Invited commentary: the search for explanations of the American health disadvantage relative to the English.

Although Americans make up just 5% of the world's population, they represent more than half of every medical dollar expended on the planet. Yet, American life expectancy appears near the bottom of rankings by the Organization for Economic Cooperation and Development, and American adults live in poorer health than most Europeans. In this issue of the Journal, Martinson et al. (Am J Epidemiol. 2011;173(8):870) provide us with further evidence of the generality of this phenomenon, showing a pattern of poorer health in the United States relative to England across the entire life course. Recent research points at single risk factors such as smoking as potential explanations, but such hypotheses are of limited scope to explain the pervasive US health disadvantage across the entire life course. In this commentary, a potentially promising line of inquiry based upon differences in social policy contexts is proposed. Life in the United States can be distinguished from that of the rest of the member countries of the Organization for Economic Cooperation and Development in terms of the weakness of its social safety nets, the magnitude of social inequalities, and the harshness of poverty. The authors argue that broadening the scope of their inquiry to include the social and policy contexts of nations might help to solve the puzzle of the US health disadvantage.