The most damning thing that can be said about the world’s best-endowed

The most damning thing that can be said about the world’s best-endowed and richest country is that it is not only not the leader in health status, but that it is so low in the ranks of the nations. The United States ranks 18th among nations of the world in male life expectancy at birth, 9th in female life expectancy at birth, and 12th in infant mortality. More importantly, huge variations are evident in health status in the United States from one place to the next and from one group to the next.

The forces that affect health can be aggregated into four groupings that lend themselves to analysis of all health problems. Clearly the largest aggregate of forces resides in the person’s environment. His own behavior, in part derived from his experiences with his environment, is the next greatest force affecting his health. Medical care services, treated as separate from other environmental factors because of the special interest we have in them, make a modest contribution to health status. Finally, the contributions of heredity to health are difficult to judge. We are templated at conception as to our basic weaknesses and strengths, but many hereditary attributes never become manifest because of environmental and behavioral forces that act before the genetic forces come to maturity and other hereditary attributes are increasingly being palliated by medical care.

No other country spends what we do per capita for medical care. The care available is among the best technically, even if used too lavishly and thus dangerously, but none of the countries which stand above us in health status have such a high proportion of medically disenfranchised persons. Given the evidence that medical care is not that valuable and access to care not that bad, it seems most unlikely that our bad showing is caused by the significant proportion who are poorly served. Other hypotheses have greater explanatory power: excessive poverty, both actual and relative, and excessive affluence.

Excessive poverty is probably more prevalent in the United States than in any of the countries that have a better infant mortality rate and female life expectancy at birth. This is probably true also for all but four or five of the countries with a longer male life expectancy. In the notably poor countries that exceed us in male survival, difficult living conditions are a more accepted way of life, and, in several of them, a good basic diet, basic medical care, basic education and lifelong employment opportunities are an everyday fact of life. In the United States a national unemployment level of 10 percent may be 40 percent in the ghetto, while less than 4 percent elsewhere. The countries that have surpassed us in health do not have such severe or entrenched problems. Nor is such a high proportion of their people involved in them.

Excessive affluence is not so obvious a cause of ill health, but, at least until recently, few other nations could afford such unhealthful ways of living. Excessive intake of animal protein and fats, dangerous imbibing of alcohol, use of tobacco and drugs (prescribed and proscribed), and dangerous recreational sports and driving habits are all possible only because of affluence. Our heritage, desires, opportunities and our macho, combined with the relatively low cost of bad foods and speedy vehicles, make us particularly vulnerable to our affluence. And those who are not affluent try harder. Our unacceptable health status, then, will not be improved appreciably by expanded medical resources nor by their redistribution so much as a general attempt to improve the quality of life for all.

1. Which of the following would be the most logical continuation of the passage?

(A) Suggestions for specific proposals to improve the quality of life in America
(B) A listing of the most common causes of death among male and female adults
(C) An explanation of the causes of poverty in America, both absolute and relative
(D) A proposal to ensure that residents of central cities receive more and better medical care
(E) A study of the overcrowding in urban hospitals serving primarily the poor

2. All of the following are mentioned in the passage as factors affecting the health of the population EXCEPT

(A) the availability of medical care services
(B) the genetic endowment of individuals
(C) overall environmental factors
(D) the nation’s relative position in health status
(E) an individual’s own behavior

3. The author is primarily concerned with

(A) condemning the United States for its failure to provide better medical care to the poor
(B) evaluating the relative significance of factors contributing to the poor health status in the United States.
(C) providing information that the reader can use to improve his or her personal health
(D) comparing the general health of the U.S. population with world averages
(E) advocating specific measures designed to improve the health of the U.S. population

4. The passage best supports which of the following conclusions about the relationship between per capita expenditures for medical care and the health of a population?

(A) The per capita expenditure for medical care has relatively little effect on the total amount of medical care available to a population.
(B) The genetic makeup of a population is a more powerful determinant of the health of a population than the per capita expenditure for medical care.
(C) A population may have very high per capita expenditures for medical care and yet have a lower health status than other populations with lower per capita expenditures.
(D) The higher the per capita expenditure on medical care, the more advanced is the medical technology; the more advanced the technology, the better is the health of the population.
(E) Per capita outlays for medical care devoted to adults are likely to have a greater effect on the status of the population than outlays devoted to infants.

5. The author refers to the excessive intake of alcohol and tobacco and drug use in order to

(A) show that some health problems cannot be attacked by better medical care
(B) demonstrate that use of tobacco and intoxicants is detrimental to health
(C) cite examples of individual behavior that have adverse consequence for health status
(D) refute the contention that poor health is related to access to medical care
(E) illustrate ways in which affluence may contribute to poor health status

6. The passage provides information to answer which of the following questions?

(A) What is the most powerful influence on the health status of a population?
(B) Which nation in the world leads in health status?
(C) Is the life expectancy of males in the United States longer than that of females?
(D) What are the most important genetic factors influencing the health of an individual?
(E) How can the United States reduce the incidence of unemployment in the ghetto?

7. In discussing the forces that influence health, the author implies that medical care services are

(A) the least important of all
(B) a special aspect of an individual’s environment
(C) a function of an individual’s behavior pattern
(D) becoming less important as technology improves
(E) too expensive for most people