RAND Review News for Summer 2006

Middle-Aged Americans Less Healthy Than English Counterparts

Medical spending per person is more than twice as high in the United States as it is in the United Kingdom, but middle-aged Americans are a lot less healthy than are similar-aged Britons, according to a new study by a team of researchers at the RAND Corporation, University College London, and the Institute for Fiscal Studies in London. Full results of the new study appeared in the May 3 issue of the Journal of the American Medical Association.

The analysis was restricted to non-Hispanic whites in both countries. Researchers analyzed the results of representative samples of these residents age 55-64 from several large surveys conducted in each nation from 1999 to 2003.

Middle-Aged Americans Are More Likely Than Their English Counterparts to Suffer from Diabetes, Cancer, and Heart Disease

SOURCE: “Disease and Disadvantage in the United States and in England,” The Journal of the American Medical Association, Vol. 295, May 3, 2006, James Banks, Michael Marmot, Zoe Oldfield, James P. Smith. NOTE: The numbers are adjusted to take account of differences in drinking, smoking, and being obese/overweight.

The research showed that Americans between the ages of 55 and 64 suffer from diseases such as diabetes, lung cancer, and high blood pressure at rates up to twice those seen among people of similar ages in England. The figure shows the prevalence rates for diabetes, cancer, and heart disease, with the black bars comparing total prevalence rates in this age group in the two countries.

The prevalence of diabetes was twice as high in the United States (12.5 percent), compared with England (6.1 percent). The cancer rate was nearly twice as high in America (9.5 percent versus 5.5 percent), and heart disease was 50 percent more common among middle-aged Americans than among their English counterparts (15.1 versus 9.6 percent).

Because the differences are based on self-reports, the differences could simply be the result of Americans’ greater willingness to report illnesses. But researchers also analyzed separate studies that collected blood samples from participants to look for biological markers of disease. “It’s not just a difference in how people characterize their own health. The biological measures confirm that there is a difference,” said James Smith, a RAND economist and a study coauthor.

The colored bars in the figure show that the self-reports of poorer health were seen across all economic groups in the United States compared with their English peers, not just among the poor, who are generally perceived as having more health problems.

People with low incomes in the two nations were more likely to report being sick than were people with high incomes, except with respect to cancer. But because of the overall differences between the two nations, those at the top of the income scale in the United States reported rates of diabetes and heart disease similar to those at the bottom of the income scale in England.

Researchers say that differences in health between the two countries are not fully explained by lifestyle factors, such as smoking, drinking, excess weight, and lack of exercise. Smoking behavior is similar in the two nations, while excessive drinking of alcohol is more common in England. Obesity is more common in the United States. Researchers estimate that lifestyle factors account for less than half of the differences seen between middle-aged people from the United States and England.

The two nations also have different health systems, with the United Kingdom providing universal publicly funded health care for all households, while the United States has universal publicly funded health care only for citizens over age 65. But over 94 percent of the American sample had access to health insurance. Thus, lack of insurance cannot explain the findings either.

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Highest Safety Risks Found at Small Worksites of Larger Businesses, Not at Small Businesses

Previous research has shown that worksites with fewer than 20 workers generally have much higher fatality rates than do worksites with larger numbers of workers. Some have wondered if this pattern has reflected poorly on small businesses. No one, however, had compared the fatality rates by size of business as opposed to size of worksite.

A new RAND study has confirmed the existence of high risks at small worksites but has also found that employees at worksites of fewer than 100 employees were much safer when a small business owned the plant than when a larger business did.

The first result can be seen on the left side of the table: Death rates in the left column are always much higher than the death rates in the other columns. The second effect can be seen in the green boxes. For worksites with 1-19 workers, the death rate among workers in businesses having a similar overall total of just 1-19 workers is only 3.4 per 100,000, many times lower than the risk faced in worksites of comparable size but within larger businesses.

For worksites with 20-49 workers, the death rate for businesses of that size is 2.3, less than half the rate in the next two larger business categories. These results are all for the manufacturing sector, but the pattern was found to be the same for most other industry sectors studied — transportation/public utilities, wholesale trade, and services — except for retail trade.

The green boxes represent single-worksite businesses (where the employment of the worksite equals the employment of the business). Thus, for small workplaces, there could be a protective factor associated with being part of a single-worksite firm. The authors of the study speculate that this protective factor may be the result of having the owners of the business on-site.

Employees at worksites of fewer than 100 employees were much safer when a small business owned the plant than when a larger business did.

At small workplaces of much larger businesses, certainly those with 500 or 1,000 employees, owners are probably less likely to be on-site, and if they are, they will have less ability to oversee production. Further research is needed to determine whether these speculations have merit.

The study argues that the respectable safety record at small single-site businesses may justify lighter regulatory intervention of them. Meanwhile, instead of focusing exclusively on worksites, the federal Occupational Safety and Health Administration (OSHA) might focus on medium-sized businesses (with 20-999 employees) that have small worksites (with 1-19 workers), because those worksites, as shown among those highlighted in red, have by far the highest fatality rates.

If fatality rates for small worksites in these medium-sized businesses could be reduced to the rates found for small worksites in either the smallest or the largest businesses, more than two-thirds of workplace fatalities at the medium-sized businesses would be prevented.

The study used data from OSHA accident investigation reports from 1992 to 2001.

For more information:
Small Businesses and Workplace Fatality Risk: An Exploratory Analysis, ISBN 0-8330-3944-X, 2006.

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Advanced Nations Will Benefit Most from Future Technologies, Study Finds

The world is in the midst of a technology revolution that shows no signs of abating, but not everyone will benefit equally from it. “Where people live will have a big impact on how new technology applications affect their personal health and standard of living and the environment,” said Richard Silberglitt, one of the lead authors of a new RAND study.

Researchers identified 16 technology applications that seemed to have the greatest likelihood of being widely commercially available, enjoying significant market demand, and affecting multiple sectors (such as water, food, energy, health, and education) by 2020. Researchers then analyzed the capacity of 29 representative countries — selected for variation in size, region of the world, and sociopolitical conditions — to acquire those 16 applications.

National capacity was measured in terms of multiple social, economic, and cultural variables that might act as implementation drivers or barriers. These variables included cost and financing, infrastructure, social values, public opinion, and politics.

The table shows that the countries fall into four capability levels based on their capacity to acquire technology applications. (The countries in each level would be able to acquire the technologies in that level and in the levels below, as shown in the table.)

According to the study, China and India lead the group of “scientifically proficient” countries, and their ability to adapt new technologies supports their emergence as military and economic powers. However, if they are to advance, they need to continue to make progress with respect to financial institutions, legal and policy issues, rural infrastructure, environmental protection, research and development investments, rural education and literacy, and governance and stability.

The study notes that some scientific advances will be controversial for environmental, privacy, religious, or other reasons. These advances might not take hold even if they are technologically feasible. For example, radio-frequency identification tagging has already raised questions of privacy that could limit its use.

If scientifically advanced countries are to stay ahead, they will need to ensure that laws, public opinion, investment in research and development, and education and literacy are drivers for, and not barriers to, technology implementation, the report concludes.

For more information:
The Global Technology Revolution 2020, In-Depth Analyses: Bio/Nano/Materials/Information Trends, Drivers, Barriers, and Social Implications, ISBN 0-8330-3975-X, 2006.

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Airbus or Boeing Derivatives Favored for U.S. Air Force Tankers

An extensive RAND study has concluded that the most cost-effective way for the U.S. Air Force to replace its aging fleet of KC-135 aerial refueling tankers is to acquire a fleet of new commercial aircraft derivatives — with candidates based on either medium-sized or large passenger jets manufactured by either Airbus or Boeing.

The KC-135 fleet is almost 50 years old and has been prone to technical difficulties and increased costs of operation.

Without aerial refueling tankers, the United States would be unable to effectively deploy or operate air power overseas or to operate effective homeland defense air patrols. But the KC-135 fleet, the backbone of current refueling capability, is almost 50 years old and has been prone to technical difficulties and increased costs of operation.

The team of more than two dozen researchers compared the cost-effectiveness of a wide range of alternative aircraft and replacement schedules. The most “cost-effective” alternative was defined as the one that could meet the military aerial refueling requirement at the lowest cost.

AP PHOTO/U.S. NAVY   A KC-135 tanker refuels two F/A-18C Hornets over Kuwait on April 3, 2003. Hornets dropped bombs over Iraq in support of Operation Iraqi Freedom.

The study found that a fleet of new medium to large commercial derivatives — based on either the Airbus 330 and 340 or the Boeing 747, 767, 777, and 787 — is the most cost-effective alternative. Fleets consisting of two kinds of such aircraft have comparable cost-effectiveness as those consisting of only one kind. Other options, including used commercial derivatives, smaller or larger commercial derivatives, and a range of noncommercial alternatives (including unmanned or stealthy tankers), are less cost-effective.

The study also looked at the timing of recapitalization of the tanker fleet. It found that if the new fleet meets or exceeds the future aerial refueling requirement, then the timing of the recapitalization does not significantly affect the total cost of all tanker acquisitions and operations. In that case, the timing should depend on considerations other than cost, such as technical risk associated with the KC-135 fleet, the additional capabilities that new tankers would offer, or uncertainties that could reduce their desirability.

However, if meeting the future requirement necessitates additional tankers, then the cost of closing the requirement gap will be greater the more rapidly the additional tankers are acquired.

For more information:
Analysis of Alternatives (AoA) for KC-135 Recapitalization: Executive Summary, RAND/MG-495-PAF, 2006.

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