A well-known health policy leader asked if wasn’t true that our country has a higher rate of preventable mortality than any other of the OECD countries, as the Commonwealth Fund has demonstrated. My answer was, it depends on which of our countries he is talking about. We have many. The map below shows just two – the Confederacy and the rest. Except for the Confederate states, the United States is rather average among OECD countries, with preventable mortality most similar to Finland. But the Confederate states are the worst in the world, with a preventable mortality rate double that of France.
Much of this can be traced to higher mortality among blacks, who account for 20% of the population in the old Confederacy, but only 10% elsewhere. Across all states, preventable mortality correlates strongly with percent of the population that is black (correlation coefficient = 0.8). But there are sharp north-south differences even among blacks. Black mortality in the Confederacy is 55% higher than in the rest of the country, and white mortality is 15% higher.
So we should not be too quick to malign the US health care system for spending too much and having poor outcomes. We are a nation of nations and must be understood in those terms. And the effects of race and poverty must be understood in each of these “nations.” Real health care reform will have to be built around regional realities and about the realities of wealth and poverty in each.