The "falling behind" spoken of in the title of the study is particularly pronounced when data on the United States is compared with equivalent data from the 10 nations with the highest life expectancy. The 10 countries, 7 in western Europe, include Iceland, Switzerland, Sweden, Japan, Australia, Norway, Canada, Spain, France and the Netherlands.
The study calculated historical averages for life expectancy, year by year, for the top 10 countries, and then rated each US county against that scale--in other words, how many years behind (or in a few cases, ahead) each county was, compared to what the study called the health "frontier," i.e., the average of the top 10 countries.
Some of the Mississippi counties, for example, had life expectancies equal to those achieved in the top 10 countries as far back as 1957, giving them a rating of 50 years "behind" the frontier. A few wealthy areas, such as Fairfax County, Virginia, were actually better than the average of the top 10 countries today, and received a rating of 16 years "ahead" of the frontier.
The overall trend was a wider and wider gap between the US performance and the top 10 countries. In 2007, only 78 US counties had improved their ranking for male life expectancy on this international scale, while 1,406 counties fell further behind and 1,663 counties were essentially unchanged. For female life expectancy, the figures were even worse: only 45 counties improved, 2,054 fell further behind, and 1,048 counties stayed the same.
Another striking feature of the report was the scale of inequality in health outcomes. A relative handful of affluent suburban counties, mainly in the Northeast and West Coast, have life expectancies better than or equal to those in Japan and western Europe. But overall, some 80 percent of US counties were behind the average for the top 10 countries, and this proportion has increased dramatically over the last decade.
One part of the study looked at local variations in Britain and Canada, and found that the United States had much greater internal disparities. While 17 percent of US counties were 30 years or more behind the world's best countries, only 2 percent of Canadian localities were that far behind--mostly among the Inuit population in the far north--and in Britain, with its National Health Service, only two tenths of 1 percent of local jurisdictions were more than 30 years behind.
There were some positive findings in the study:
*Despite high poverty rates, Southern California and other parts of the Southwest have relatively better life expectancy because the Hispanic immigrant population is much healthier than the US average.
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