You can add Canadians to the list of foreigners who are healthier than Americans. Americans are 42 percent more likely than Canadians to have diabetes, 32 percent more likely to have high blood pressure, and 12 percent more likely to have arthritis, Harvard Medical School researchers found. That is according to a survey in which American and Canadian adults were asked over the telephone about their health.

The study comes less than a month after other researchers reported that middle-aged, white Americans are much sicker than their counterparts in England.

"We're really falling behind other nations," said Dr. Steffie Woolhandler, a co-author of the Canadian study.

Canada's national health insurance program is at least part of the reason for the differences found in the study, Woolhandler said. Universal coverage makes it easier for more Canadians to get disease-preventing health services, she said.

James Smith, a RAND Corp. researcher who co-authored the American-English study, disagreed. His research found that England's national health insurance program did not explain the difference in disease rates, because even Americans with insurance were in worse health.

"To me, that's unlikely," he said of the idea that universal coverage explains international differences.

Woolhandler said her findings were different in at least one important respect: In the Canadian study, insured Americans and Canadians had about the same rates of disease. It was the uninsured Americans who made the overall U.S. figures worse, she said.

The study, released Tuesday, is being published in the American Journal of Public Health. It is based on a telephone survey of about 3,500 Canadians and 5,200 U.S. residents in 2002-03. Those surveyed were 18 or older.

The results are based on what those surveyed said about their health. In contrast, the researchers in the American-English study surveyed participants and also examined people and conducted laboratory tests on them.

The new study found that 6.7 percent of Americans and 4.7 percent of Canadians reported having diabetes; 18.3 percent and 13.9 percent, respectively, reported having high blood pressure; and 17.9 percent and 16.0 percent said they had arthritis. The Americans also reported more heart disease and major depression, but those difference were too small to be statistically significant.

About 21 percent of Americans said they were obese, compared with 15 percent of Canadians. And about 13.5 percent of the Americans admitted to a sedentary lifestyle, versus 6.5 percent of Canadians. However, more Canadians were smokers — 19 percent, compared with about 17 percent of Americans.

About 42 percent of the Americans rated their quality of health care as excellent, while 39 percent of Canadians did.

Also, 92 percent of American women said they had a Pap test within the last five years, while 83 percent of Canadian women had. But Canadians have lower death rates from cervical cancer. "It's a little hard to interpret," Woolhandler said.

One more plus for the Americans: Fewer than 1 percent said they were unable to get needed care because of long waits, compared with 3.5 percent of Canadians.

However, about 80 percent of Americans had a regular doctor, while 85 percent of Canadians did. And nearly twice as many Americans said there were medicines they needed but couldn't afford (9.9 percent versus 5.1 percent).