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Americans Grow Shorter, Blame It on Weak Healthcare

by Gopalan on  July 10, 2007 at 11:23 AM General Health News   - G J E 4
Americans Grow Shorter, Blame It on Weak Healthcare
It is just not President George W. Bush who has suffered a disastrous decline in stature. It now turns out that literally too Americans have been growing shorter these days, falling behind the Europeans.
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The title of the study published by Benjamin Lauderdale at Princeton University and John Komlos at the University of Munich in the Social Science Quarterly tells it all: Underperformance in Affluence: The Remarkable Relative Decline in U.S. Heights in the Second Half of the 20th Century.

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Americans had always been giants, with the tallest men in the world going back as far as the data exists (at least to the mid-19th century).

During the First World War, American GIs still towered over the Europeans they liberated. But for three decades beginning at the end of World War Two, Americans' average height stagnated while Europeans continued the growth-spurt that one would expect to see during a period of relative peace and rising incomes.

Now, with an average height of 5'10", American men are now significantly shorter than men from countries like Denmark (6 footers) or the Netherlands (6' 1"). In fact, Americans -- men and women -- are now shorter, on average, than the citizens of every single country in Western and Northern Europe.

How can one explain that reversal? The study's authors, believe it's a result of "differences in the socioeconomic institutions of Europe and the United States".

We conjecture that the U.S. health-care system, as well as the relatively weak welfare safety net, might be why human growth in the United States has not performed as well in relative terms.

Scientists have a good understanding of the factors that determine height. Genetic variations are key to individuals' heights, but aren't a significant factor in the average height of a population. That has to do with health and nutrition, especially during childhood, from prenatal health through adolescence. The authors of the study note that in the scientific community, "there is widespread agreement that nutritional intake, the incidence of diseases, and the availability of medical services have a major impact on human size."

More research is needed to fully understand why Americans are shrinking relative to the Europeans, but some differences between the two cultures -- and their political economies -- stand out.

Healthcare is one. It's not just that Europeans are universally covered while one out of seven Americans is uninsured; it's also the difference in approach.

Specifically, public-sector healthcare puts a greater emphasis on prevention, while the US system creates incentives to treat illness rather than prevent it. This leads not only to much greater costs -- the United States spends about twice as much per person on healthcare as the rest of the advanced economies do -- it also plays a likely role in their declining stature.

A previous study had remarked, "[T]he United States is an outlier for financial burdens on patients and patients forgoing care because of costs. Half of sicker adults in the United States said that they did not see a doctor when sick, did not get recommended treatment, or did not fill a prescription because of cost."

The United States also has far more concentrated wealth than any of its European allies. That means that while we are, on average, one of the wealthiest countries in the world, we also lead all the advanced economies in poverty. Poverty limits access to both healthcare and good nutrition.

More importantly in terms of average height is childhood poverty. Here, the United States stands alone among the advanced economies with a stunning figure: eighteen percent of American children -- almost one in five -- live in poverty. No other industrialized country comes close -- it's about five times the child poverty rate in Northern Europe. Again, nutrition and access to healthcare both vary with family income for children just as they do in adults.

Nutrition is a key determinant of height. According to the study, "U.S. children consume more meals prepared outside the home, more fast food rich in fat, high in energy density, and low in essential micronutrients, than do European children." That is ultimately a cultural issue -- a result of a fast-food lifestyle that may have long-term consequences for growing bones. Public and corporate policies play a role as well: the United States stands out from Europe (and the rest of the world) in its lack of family-friendly workplaces. According to a study conducted by researchers at Harvard, it is among only five countries in the world that doesn't mandate some form of paid maternal leave. The only other advanced economy among those five is Australia, where women are guaranteed an entire year of unpaid leave.

That makes it all but impossible for most people to effectively balance work and family life and that, in turn, means more fast food on the run and less time taking care of sick kids -- both factors that constrain average height. And the potential impact on height might be greater still before the kids are born; research shows that every week of paid maternity leave significantly reduces infant mortality rates, a key indicator of prenatal health.

And it's not just height. Among the 20 most developed countries in the world, the United States is now dead last in life expectancy at birth, but leads the pack in infant mortality -- forty percent higher than the runner-up -- and in the percentage of the population that will die before reaching 60. Americans also lead the world in mental illness.

According to Lauderdale and Komlos, one has to look at the interplay between several factors to understand what's going on. "[T]he political economy of the health-care system, education, transfers to the poor, and government policy toward equality (hence taxation policy) all matter" in determining average height, they say.

Source: Medindia
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