Despite the widespread claims from politicians, providers, and even many members of the public that American health care is the best in the world, a new report from the Institute of Medicine concludes that growing up in the United States actually puts people’s health at risk compared to other wealthy nations. There are a number of factors involved. Chief among them are deaths from gun violence, car accidents, and drug overdoses, the rates of which are significantly higher in the U.S. than elsewhere in the developed world.

It appears that these dramatic differences in what are, essentially, preventable causes of death among our young people help to explain much of the reason why the United States routinely lags behind other countries when it comes to life expectancy. And these sorts of issues are more in the domain of public health than they are the health care system, which begins to raise some interesting questions about how we are allocating our limited resources.

We already know from earlier research that medical care is only responsible for about 10 to 15% of the avoidable mortality in this country. Sociobehavioral factors play a much larger role–nearly 50%–with genetics and the environment accounting for the remainder. So, it seems clear that we need to do more to reduce access to guns, keep our kids (and adults) off drugs, promote policies to encourage safer driving (or consider investing in more public transportation so that we drive less overall), and continue to work on getting people to eat healthy foods and exercise regularly. It would appear that we have our work cut out for us.

Of course, many readers will not agree that government has a role in encouraging these activities. To the conservative or libertarian, these personal decisions are just that–personal–and government has no right to intrude. I would be inclined to agree if our American society as a whole didn’t wind up responsible for the costs of those personal decisions. Unfortunately, that’s not the case. Thus, until we decide to shift our focus more in the direction of public health activities, or promote policies of complete and total individual responsibility, we will continue to pour ever-increasing gobs of money down the health care drain, and all of us will have to pay the plumber.