More evidence that health in the United States is lagging behind other industrial nations.

Burkhard Bilger in the New Yorker looks at the growing height disparities between the U.S. and Europe. Even after controlling for immigration and race, increases in height in America have flattened out: American children today can expect to grow to be about as tall as their parents. But elsewhere in the industrialized world, heights are still on the rise.

If height were the only issue here, this wouldn’t be particularly interesting. But as it turns out, average height is a great indicator of the overall health of a population. Like life expectancy, it’s an objective measure of health outcomes, not a measure of inputs (such as total spending on health care—in which the U.S. is by far the world leader). Height is a particularly sensitive indicator for children’s health, since disease and poor nutrition early in life can permanently stunt growth.

And contrary to intuition, most of the height difference among different nations or populations is due to health and nutrition, not genetics. Yes, tall parents do tend to have tall kids, but different populations don’t differ that much in height; as Bilger puts it, “If Joe is taller than Jack, it’s probably because his parents are taller. But if the average Norwegian is taller than the average Nigerian it’s because Norwegians live healthier lives.”

So what to make of the poor performance of the U.S. in comparison with other countries? It’s actually consistent with other health data. A century ago, U.S. residents were probably the healthiest in the world. Today, the U.S. ranks about 26th in life expectancy, behind all industrial democracies but the Danes, behind Costa Rica and Cyprus, and just a bit ahead of Cuba. (One local example: British Columbians live two years longer than US northwesterners, and the gap is growing.) Deciphering the causes of the relative decline is no easy task. But the data certainly suggests that high GDP, or massive spending on health care, are no guarantees of a healthy society.