More than Medicine

American science produces the best--and most expensive--medical treatments in the world. Yet U.S. citizens lag behind their global peers in life expectancy and quality of life. Robert Kaplan brings together extensive data to make the case that health care priorities in the United States are sorely misplaced. America's medical system is invested in attacking disease, but not in addressing the social, behavioral, and environmental problems that engender disease in the first place. Medicine is important, but many Americans act as though it were all important. The U.S. stakes much of its health funding on the promise of high-tech diagnostics and miracle treatments, while ignoring strong evidence that many of the most significant pathways to health are nonmedical. Americans spend millions on drugs to treat high cholesterol, for example, which increase life expectancy by six to eight months on average. But they underfund education, which might extend life expectancy by as much as twelve years. Wars on infectious disease have paid off, but clinical trials for chronic conditions--costing billions--rarely confirm that new treatments extend life. By comparison, the National Institutes of Health spends just 3 percent of its budget on research in social and behavioral determinants of health, even though these factors account for 50 percent of premature deaths. America's failure to take prevention seriously costs lives. More than Medicine argues that we need a shake-up in how we invest resources, and it offers a bold new vision for longer, healthier living.

 Kaplan, director of research at the Stanford School of Medicine Clinical Excellence Research Center