Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Page 74 Page 75 Page 76 Page 77 Page 78 Page 79 Page 80 Page 81 Page 82 Page 83 Page 84 Page 85 Page 86 Page 87 Page 88 Page 89 Page 90 Page 91 Page 92 Page 93 Page 94 Page 95 Page 96 Page 97 Page 98 Page 99 Page 100 Page 101 Page 102 Page 103 Page 104 Page 105 Page 106 Page 107 Page 10873 CHAPTER 4 | CROSS-NATIONAL HEALTH DISPARITIES AND US DISADVANTAGE Lack of physical activity, caloric intake, time spent on cooking, and time and money spent on eating at home and away from home are all associated with obesity, but not consistently so across countries. For example, men from Spain and Italy have the highest levels of physical inactivity but lower levels of obesity than American men who are slightly more active. Whereas physical activity is strongly correlated with obesity in the US, it is only weakly associat- ed with obesity in southern European countries. Eating out is also much more prevalent in the US and associated with obesity; in Europe, there is no clear association between eating out and obesity rates. A strong association between SES and obesity appears across all countries with lower SES linked to higher weight. Yet account- ing for the differences in physical activity and other behavioral risks in this study, the gradient between SES and obesity is not eliminated. Moderate alcohol use is shown to have health benefits, but the amount of alcohol use consid- ered harmful depends on age. Ten percent of US men, 28.6% of English men, 2.9% of US women, and 10.3% of English women drink more than the US National Institute on Alcohol Abuse and Alcoholism recommended limit for people aged 65 and older (Lang et al. 2007). However, physical functioning and mortality outcomes in older people with alcohol intakes above US recommend- ed levels for the old (but within recommendations for younger adults) are not poor in either country. Inclusion of health behavior risks —  smoking, obesity, low physical activity levels, and alcohol consumption — explains part but not all of the cross-national health disparities, according to Banks et al. (2006), Avendano et al. (2009), and Crimmins, Garcia and Kim (2010). Moreover, these risks are also socially and economically patterned, and research using HRS and sister studies investigates the possibility that they can help explain some of the SES-health gradient. Yet after accounting for health behaviors, poorer Americans remain at significantly greater risk for disease than their English or European counterparts. Higher wealth Americans report similar health to much poorer Europeans (Avendano et al. 2009). 0% 5% 10% 15% 20% 25% 30% 35% United States Austria Germany Sweden Netherlands Spain Italy France Denmark Greece Total Europe Men Women FIGURE 4-4  Percent obese in the US and Europe: 2004 Source: Michaud et al. (2007).