are being diagnosed with depression. This is a serious point I'd like to address. Do you think this has something to do with your culture of aspiration?

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It seems evident that most of you seem to have a bloody therapist to help you with the most basic functions of life.

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The results of the annual "Stress in America" survey by the American Psychological Association, released last week, found that while 85 percent of Americans say their stress level has remained the same or increased in the past year, just 4 percent of people use therapy as a way to combat that stress. More at http://www.news-medical.net/news/20091109/Survey-finds-fewer-Americans
-use-therapy-to-manage-stress.aspx

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You are a very emotional nation, which again, isnt necessarily a negative thing, but maybe The Briitsh.... in a better position to cope with adversity.

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are the upper lips of British people today as stiff as they once were? According to our poll, no.

Asked if British people these days still have a stiff upper lip in terms of being restrained in displaying their emotions, a majority (57%) of Britons say no, they do not, while only 33% say British people do have a stiff upper lip. Meanwhile, 62% of the public also believes that British people have become more emotional in recent decades. Only 14% say British people have become less emotional, and 18% believe they are about the same. More at http://yougov.co.uk/news/2012/10/04/do-brits-still-have-stiff-upper-li
ps/

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seem to have somewhat of a "victim culture" on occasion

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I sometimes wonder whether people turn to counselling and therapy because of the lack of emotional support that they have in their lives in general.

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A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

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Single Episode

A. Presence of a single Major Depressive Episode

B. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

Recurrent

A. Presence of two or more Major Depressive Episodes.

Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.

B. The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects or a general medical condition. http://www.mental-health-today.com/dep/dsm.htm

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