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This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block.

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And I'm Audie Cornish. The United States spends far more on health care than any other nation, but Americans are actually less healthy than citizens of other wealthy countries. That's the conclusion of a blue ribbon panel at the National Academy of Science. NPR's Richard Knox says the reasons for America's low rank go way beyond how much medical care we get.

RICHARD KNOX, BYLINE: It's no news that the United States has lower life expectancy or higher infant mortality, but the lead author of the report says Americans have worse health than in 16 other countries across the whole span of their lives.

STEVEN WOOLF: What struck us - and it was quite sobering - was the recurring trend in which the U.S. seems to be slipping behind other high-income countries.

KNOX: That's Dr. Steven Woolf of Virginia Commonwealth University. He says Americans of all ages up to 75 have shorter lives and more illness and injury. Even Americans who are white, insured, college-educated and upper-income are worse off than their counterparts around the world.

WOOLF: People with seemingly everything going for them still live shorter lives and have higher disease rates than people in other countries.

KNOX: For starters, Americans consume nearly 4,000 calories a day on average, more than anyone else.

WOOLF: That wasn't always the case, but over the past 20 years, the consumption of high-calorie foods and refined sugars and other dietary causes of obesity has increased dramatically in the United States in comparison to these other countries.

KNOX: But it's not just disease that shortens Americans lives. Among American males under 50, well over half the deaths are from murder, accidents and suicide. Guns have a lot to do with that. The report notes that murder rates involving guns are four times higher in the Unites States than they are in 22 other rich countries.

WOOLF: Clearly, we need to do something about violence and firearm-related homicides if we're going to close the gap. It's a major contributor to the loss of years of life in our country among young people.

KNOX: Dr. David Kindig, at the University of Wisconsin, has spent his career studying the causes of poor health. But even he finds this report so persuasive that it shouldn't be ignored.

DAVID KINDIG: You know, it's not like we haven't known some of this yet, but it hasn't penetrated how serious it is. I hope that it would be a wake-up call, almost like Sputnik. You know, let's get going on this over the next decade.

KNOX: Kindig says some clues on what to do come from a state-by-state analysis of U.S. health problems that he and his colleagues do every year.

KINDIG: Some of the healthiest states, say, like Minnesota, they actually spend less on health care. And presumably that allows them to spend more on some of the other determinants of health.

KNOX: Like education. So he says it would be a mistake to cut spending on schools since education and health are tightly linked. Cuts there will just show up later in poorer health. Woolf, the panel chairman, says the nation's problems may be deeply rooted in Americans' love of personal choice and aversion to government regulation of health and safety. That won't be easy to change.

WOOLF: It is a difficult one to tackle. But we need to have a national discussion about whether we do or don't. We're living shorter lives and we're living sicker because of something we're doing in this country.

KNOX: He says Americans need to decide if they're OK with that or are prepared to make different choices. Richard Knox, NPR News.

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