单选题
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The most damning thing
that can be said about the world's best-endowed and richest country is that it
is not only not the leader in health status, but that it is so low in the ranks
of the nations. The United States ranks 18th among nations of the world in male
life expectancy at birth, 9th in female life expectancy at birth, and 12th in
infant mortality. More importantly, huge variations are evident in health status
in the United States from one place to the next and from one group to the
next.
The forces that affect health can be divided into four
groupings that led themselves to analysis of all health problems. Clearly the
largest group of forces resides in the person's environment. Behavior, in part
derived from experiences with the environment, is the next greatest force
affecting health. Medical care services, treated as separate from other
environmental factors because of the special interest we have in them, make a
modest contribution to health status. Finally, the contributions of heredity to
health are difficult to judge.
No other country spends what we
do per capita for medical care. The care available is among the best
technically, even if used too freely and thus dangerously. Given the evidence
that medical care is not that valuable and access to care not that bad, it seems
most unlikely that our bad showing is caused by the significant proportion who
are poorly served. Other hypotheses have greater explanatory power: excessive
poverty, both actual and relative, and excessive wealth.
Excessive poverty is probably more prevalent in the U.S. than in any of
the countries that have a better infant mortality rate and female life
expectancy at birth. This is probably true also for all but four or five of the
countries with a longer male life Expectancy. In the notably poor countries that
exceed us in male survival, difficult living conditions are a more accepted way
of life and in several of them, a good basic diet, basic medical care and basic
education, and lifelong employment opportunities are an everyday fact of life.
In the U.S. a national unemployment level of 10 percent may be 40 percent in the
ghetto while less than 4 percent elsewhere. The countries that have surpassed us
in health do not have such severe problems. Nor are such a high proportion of
their people involved in them.
Excessive wealth is not so
obvious a cause of iii health, but, at least until recently, few other nations
could afford such unhealthful ways of living. Excessive intake of animal protein
and fats, and use of tobacco and drugs, and dangerous recreational sports and
driving habits are all possible only when one is wealthy. Our heritage, desires,
and opportunities, combined with the relatively low cost of bad foods and speedy
vehicles, make us particularly vulnerable. Our unacceptable health status, then,
will not he improved appreciably by expanded medical resources nor by their
redistribution so much as by a general attempt to improve the quality of life
for all. (506 words)