U.S. a Third World Country. Or Just Third Rate?

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• The Guardian, JUST WHAT YOU DON'T WANT TO HEAR?
• Article history

Despite spending $230m (£115m) an hour on healthcare, Americans live shorter lives than citizens of almost every other developed country. And while it has the second-highest income per head in the world, the United States ranks 42nd in terms of life expectancy.

These are some of the startling conclusions from a major new report which attempts to explain why the world's number-one economy has slipped to 12th place - from 2nd in 1990- in terms of human development.

The American Human Development Report, which applies rankings of health, education and income to the US, paints a surprising picture of a country that spends well over $5bn each day on healthcare - more per person than any other country.

The report, Measure of America, was funded by Oxfam America, the Conrad Hilton Foundation and the Rockefeller Foundation. It shows each of the 11 countries that rank higher than the US in human development has a lower per-capita income.

Those countries score better on the health and knowledge indices that make up the overall human development index (HDI), which is calculated each year by the United Nations Development Programme.

And each has achieved better outcomes in areas such as infant mortality and longevity, with less spending per head.

Japanese, for example, can expect to outlive Americans, on average, by more than four years. In fact, citizens of Israel, Greece, Singapore, Costa Rica, South Korea and every western European and Nordic country save one can expect to live longer than Americans.

There are also wider differences, the report shows. The average Asian woman, for example, lives for almost 89 years, while African-American women live until 76. For men of the same groups, the difference is 14 years.

One of the main problems faced by the US, says the report, is that one in six Americans, or about 47 million people, are not covered by health insurance and so have limited access to healthcare.

As a result, the US is ranked 42nd in global life expectancy and 34th in terms of infants surviving to age one. The US infant mortality rate is on a par with that of Croatia, Cuba, Estonia and Poland. If the US could match top-ranked Sweden, about 20,000 more American babies a year would live to their first birthday.

"Human development is concerned with what I take to be the basic development idea: namely, advancing the richness of human life, rather than the richness of the economy in which human beings live, which is only a part of it," said the Nobel laureate economist Amartya Sen, who developed the HDI in 1990.

"We get in this report ... an evaluation of what the limitations of human development are in the US but also ... how the relative place of America has been slipping in comparison with other countries over recent years."

The US has a higher percentage of children living in poverty than any of the world's richest countries.

In fact, the report shows that 15% of American children - 10.7 million - live in families with incomes of less than $1,500 per month.

It also reveals 14% of the population - some 40 million Americans - lack the literacy skills to perform simple, everyday tasks such as understanding newspaper articles and instruction manuals.

And while in much of Europe, Canada, Japan and Russia, levels of enrolment of three and four-year-olds in pre-school are running at about 75%, in the US it is little more than 50%.

The report not only highlights the differences between the US and other countries, it also picks up on the huge discrepancies between states, the country's 436 congressional districts and between ethnic groups.

"The Measure of America reveals huge gaps among some groups in our country to access opportunity and reach their potential," said the report's co-author, Sarah Burd-Sharps. "Some Americans are living anywhere from 30 to 50 years behind others when it comes to issues we all care about: health, education and standard of living.

"For example, the state human development index shows that people in last-ranked Mississippi are living 30 years behind those in first-ranked Connecticut."

Inequality remains stark. The richest fifth of Americans earn on average $168,170 a year, almost 15 times the average of the lowest fifth, who make do with $11,352.

The US is far behind many other countries in the support given to working families, particularly in terms of family leave, sick leave and childcare. The country has no federally mandated maternity leave.

The US also ranks first among the 30 rich countries of the Organisation of Economic Cooperation and Development in terms of the number of people in prison, both in absolute terms and as a percentage of the total population.

It has 5% of the world's people but 24% of its prisoners.