The Poor State of America’s Health: Population Health Ethics

Despite spending more on healthcare than any other nation, Americans live shorter sicker lives than their counterparts in other rich and some middle-income countries. The “US health disadvantage” is explained primarily but not completely by the poor health and truncated life spans of America’s poor and low income populations. Contributing, too, are poor levels of health among America’s middle- and upper-classes, who fare worse than their counterparts in other rich nations. Within the U.S., people experience vastly different health and longevity outcomes. Numerous national reports have documented the poor state of America’s health and laid a foundation for action.

Some two decades ago, U.S. bioethics increasingly began to address questions raised by stark differences in health associated with social class, race and ethnicity, geography, and gender. Which health inequalities constitute health inequities? What role does health play in those judgments? How should we think about responsibility for health? Is health a societal, individual, or shared responsibility? How can we address inequities without marginalizing communities burdened by poor health? These are just a few of the central questions of population health ethics.