The End of the Population Pyramid

The issue of overpopulation has been a bugbear of the popular imagination for decades, and remains so especially into the 21st century, when humanity crossed its seven billion mark — unprecedented in both size and scale of growth (consider that while it took millennia for humanity to finally reach a billion only in 1804, it took just another two centuries to hit seven times that number).

Given all that, it is perfectly understandable why people would be concerned about the impact such rapid growth is having on everything from the environment to global food supplies and energy resources (to say nothing of the subsequent social, political, and economic instability that results from such strains).

But as the following video from The Economist shows clearly, the global population — though set to grow by another two billion by 2042 — has already begun slowing down in its rate of expansion.

An excerpt from the original article nicely sums up the visual data:

 The pyramid was characteristic of human populations since the day organised societies emerged. With lifespans short and mortality rates high, children were always the most numerous group, and old people the least. Now the shape of the global population is changing. Between 1970 and 2015 the dominating influence on the global population was the fertility rate, the number of children a woman would typically bear during her lifetime. It fell dramatically over the period, meaning that the world shifted from having larger to smaller families. The age groups start to become markedly smaller only about the age of 40, so the incline starts much further up the chart than with the pyramid. The shape looks more like the dome of the Capitol building in Washington, DC. Between 2015 and 2060 the biggest influence upon the population will be ageing. Small families are already becoming the norm, the fall in fertility is slowing down and now almost everyone is living longer than their parents—dramatically so in developing countries. So, by 2060, the dome will have come and gone and the shape of the population will look more like a column (or perhaps an old-fashioned beehive).

In other words, barring any sort of unlikely massive uptick in the global birthrate, humanity is currently entering its peak of population: shortly after hitting nine billion, growth will begin to stagnate as the number of people of childbearing age declines.

Indeed, a map of fertility rates by nation shows that most of the world’s countries (many of them developing) are already experiencing slowing, stagnating, or even shrinking populations.

Total fertility rates as of 2013. Courtesy of Wikipedia / CIA World Factbook.

Keep in mind that a fertility rate between 2-3 (green) is considered the sweet spot for stable growth: any lower and you face rapid population aging followed by, and concurrent with,population shrinking (unless immigration is high enough to offset the difference); any higher, and populations grow too quickly for resources and institutions to accommodate. Both circumstances bring their own challenges and issues, which in turn vary from country to country.

But note how the majority of the world’s population growth is taking place in the developing world, especially in Africa (where not a single country has a total fertility rate of less than 2. Indeed, as The Economist video showed, 90 percent of the world’s youth will be living in emerging economies, with Africa having more young people than any other continent.

Conversely, it is mostly mid- to high-income countries whose fertility and birth rates are low, and whose populations have already begun stagnating, if not shrinking. The few exceptions — namely the U.S., Canada, the U.K, Ireland, and France — are growing mostly due to immigration and the subsequent increase it brings to the birthrate (since immigrants tend to have more children than native-born individuals).

The following map shows the population growth of the world’s countries by percentage between 2000 and 2010.

Courtesy of Wikipedia / United Nations. Note: data vary by source.

Notice again a similar pattern: broken down by country, most of the world is seeing low to negative population growth, even if the world as a whole is growing. Basically, the global population is growing highly unevenly, with a relatively small number of countries making up the lion’s share of total growth.

Moreover, as the video showed, much of this population “growth” is really a reflection of more people living longer: previously, population stabilized or shrank because enough people would die by the time the next generation came of age to have children. But as more people stick around longer, even the effects of a low birthrate will not be felt since so many people remain.

Hence why countries like Germany and Japan — which have long had some of the lowest fertility rates, and thus fastest-aging populations, in the world — did not begin to experience stagnation or decline until decades later. Their peoples are also among the longest-lived (note that higher immigration as of late has lead to modest but noticeable growth in Germany).

So what is the significance of all this? Well, there are many issues and challenges facing the world now and in the future as population dynamics rapidly change. Frankly, I do not have time to get into the larger social and economic ramifications of having whole societies without enough working-age adults; too many older people strains social security systems

But with regards to the most commonly cited concern — that of overpopulation straining resources — the solution is simple to recognize but difficult to implement: more efficient allocation of resources on a global level.

There is plenty of capital, food, and energy in the world to go around, but most of it is concentrated in and consumed by a wealthy few nations (and within those nations in turn, by a wealthy few people). Finding a way to allocate such resources to where it is needed most would lift hundreds of millions from poverty.

Consider that food output is well above what is needed, but that chronic malnourishment afflicts hundreds of millions of people — especially in fast-growing populations — because much of that food does not go to the poorer parts of the world, and 40 percent is wasted altogether. (To further underline this misallocation, in recent years the number of overweight and obese people in the world has outnumbered the malnourished.)

Moreover, shrinking wealthy countries could benefit from taking in the younger workers overflowing fast-growing poorer nations — as several immigration-friendly nations are experiencing — but there is (and would be) much resistance.

Perhaps as the world continues to develop its global consciousness — and with it the necessary global institutions to implement such policies — we will find a mutually beneficial way address the mismatch in demographic changes. There is a lot more to this topic that I have not touched on given my time constraints, but as always I welcome your thoughts and feedback.

The Greatest Threat to the World?

There seems to be no shortage of candidates for greatest threat to the world (by which we usually mean humanity specifically) — climate change, world war, nuclear weapons, a pandemic, an asteroid, or maybe even a combination of these factors. As it turns out, however, where you live determines what you consider to be most dangerous to the rest of the world.

That is the conclusion of a recent survey by the Pew Research Center, which asked 48,643 respondents in 44 countries what is the greatest danger to the global community (note, this took place before the breakout of Ebola but after events like the Syrian Civil War and the showdown between the West and Russia over Ukraine).

As Mic.com reports:

In the United States and Europe, income inequality came out on top. In the Middle East, religious and ethnic was considered the biggest threat. While Asia listed pollution and the environment, Latin America cited nuclear weapons, and Africa chose AIDS and other diseases.

Unsurprisingly, the concerns fell largely within geographic and regional boundaries. The United States and Europe are home to some of the largest and most advanced economies in the world, so it’s somewhat expected — if ironic — that they’re worried about income inequality. Asia is home to 17 out of the 20 most polluted cities in the world, and, as of 2012, sub-Saharan Africa accounted for 70% of the world’s AIDS cases.

In other words, all of us appear to have an exceptionally narrow view of the world: We see the biggest threats to our region as the biggest threats to everyone else, too.

Here is a visual representation of that data, also courtesy of Mic.com:

Moreover, the perception that religious and ethnic hatred poses the greatest threat to the world has seen the most growth over the past seven years, no doubt due to numerous high-profile sectarian conflicts across the planet.

Courtesy of The Atlantic is a color-coded map of the world that better shows how these great threats are geographically and culturally spread out:

A few other observations of the data from The Atlantic piece:

  • Other than Japan, the countries that saw nuclear weapons as their biggest danger included Russia (29 percent), Ukraine (36 percent), Brazil (28 percent), and Turkey (34 percent).
  •  The U.K.’s greatest concern was religious and ethnic hatred (39 percent), putting it in the same group as India (25 percent), Israel (30 percent), the Palestinian territories (40 percent), Lebanon (58 percent), and Malaysia (32 percent).
  • People in France were equally divided on what they consider the biggest threat, with 32 percent saying inequality and the same percentage saying religious and ethnic hatred.
  • Likewise in Mexico, nuclear weapons and pollution were tied as most menacing, at 26 percent.

It is also important to point out that in many cases, no single fear was dominant: in the U.S. for example, inequality edged over religious and ethnic hatred and nuclear weapons by only a few points. And in almost every region, anywhere from a fifth to a quarter of respondents expressed fear towards nuclear weapons (which I feel can be taken to mean war among states where the use of nukes is most likely). The survey observed that in many places, “there is no clear consensus” as to what constitutes the greatest danger to humanity, as this graph of all countries shows:

These results are very telling: as the earlier excerpt noted, you can learn a lot about a country’s circumstances based on what its people fear the most. Reading backwards from the results, it makes sense that what nations find the most threatening is what they have been most imperiled by presently or historically.

It is also interesting to note how societies, like individuals, view the world through their own experiential prism: because we are obviously most impacted and familiar with what immediately effects us, it makes sense that we would project those experiences beyond our vicinity. Just as our own individual beliefs — be they religious, political, social, etc. — are colored by personal life experiences, so too do entire nations often apply their most familiar concerns and struggles to the world at large.

Of course, this varies by country as well as by the respondents who represent said country; in many cases, participants are more likely come from higher educational and socioeconomic backgrounds, and thus reflect their class views rather than that of their wider society. (Admittedly, I am not sure if that applies to this particular Pew survey, as the respondents were interviewed by phone or face-to-face, with no indication as to their background.)

For my part, I personally put the most weight behind climate change, especially as it can exacerbate a lot of existing issues over the long-term (clashes among ethnic/religious groups over strained resources, refugees fleeing crop failures and placing strain upon host countries, etc.). What are your thoughts and opinions regarding the world’s greatest threat?

Chart: Global Wealth Distribution

Since I have been on a bit of an infographic kick lately, here is yet another interesting chart courtesy of The Economist, which measures an issue dear to my heart: wealth inequality. The contrasts inherent in it are quite sobering:

To recap, there are around 35 million millionaires in the world, constituting just 0.7 percent of the adult population — yet together, they hold 44 percent of the world’s total wealth of $262 trillion (up from $117 trillion in 2000). This is an increasingly common arrangement in most parts of the world, so it is little surprise that the same plays out on the international stage, especially as globalization proliferates the systems and trends that contribute to this top-heavy concentration of wealth.

Here are some additional details from the article:

Today 94.5% of the world’s household wealth is held by 20% of the adult population, according to new data from Credit Suisse. Wealth is so unevenly distributed, that you need just $3,650 (less debts) to count yourself among the richest half of the world’s population. A mere $77,000 brings you among the wealthiest 10%. And just $798,000 puts you into the ranks of the 1%—within the reach of many white-collar urban professionals in the West. Hence, more than 35m people carry such a plump purse. Among the three billion adults at the bottom with less than $10,000 in wealth, 90% reside in developing countries. Yet 15% of millionaires live in developing countries too.

Such a stark contrast in fortunes, especially with so much of the world remaining poor despite all the growth in wealth, does not bode well for the economic and sociopolitical stability of this planet (much less of many individual nations, where circumstances are even more dire). What are your thoughts and reactions?

World’s Biggest Economies — GPD Per Capita

In a previous post, we looked at the world’s largest economies during the past 2,000 years. To recap, China and India both overwhelmingly dominated the global economy for much of this period, being superseded only 100 years ago (only to begin rising once more at the turn of the 21st century).

This time around, we will see the world’s top three richest economies during the same period, but based on GDP per capita (e.g. adjusted by population). As before, The Economist is the source, and the results are pretty interesting.

Since I am busy today, I will not have the time to weigh in on these results as before — I will leave that to you all!

Graph: The U.S. Leads the Way in Low-Wage Work and Pay

As has sadly been the case all too often these days, one of the latest reports from the Economic Policy Institute, an American think-tank, is grim: low-wage workers (the 10th percentile of wage earners) have seen their real pay decline by five percent over the 1979-2013 period, despite concurrent productivity gains of 64.9 percent.

Consequently, American low-wage workers fare the worst in the developed world: according to the OECD, as of 2012, they earned just 46.7 percent of what a median worker worker does, far below the OECD average of 59.9 percent; to catch up to that average, U.S. low wage workers would need a 28 percent raise in their wages.

The graph below highlights this issue rather starkly:

Note that over a quarter of America’s labor force — 25.3 percent to be exact — is low wage, which is defined as earning less than two-thirds of the median wage. On this metric, too, the United States ranks the highest among the 26 countries surveyed, and far higher than the OECD average of 16.3 percent.

Thus, the U.S. has the largest number of low-paid workers in the developed world, and they in turn are the lowest paid in the developed world. And while several countries, such as the U.K., Ireland, and Canada, come close, most of them at the very least have more developed social safety nets to offset the shortfall among low-wage workers (universal healthcare alone is a major mitigating factor, given that medical bills account for many cases of bankruptcies among the American poor).

Setting aside the considerable amount of misery that comes with low paying and often menial labor, the broader impact on the long-term prosperity of the nation cannot be understated: with one out of four workers (and their dependents) having so little income, consumer demand — the lifeblood of the economy — stagnates. Fewer people are able to afford an education or vocational training, leading to a lot of untapped and desperately needed potential.

All this despite the nation’s economic elites — its executives, shareholders, and investors — broadly doing better than ever. Is it really so untenable for companies to spare some of their record, post-recession profits to improve the plight of their beleaguered workers — i.e. the consumers and patrons they all so badly need?

 

In any case, this is a point I have made too many times before, so instead of retreading it once more, I will leave you with this illuminating report by  Elise Gould (also from EPI) on Why America’s Workers Need Faster Wage Growth—And What We Can Do About It. As always, feel free to share your thoughts and feedback.

Hero Highlight: Kailash Stayarthi

As many readers know, the 2014 Nobel Peace Prize rightly went to Malala Yousafzai, who at 17 is the youngest Nobel laureate in history, for her courageous advocacy of women’s rights to education and equal opportunity (both in her native Pakistan and across the world). For this she was subject to a high-profile assassination attempt that nearly claimed her life and forced her and her father (the equally courageous Ziauddin Yousafzai) to flee to the U.K.,from where they nonetheless continue to fight for various human rights causes).

Although an already (justifiably) global figure by the time of her widely anticipated award, Malala’s co-recipient was unfortunately lesser known outside humanitarian circles and his native India: children’s rights activist Kailash Satyarthi (the Prize Committee was explicit about the symbolic message of selecting a Pakistani Muslim and Indian Hindu to share the prize). Such a pairing is well-warranted, for together with Malala, he has helped bring attention to, and advance the cause of, helping one of the world’s most vulnerable demographics.

Satyarthi has been a leading figure in fighting child slavery and labor exploitation for nearly three decades, beginning with his founding of Bachpan Bachao Andolan (Save Childhood Movement) in 1980, which campaigns to free children from bondage and promote their education. It has so far freed over 80,000 children from servitude, also helping to successfully re-integrate, rehabilitate, and educate them.

Since that time, his storied career in human rights has spanned numerous other movements and groups — he has served as secretary general for for the Bonded Labor Liberation Front; has been involved with the Global March Against Child Labor and its international advocacy body, the International Center on Child Labor and Education (ICCLE); founded Goodweave, the first voluntary monitoring and certification system for rugs manufactured without the use of child-labor in South Asia; and co-founded the Global Campaign for Education, for which he served as president of from its inception in 1999 to 2011.

A clearly energetic and dedicated figure, a recent article in The Guardian highlights just how active Satyarthi is on this front, going so far as to involve himself directly in the risky operations on the ground:

He would show the scars from the interventions that had gone really badly, like the time a group of men from the Great Roman Circus – who were employing trafficked teenagers from Nepal as dancing girls – attacked him with iron rods and cricket bats.

And we would discuss the industries and the places that were proving harder to rid of the “scourge of child labour”– his phrase – than others.

With Kailash’s guidance and contacts, I pursued stories on Indian children making footballs for sale in Australia; girls sold into bonded labour schemes in textile mills; boys from poor families trafficked thousands of kilometres to work in tiny, collapse-prone ‘rat-hole’ coal mines; girls from itinerant families forced by economic circumstance into mining mica, the mineral that goes into makeup to make it shiny.

From direct intervention, to constantly shining a spotlight on this often ignored issue, Satyarthi is as unrelenting as Malala in ensuring that the fight for human rights continues onward, unabated. Quoting a telling part of The Guardian piece:

But always there was more with Kailash: more stories the media could cover to highlight the problem; more that the government could do to enforce the legislation parliament had passed to outlaw child labour and mandate education; more police could do to stamp out the corruption that meant officers looked the other way; more that multinational companies in the developing world could do to ensure they weren’t making their money from the bent backs of children.

Like Malala, he places a considerable emphasis on education as a means to uplift the plight of children and, subsequently, improve the condition of millions of people worldwide for years to come:

Children in schools will change the world.

Girls born to a literate mother are 50% more likely to survive until the age of five.

Boys who have the chance at a genuine education and a working life beyond don’t become radical fundamentalists.

Universal education will transform developing nations such as India, Pakistan and Bangladesh, places where the practice of keeping children (especially girls) from school – to work, to be married, to raise siblings – stubbornly persists.

Across those three countries, an estimated 22 million primary-school aged children are not in school. But, overwhelmingly, the obstacles that keep them from class are solvable.

Malala was stopped from going to school by the vile fanaticism of the Pakistani Taliban. But for every girl stopped by fundamentalism, there are 10 in her part of the world who are not at school for much more prosaic reasons.

They don’t go because the school is too far away, because it is not safe to walk there, because there is no segregation of boys and girls, no modesty wall, or working toilets.

They stop going because the teacher turns up only to mark the roll and get paid, or because there are no books or pencils.

They stay at home because they have to care for younger siblings, because they have been married off as children, or because they are made to go to work.

In the wake of his Nobel win, Satyarthi promised to “join hands” with his fellow laureate. But the Indian man rescuing children from slavery and the Pakistani teenage girl encouraging them into school are already working hand in hand.

With an estimated 168 million children still living in bondage, deprived of an education and decent standard of living, their work is as relevant as ever. But with the number of such victims declining by a considerable 78 million since 2000, it is clear that the work of such tireless advocates is having an incredible impact. Let us hope that the spotlight of this year’s Nobel Prize does a bit more to advance this worthy cause.

Kailash Satyarthi and Malala Yousafzai (Source: India Today).

Chart: Educational Mobility Around the World

The Organisation for Economic Co-operation and Development (OECD), an international group of 34 mostly-rich countries, has published its most recent Education at a Glance report for 2014, which ranks countries according to the proportion of adults (those age 25 to 64) who are better educated than their parents. This helps to determine how well member countries are doing at improving educational opportunity.

The full study can be found in the hyperlink above, while The Economist has put together the results in the following chart (note that for the sake of fair comparison, developing countries like Turkey, Brazil, and Mexico are not listed).

The New York Times also reported on this study, providing an even more telling chart:

As the article noted, the U.S. is doing far poorly than a nation of its size and wealth should:

Barely 30 percent of American adults have achieved a higher level of education than their parents did. Only Austria, Germany and the Czech Republic do worse. In Finland more than 50 percent of adults are more educated than their parents.

And matters are getting worse, not better. Among 25- to 34-year olds, only 20 percent of men and 27 percent of women, both out of school, have achieved a higher level of education than their parents.

It’s even bleaker at the bottom: Only one in 20 Americans aged 25 to 34 whose parents didn’t finish high school has a college degree. The average across 20 rich countries in the O.E.C.D. analysis is almost one in four.

Moreover, as usual, it is the poorest and most vulnerable members of society that are hit the hardest: there is a wide and ever-growing income gap in the graduation rate of teenagers from lower-income backgrounds versus higher-income ones; one study found a sharp increase in the impact of family income on the likelihood of graduation.

Basically, you need an education more than ever to make decent money, but need more money than ever to get a decent education. In such a competitive, globalized economy, that catch-22 is not sustainable. This is all the more tragic given that the U.S. once lead the way in providing free or affordable education at all levels (the Times piece notes how decades ago, America was already educating far more of its citizens before European countries did).

Given that the OECD’s report runs over 500 pages long, I have not had the chance to read the complete findings. However, one highlight that did catch my attention was the following:

In Brazil, Turkey and the United States, adults without upper secondary education are the most penalised in their wages, earning, at best, 35% less than people with that qualification. In Chile, Brazil and Hungary, those with tertiary education are, comparatively, the most highly rewarded, earning more than double the income of a person with upper secondary education.

This is just a small snippet, but it suggests that education is not as vital for economic success across the board. Some countries, such as Austria and Germany, still manage to have largely prosperous middle-class societies despite low educational mobility, thanks to a relative abundance of vocational schools, job training opportunities, and well-paying low-skill work.

However, the overall trend is clear:

In all OECD countries, adults with tertiary education earn considerably more than adults with below upper secondary education. Between 2005 and 2012, in countries with available data for both years, the relative earnings of adults without upper secondary education either remained stable or fell, to some degree, when compared with earnings of adults with upper secondary education.

In addition, in most of these countries, earnings of tertiary-educated adults relative to earnings of adults with upper secondary education increased or remained stable during the same period; the only exceptions are Hungary and the United States.

These differences suggest that the demand for higher-level and updated skills have grown, and that individuals with lower levels of skills are even more vulnerable today

In much of the rich world — and increasingly in the developing world as well — an education remains more vital than ever for individual and societal prosperity. But is the solution to make education on all levels more accessible and affordable, or to instead develop economies in which even those without a formal education can succeed? Perhaps a bit of both? What are your thoughts?

 

The World’s Most Livable Cities

Which cities are the best places to live? The Economist Intelligence Unit (EIU) has set out to answer this question with its livability survey, which asses 140 cities based on such factors as overall stability (25% of total score), health care (20%), education (10%), infrastructure (20%) and culture and environment (25%) — the sorts of things most people agree are fundamental to individual and collective quality of life.

Here are the results for 2014, courtesy of Mic.com:

For the fourth year in a row, Melbourne took the top spot with a total score of 97.5 out of 100. The impressive score can be partially attributed to their perfect scores in the health care, infrastructure and education classifications. Several of Melbourne’s fellow Australian cities filled out much of the top 10, along with a handful from the Great White North. Combined, Australia and Canada scored big, claiming 7 out of the top 10 cities.

The remaining three cities were Vienna, Austria (2nd place), Helsinki, Finland (8th), and Auckland, New Zealand (10th).

As the article notes, while these top ten performed well in all the indicators measured, health care had a particularly strong impact:

A common factor of these livable cities was a high score in the health care category. The top nine spots all garnered scores of 100 in that category. To determine health care, the EIU looked at the availability and quality of private health care, availability and quality of public health care, availability of over-the-counter drugs, and general health care indicators.

Canada, Australia and New Zealand offer a variety of very livable cities, thanks in large part to their great health care, education, culture and environment, affording the countries general stability. Plus, as all English-speaking countries, they’re especially attractive destinations for any Americans considering a move.

Not only does being healthy have the obvious benefit of improving an individual’s mood, comfort, and longevity — all vital to life satisfaction — but in the aggregate, it improves entire communities. Healthy individuals are likelier to be more economically and socially productive, helping businesses and societies at large. They will be less burdensome to more expensive emergency services, and will have more disposable income on hand, since pooling the costs of health care through socialized insurance is less costly then spending a lot per person on expensive treatments.

But this study also highlight that there is more to quality of life than the bare necessities. Each of these cities offer an abundance of recreational and leisure options — well-kept green spaces, cultural centers, community events and facilities — that enliven individual lives and cultivate a sense of shared community. Good infrastructure provides access to these areas and events while helping to create more cohesion and interaction between various neighborhoods and enclaves. It is also telling that all the top cities are medium-sized, which suggests that being too big could present challenges to accommodating residents optimally.

All of this should be pretty obvious. But unfortunately, not enough municipal governments in the world, including in the U.S., have the vision and/or finances to make it happen, and too many city residents are apathetic, disenfranchised, or lack the community spirit to come together. Sub-national and national governments could be doing more to help local communities as well, especially as most countries, and the world at large, are either highly urbanized or becoming rapidly so. As cities begin to house more of the world’s population, and become the main drivers of economic, social, and cultural life, we need to work on making them as ideal for the human condition as possible. We have much to learn from the like of Melbourne, Vancouver, and other successful polities.

Melbourne, Australia — by some accounts, the best city in the world to live. Source: Getty Images / Mic.com

Nine Maps That Help Put Geography in Perspective

I cannot seem to embed the original video for some reason, so pay a visit to Business Insider to check out this neat minute-long video that shows how much large certain countries and landmasses are compared to their map projections. While the world is getting smaller in some respects, geographically it is still much larger than we realize .

Another Study Finds U.S. Healthcare System Among Worst

I know reports like these are a dime a dozen, especially in post-recession America, but it bears reaffirmation, if only because a fair number of Americans still seem to think that our system is vastly superior to any existing or hypothetical alternative — even though the social and economic costs are vast and growing.

Let us start with this chart, courtesy of i09, which comes from a new report by the Commonwealth Fund, a private U.S-based foundation that promotes a more efficient healthcare. It compares the results of an extensive survey of patients and physicians across ten developed countries, looking at several relevant metrics.

Notice that by all measures, the United States is either middle-of-the-road or dead last , despite spending the most per person by far — $8,508 compared runner up Norway at $5,669 (incidentally the latter also does not perform all that well). Canada, while comparatively more efficient at nearly half the cost, does not perform all that impressively either.

By contrast, the highest ranked country on average, the United Kingdom, spends just $3,405 per person on health care. Taken as a whole, it appears that per capita spending has little bearing on the overall quality and effectiveness of the healthcare system (something that has been noted in similar international studies). Another chart from the report confirms this:

Despite such astronomical spending, in both proportional and absolute terms, the report sums up the America’s performance thusly: “[the country] fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity.”

The culprit for such inefficiency? The very fact that many Americans lack access to reliable health care (including those who are technically insured).

Not surprisingly—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost. Patients in the U.S. have rapid access to specialized health care services; however, they are less likely to report rapid access to primary care than people in leading countries in the study. In other countries, like Canada, patients have little to no financial burden, but experience wait times for such specialized services. There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; however, the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.

However, as i09 notes, the study’s conclusion points to more than just broadening access:

The authors believe that the problems inherent in the U.S. healthcare system are so pervasive that it will take more than better access and equity to solve them. According to Karen Davis, lead author of the study, overall improvement “is a matter of accountability, having information on your performance relative to your peers and being held accountable to achieving a kind of care that patients should expect to get.”

But it’s not an intractable problem. The U.K.’s excellent result can be attributed to a number of reforms, including the hiring of more specialists, allocating bonuses to family physicians who meet quality targets, and adopting health system information that allows physicians to easily share information about their patients. Moreover, every citizen (apparently) has a doctor.

If there is any silver-lining, it is that the U.S. is moving in the right direction, if ever so slowly. In addition to the flawed but still impactful Affordable Care Act:

The U.S. has significantly accelerated the adoption of health information technology following the enactment of the American Recovery and Reinvestment Act, and is beginning to close the gap with other countries that have led on adoption of health information technology. Significant incentives now encourage U.S. providers to utilize integrated medical records and information systems that are accessible to providers and patients. Those efforts will likely help clinicians deliver more effective and efficient care.

Indeed, all of this attention towards the inefficiency of our healthcare system is leading to changes in both the political and private spheres. However, it will take a lot more than this piecemeal and hodgepodge approach to rectify what is very clearly a failing system. The solutions, while often difficult to implement, are clear, and both the necessary capital and public will is available. When will that be enough to spur necessary change?