Submitted by Sadie Vitkus

The United Nations, of which the United States is one of five permanent members, established 17 Sustainable Development Goals (SDGs) to achieve by 2030. The United States, long an influential and wealthy world power, is struggling in the face of a number of SDGs, most notably an inaccessible health care system. The nation spends a significantly higher percentage of its GDP on health care measures relative to other high-income countries. The health care system places an emphasis on complex treatments, and less so on generalized public health. These system-wide foci are contributing to subpar health outcomes and shortened longevity, placing the country in a standstill against further SDG development. 

Why are Americans spending the highest amount on health, and not achieving the highest standards of health?

The United States spends about percent of its GDP on health-care expenses, a “higher figure than for any other country” according to Eileen M. Crimmins and associates.  A higher amount of money spent on health care would typically be a favorable figure, as, logically, it leads to a better “investment” in health for a country. But the United States is the anomaly here. Other high-income countries around the globe are doing significantly better in terms of citizen health and longevity and spending only a portion of what the United States  spends to do so. Notably, France and Japan spend only 11 and 8 percent of their GDP, respectively, on health care. To personify these figures, according to the World Bank the average life expectancy between both sexes in the United States is 77 years, while Japan is at 84 and France is at 82. A difference of four to six years of life expectancy is substantial and noteworthy. 

Richard L. Skolnik has explained that the United States runs a pluralistic health system, in which the public and private sectors both play roles in providing health care.The private sector plays a predominant role. Since universal coverage does not currently exist in the United States, private insurance must be acquired through one’s occupation or purchased independently, but buying into the American health-care system comes at a high cost. Many countries at parallel development stages as the United States have adopted universal health-care coverage, referring  to “health as a right” and considering treatment “fundamental” for all citizens (Skolnik, 2017). In countries with publicly-paid-for health care, the governments typically provide encouragement for healthier lifestyles and public health provisions in order to prevent their citizens from acquiring morbid conditions and needing medical intervention, which comes as a direct financial cost to the governments themselves. The United States, once again dissimilarly to its high income counterparts, places more of a focus on treatment of illnesses and has a rather limited public health movement. 

The National Institute of Health states that a large proportion of the money set aside for U.S. health care is spent on the treatment of major diseases, including diabetes, cardiovascular disease and hypertension. These diseases are the “killers,” those that cause the most deaths in the United States. This collection of “killer” diseases is, unfortunately, commonly brought on by the citizens’ own habits, such as  poor diet choices that contribute to cholesterol build up, unusually high sugar consumption that leads to chronically high blood sugar levels, or the lack of daily movement. Poor health habits are, in part, a consequence of not having decent, accessible and pervasive public health protocols instilled in our system. People continue to get sicker, and our continued dependence on this financially inaccessible health-care system is being reinforced. 

At the core, these markers suggest that the United States has plateaued with regard to the  development of health security for its citizens. Reshaping of the current health system is due. Standards such as directing more funds towards the promotion of public health experts at schools and businesses, government-wide changes in subsidy receivers in the food industry and assembling a built environment that is suitable for daily movement need to be present and promoted.  Knowing that a large portion of costs are spent on diseases that are preventable through lifestyle changes, it is hopeful that these changes could reduce the reliance on expensive care, medications and procedures, and costs could subsequently decrease. 

A town in the suburbs of southern California serves as an ongoing health success story for American citizens. They are showing progress towards the UN’s SDGs much more effectively than the general United States. Loma Linda is one of the world’s five Blue Zones, which are areas around the world where large populations of centenarians live. Loma Linda happens to be home to a sizable group of Seventh-day Adventists, and according to Sabaté and Buettner,  their devotion to the pillars of their religion has been shown to be the invisible factor contributing to their outstanding health. The inhabitants of Loma Linda not only have a longer life expectancy than the U.S. population in general, but also their fellow Californians, which hints that a mere difference in habit might be the secret to improving one’s health and extending one’s life. This community of Seventh-day Adventists “evangelize with health.” They commit to plant-based diets, they prioritize volunteerism and community-building and they believe that staying healthy will allow them to continue to connect with “the Divine.” They encourage community-oriented physical activity through exercise classes, local gyms and group sports. Their lifestyle choices are simply an effect of their devotion to their religion, but have produced a community with a decreased prevalence of the “killer” diseases, thus a lesser need for expensive healthcare intervention. 

The Blue Zone scientists have extracted nine principles- the Power 9-  from the centenarian-rich communities around the world that can be applied to cities to make them more akin to the existing Blue Zone regions. Pasecinic describes how the Power 9 were applied to Albert Lea, Minnesota, a location of a “Blue Zone Project,” and the city has, as a result, shown major progress in their local health-care system, such as a “$7.5M in savings in annual healthcare costs for employers.” 

From the Loma Linda centenarians and their respective communities, it can be  that focusing on good health and well-being and sustainable community development, two of the named SDGs to achieve by the year 2030, can reduce disease prevalence and help people live longer and healthier lives. In the long term, an increased emphasis on public health will lead to reduced medical expenditures for the larger United States. A governmental shift towards public health and a heavier reliance on lifestyle changes like the Blue Zone Power 9 will provoke positive American health outcomes. With success stories on U.S. soil, there is hope for the rest of the U.S. population.

Editor’s note: This opinion piece was originally researched for the Global Health Tutorial offered by Professor Kristopher Fennie and Professor Jennifer Wells.