High anxiety: what ails the world's big spender on health

Few ideas express an underlying belief in American culture better than the notion that "you get what you pay for".

On healthcare the US spends more than any other country on earth - and more than twice as much per head as the UK - so Americans expect a healthy society. This article of faith was shaken when an international study by renowned researchers concluded this year that Americans were "much less healthy" than their English counterparts. The comparison of late-middle-aged white populations in the US and England, funded by government research agencies in both countries, appeared in May in the 'Journal of the American Medical Association'. …

Professor Sir Michael Marmot [UCL Epidemiology & Public Health], the study leader … says: "I know that our results have caused a lot of anguished brow-beating among our American colleagues. But I do not think differences between the healthcare systems can explain why middle-aged Americans are less healthy than middle-aged English people." …

Answers to why Americans are significantly less healthy than the British may lie in a different cultural divide. Many experts agree with Sir Michael that social differences, rather than healthcare systems, are responsible. They point particularly to the intense competition, economic insecurity and high levels of stress that run through American society. …

A key piece of American mythology is that the country and its culture are a grand experiment. But the experiment is generating some unexpected data along the way, as the Marmot study shows. results could challenge another key part of US mythology: that its go-getting way of life is best. …

A frequent piece of folk advice on both sides of the Atlantic is to avoid an obsession with "keeping up with the Joneses". If status anxiety is indeed harming Americans' health, it is perhaps wiser advice than anyone imagined.

Christopher Bowe and Clive Cookson, 'Financial Times'