Four major lessons on health Americans can learn from the rest of the world
An exploration of some of the subtle- but significant- ways culture shapes healthcare across the globe
When it comes to healthcare, the United States spends far more per capita than any other country- and gets surprisingly little in return. As of 2019, America spent a whopping $11,582 per person on healthcare. Despite that investment, the US has the lowest life expectancy, highest suicide rate, highest obesity and chronic disease burden, and highest rate of preventable deaths of any of the OECD countries.
Though there are many variables that impact healthcare outcomes in a country, conversations with friends abroad have made me realize that the most significant and overlooked factors may be so deep in our culture that they are invisible to us. For example, it’s not just that German patients are prescribed far fewer painkillers than American patients- they view pain itself differently. And when Israeli physicians discuss PTSD, they use a word that translates to “soul,” a term that would never appear in a discussion of the topic in America. When it comes to what health means and how it is best attained, Americans differ significantly from the rest of the globe.
Here are four stories that showcase some of the surprising ways the United States approaches healthcare differently than other countries across the world- and the lessons we could stand to learn from them.
Germany: Pain is a valuable signal in the healing process
When I was first diagnosed with arthritis, something always baffled me in conversations with doctors: all of them wanted to discuss pain management and none were interested in the cause of my condition. Why don’t you take an NSAID? Take 1–2 ibuprofen when it gets bad. None of them were curious about a 25-year-old suddenly developing arthritis or concerned about the longer-term health impacts of NSAIDS.
It took me months to realize that this response went far deeper than arthritis care: pain suppression is fundamental to American culture. An article quoting the former US Surgeon General Vivek Murthy highlights just how much further Americans go than the rest of the world in suppressing pain: “We have nearly 250 million prescriptions for opioids written every year. That’s enough for every person in America to have a bottle of pills and then some… Our opioid prescription rate is 50% higher than in Germany and 40x higher than in Japan.”
While there are many reasons behind the rates of opioid prescriptions in America, a major factor is how American patients view pain in the context of healing. In an article titled “After Surgery…I wanted Vicodin, not Herbal Tea,” Firoozeh Dumas writes about being told before her hysterectomy in Germany that she would not receive any painkillers after. In disbelief, she turns to her anesthesiologist, who tells her:
“We cannot eliminate it nor do we want to. The pain will guide you. You will know when to rest more; you will know when you are healing. If I give you Vicodin, you will no longer feel the pain, yes, but you will no longer know what your body is telling you. You might overexert yourself because you are no longer feeling the pain signals. All you need is rest.”
The idea that pain is a valuable message from the body is practically antithetical to the American demand for immediate relief. But if the alarming reality of the opioid and chronic illness crises are any indication, our pain silencing often does far more harm than good.
India: A healthy diet keeps the dentist away
Of all the surprising things I learned about my housemates during lockdown, one of the most surprising was this: the Indian men in our house had never been to the dentist until they came to America in their twenties. And they were fine, with full sets of white, straight teeth.
After I did some further research, I learned that my housemates were not exceptions. As one Indian newspaper reports: “Nearly 67 per cent of Indians have never never visited a dentist and around 87 per cent do not believe in visiting one unless there is a problem.” Though the article hints at “low awareness” and “lack of access,” the difference seemed to be largely cultural as well. For example, “49 per cent of the respondents associate dental problems with lifestyle related reasons such as “improper eating habits” and “not leading a healthy lifestyle.” My housemate shared a similar opinion when I pressed him. “The main difference I can think of is that our food is less adulterated in India. My friends and I exercised less back home and probably ate more, but we put on weight here.”
Interestingly, until fairly recently in American history, popular opinion on dentistry matched the views of my housemates. Dentistry and even toothbrushing were highly uncommon in America up until the early 20th century, when the “Western Diet” of refined sugars and processed food became popular. One figure who was alarmed by the surging rates of cavities (“dental carries”) and gum disease was Canadian dentist Weston A. Price. Price spent the next years of his life traveling the globe and studying the diets and dental health across various cultures. To rule out genetics, Price always compared the same, or closely related groups, who only differed in their adoption of Western diets and published his findings in a book called “Nutrition and Physical Degeneration.”
What Price ultimately found was astounding: When native populations dropped their traditional diets in favor of Western diets, they paid dearly. Those eating Western foods not only had significantly more cavities, but often passed on changes in jaw and facial structures to their children- resulting in crowded, misaligned teeth. According to Price, the problem came down to nutrients: the Western diet doesn’t provide enough of the natural fats, minerals, or probiotics to maintain healthy guts and teeth.
What Price discovered and my housemates confirmed is that constant dentistry isn’t a necessity; proper nutrition is a necessity. But when the value of quality food is ignored, as is often the case in the American diet, a dentist needs to smooth the veneer and hide the damage.
Britain: Alternative and Western medicine work best together
Walking into my first energy healing course (a variation on reiki) in Ojai, California a couple years ago, I was surprised to find that my teacher was not a long-haired hippie but a very respectable looking Brit. As he introduced himself and his background in energy healing, I was even more surprised to hear about how dramatically different Americans and British were in their treatment of alternative medicine.
When I searched for “reiki” and “energy healing” alongside the terms “American” and “British” hospitals, I noticed just how differently the two countries treated the topic. While UK sites didn’t always provide a deeply scientific explanation of energy work, even Cancer Research UK described the potential benefits of reiki and acknowledged that it’s safe for almost everyone. In contrast, an American article from PBS treated the news that some US hospitals would be introducing energy work with scorn and disdain: “[Top hospitals] offer “energy healing” to help treat multiple sclerosis, acupuncture for infertility, and homeopathic bee venom for fibromyalgia. A public forum hosted by the University of Florida’s hospital even promises to explain how herbal therapy can reverse Alzheimer’s. (It can’t.)”
What fascinated me when comparing the American and British commentary on energy healing was the extent to which Americans seemed to view anything intangible with a form of distrust and skepticism. In contrast, while British sites did not offer bold claims, they stated that energy healing and reiki “may help patients relax” and “feel a greater sense of vitality.” And most importantly, that it would not do any harm.
After all, for a technique that is based on a caring touch from one person to another, what is it we’re so worried about?
Israel: When it comes to PTSD, medicine needs to care for the whole person
In one of my first jobs out of college, I worked at Walter Reed Military hospital and had the chance to see get to know some of the servicemen coming back from Afghanistan. Over coffee one day, one of them made a comment that stayed in my mind for a long time after:
“I went to Kabul and despite all of the money and energy we’ve invested, it still looks worse than Tijuana. Then I came home and a lot of people said to me, ‘Oh, we’re still in Afghanistan? I didn’t know that.’ You don’t know how hard it is to come home and hear that.”
At the time, I remember wondering how such a disappointing experience and welcome home impacted the mental health of servicemen. A few weeks later, I stumbled on an article titled “Why do Israeli soldiers suffer from PTSD less than American counterparts?” that indirectly helped answer my question.
I learned that within the Israeli Defense Force, the rate of PTSD is an astonishingly low 1.5%, compared to 8% for soldiers returning from Afghanistan and Iraq. As the article points out, this difference is likely partially due to the unique position of Israeli soldiers: they are fighting for their homeland, a large portion of the population has also served, and there is a tradition of deep love and respect for the military. As a result, when Israeli soldiers experience trauma in warfare, they are able to make meaning from it and receive deep understanding from their community.
But the differences go beyond political and social circumstances. When it comes to treating PTSD patients, Israeli and American doctors also diverge in profound ways:
“The [American] research is varied and results are often conflicting. Much of the material consists of long lists of possible symptoms and hypotheses regarding what types of physical/biological conditions might lead to a predisposition…This suggests a number of assumptions: There is something psychologically flawed in the person suffering from PTSD…and there is potential for profit.”
“The word used in the Hebrew text [on PTSD] …actually means the system of the ‘soul.’…No matter how this is interpreted, it is understood that there are issues that are physical and issues that are intangible.”
When it comes to how Israel approaches the prevention and treatment of PTSD, it seems their medical system values something the American system overlooks: care for the whole person. A form of care for what Israelis call the “soul” rather than just the brain. And though there are many factors that can lead to PTSD, an empathetic, spiritual level of care for the whole person is undoubtedly essential for recovery.
If there’s any common thread between the stories shared, I believe it’s that American healthcare rarely values what it can’t see or measure. We spend money to keep our teeth white and straight when we smile, but forget about our guts; we spend money to get knocked out by surgery or painkillers, but are dubious of the gentler impact of energy work and reiki; and while we spend money looking at brain scans to find trauma, we rarely empathize with the whole person who has experienced it.