Phil Musgrove, now at Health Affairs, was an editor at the World Health Organization when it compiled its international comparison of nations’ health status that ranked the U.S. 37th in the world, largely because of its poor performance on infant mortality and longevity. In a letter to the editor in today’s New England Journal of Medicine, he points out that the U.S. had no statistics for nearly half the measurements used in the rankings and that most of the national rankings were inputed from data from 30 of 191 countries in the survey who fully reported their health outcomes.
He concludes:
The number 37 is meaningless . . . Analyzing the failings of health systems can be valuable; making up rankings among them is not. It is long past time for this zombie number to disappear from circulation.
Fair enough. But the U.S. ranking in infant mortality and its lagging longevity are cause for alarm because they show that the U.S. lags in health status. There’s many factors well beyond the quality of the health care system that contribute to these lagging indicators: persistent poverty in certain parts of the country and among certain subpopulations; chronic un- and underemployment; high levels of income and status inequality; and high levels of social stress and insecurity, for instance.
Someone should update the rankings and stress that they measure health status, not the quality of health care systems. If not WHO, who?
