5 ms·

Very long and well argued review of sources of excess mortality in developed countries. Bottom line: Obesity! and other non-medical factors like automobiles. Bi

Very long and well argued review of sources of excess mortality in developed countries. Bottom line: Obesity! and other non-medical factors like automobiles. Big implications about how we should spend money to increase life expectancy.

hdlothia 7y ago
Can you explain the conclusion of this article to me? I don't fully understand what he is trying to say.what are the implications? That the only improvement we can make on the american healthcare system is to fight obesity better?
- whatshisface 7y ago
  By far the biggest health improvements that could be made in America would be reductions in obesity and reductions in vehicle fatalities. Whether that's the best area of focus depends on the relative difficulty of the improvements - if one second and one penny could save one person, that would be a higher priority than spending a million dollars and one year to save a thousand (even though both would be on the list for doing some time.)
  - allovernow 7y ago
    Honestly, if our biggest barrier to healthy longevity has been reduced to automobile accidents, society is in pretty damn good shape considering how safe modern vehiclular travel is.
    - s1artibartfast 7y ago
      >society is in pretty damn good shape considering how safe modern vehiclular travel is While driving at large is safe, there are a few high risk subsets of driving: speeding, drunk driving, and inclimate weather.
- rayiner 7y ago
  There are two points to the article. 1) Healthcare spending has rapidly diminishing returns, not only comparing the US to Europe, but comparing countries within Europe (such as the Netherlands versus Spain). 2) The lower life expectancy in the US can be explained mostly by higher obesity. US states with similar obesity to European countries have similar life expectancy.
  - hackeraccount 7y ago
    I haven't looked at the numbers. Barely read the article. I bet he's wrong though. I would think it'd be a love affair with firearms (Fuck Yeah. ) and a lot of driving. Every time I read about weight the dangers of an extra 10 lbs. seem to be pretty ambiguous. Though I'm totally going to drop that 10 lbs. I only had 2 donuts today.
    - nradov 7y ago
      An extra 10 lbs isn't the issue here. The average American man is now 23 lbs overweight.
      - s1artibartfast 7y ago
        It is much worse than that. 40% of american men are obese, which,for the average body type, is ~50 lbs above normal. From wikipedia: >The National Center for Health Statistics at the CDC showed that 39.6% of US adults age 20 and older were obese as of 2015-2016 (37.9% for men and 41.1% for women).[1] Obesity in an adult is defined as a BMI of 30 and above. The Average american male is 5'10. A "normal healthy" BMI of 22 is 153 lbs. A BMI of 30 is 209 lbs. [2] [1] https://en.wikipedia.org/wiki/Obesity_in_the_United_States https://en.wikipedia.org/wiki/Obesity_in_the_United_States [2] https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_tbl.htm https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi...
  - smt88 7y ago
    Re: #2, my understanding from friends at the CDC is that lower life expectancy is due to lower incomes (meaning food, medicine, and doctor visits are unaffordable even with health insurance), suicides, and the opioid crisis. Suicides and obesity can also be caused by low income and drug abuse, so it sounds like the author may be seeing causation where correlation is more accurate.
- hackeraccount 7y ago
  So I just skimmed but I think the point he's making is that Public Health and Healthcare are 2 different things. Public Health is - get some exercise. Don't drink. Keep a reasonable weight. Don't do drugs. Avoid getting shot. Get vaccinated. Don't drive a lot. Almost all of these things aren't really "Healthcare". I don't need to go to a Dr. to know I should lose 10 lbs. Maybe - maybe, maybe - a Dr. can help me quit heroin (frankly I doubt it) and certainly a Dr. can give me a flu shot. Most of "healthcare" money has nothing to do with longevity. If my buddy had a heart attach you can spend $500,000 on treatment. Heck, you can give him a new heart. It's all great. Who would say no? Not me. (He's my buddy after all). At population scale though that does nothing for longevity. At population scale you'd be better off setting the speed limit to 40mph. Taxing alcohol to high heaven. Playing tons of old Erol Flynn movies (To encourage people to get into sword fights instead of gun fights.) None of that stuff is sexy though. Even the non-crazy version of that list is un-sexy. It probably doesn't cost a lot of money but it royally pisses off people. People also vote. They don't like it if you try to run their lives for them - even if you would technically do a better job then those idiots do. Except for me. And I'm going to lose that 10 lbs. really soon.
  - Angostura 7y ago
    In the UK now, if you go to the GP with an ailmentr, you are quite likely to be prescribed joining the local Parkrun group, or other 'public health' measures.
    - s1artibartfast 7y ago
      GPs in the US also tell people to exercise and lose weight.
- analog31 7y ago
  I'm not sure the article addressed it, but it appears that we could improve the US healthcare system by making it cheaper without losing quality, simply by letting another country run it for us. If there's no gain from spending more, then there should be no loss from spending less, assuming that we get to restructure the system accordingly.
jorblumesea 7y ago
> Obesity! and other non-medical factors like automobiles Socialized medicine and other forms of "planned state healthcare" seem to do a better job promoting lifestyle changes and preventative medicine, which reduces the costs of these externalities.
- jedharris 7y ago
  Makes sense to me, but I would like to have specific data that would help me understand: - How much money work needs to be invested for what incremental effect? - What kinds of investments are most effective? - How much does effectiveness depend on specific cultural factors, vs. being culture independent? And many more similar questions.
- virmundi 7y ago
  Could it be that the socialized medical systems of which you speak are Western? Many of the European systems exist within a realm where people ate and continue to eat relatively healthy food due to historical circumstances. Further, they had and continue to have economies based around the idea of walkable cities. These two factors reduce the chances of obesity and the risk of death due to cars. The only way for America to approach either of these is to have everyone one to move into planned mega-cities.
- xyzzyz 7y ago
  The socialized medicine in my home country does pretty much nothing to promote healthy lifestyle. People generally are healthy and not obese, but socialized medicine have nothing to do with it, it’s rather the culture at large that’s responsible.
nradov 7y ago
Yes we are well into diminishing returns for medical interventions. Many of us are digging our graves with our teeth. While the USA seems particularly bad in that regard other wealthy, industrialized countries are on the same general trend line and will eventually face similar problems.

hdlothia 7y ago

Can you explain the conclusion of this article to me? I don't fully understand what he is trying to say.what are the implications? That the only improvement we can make on the american healthcare system is to fight obesity better?

whatshisface 7y ago
By far the biggest health improvements that could be made in America would be reductions in obesity and reductions in vehicle fatalities. Whether that's the best area of focus depends on the relative difficulty of the improvements - if one second and one penny could save one person, that would be a higher priority than spending a million dollars and one year to save a thousand (even though both would be on the list for doing some time.)
- allovernow 7y ago
  Honestly, if our biggest barrier to healthy longevity has been reduced to automobile accidents, society is in pretty damn good shape considering how safe modern vehiclular travel is.
  - s1artibartfast 7y ago
    >society is in pretty damn good shape considering how safe modern vehiclular travel is While driving at large is safe, there are a few high risk subsets of driving: speeding, drunk driving, and inclimate weather.
rayiner 7y ago
There are two points to the article. 1) Healthcare spending has rapidly diminishing returns, not only comparing the US to Europe, but comparing countries within Europe (such as the Netherlands versus Spain). 2) The lower life expectancy in the US can be explained mostly by higher obesity. US states with similar obesity to European countries have similar life expectancy.
- hackeraccount 7y ago
  I haven't looked at the numbers. Barely read the article. I bet he's wrong though. I would think it'd be a love affair with firearms (Fuck Yeah. ) and a lot of driving. Every time I read about weight the dangers of an extra 10 lbs. seem to be pretty ambiguous. Though I'm totally going to drop that 10 lbs. I only had 2 donuts today.
  - nradov 7y ago
    An extra 10 lbs isn't the issue here. The average American man is now 23 lbs overweight.
    - s1artibartfast 7y ago
      It is much worse than that. 40% of american men are obese, which,for the average body type, is ~50 lbs above normal. From wikipedia: >The National Center for Health Statistics at the CDC showed that 39.6% of US adults age 20 and older were obese as of 2015-2016 (37.9% for men and 41.1% for women).[1] Obesity in an adult is defined as a BMI of 30 and above. The Average american male is 5'10. A "normal healthy" BMI of 22 is 153 lbs. A BMI of 30 is 209 lbs. [2] [1] https://en.wikipedia.org/wiki/Obesity_in_the_United_States https://en.wikipedia.org/wiki/Obesity_in_the_United_States [2] https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_tbl.htm https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi...
- smt88 7y ago
  Re: #2, my understanding from friends at the CDC is that lower life expectancy is due to lower incomes (meaning food, medicine, and doctor visits are unaffordable even with health insurance), suicides, and the opioid crisis. Suicides and obesity can also be caused by low income and drug abuse, so it sounds like the author may be seeing causation where correlation is more accurate.
hackeraccount 7y ago
So I just skimmed but I think the point he's making is that Public Health and Healthcare are 2 different things. Public Health is - get some exercise. Don't drink. Keep a reasonable weight. Don't do drugs. Avoid getting shot. Get vaccinated. Don't drive a lot. Almost all of these things aren't really "Healthcare". I don't need to go to a Dr. to know I should lose 10 lbs. Maybe - maybe, maybe - a Dr. can help me quit heroin (frankly I doubt it) and certainly a Dr. can give me a flu shot. Most of "healthcare" money has nothing to do with longevity. If my buddy had a heart attach you can spend $500,000 on treatment. Heck, you can give him a new heart. It's all great. Who would say no? Not me. (He's my buddy after all). At population scale though that does nothing for longevity. At population scale you'd be better off setting the speed limit to 40mph. Taxing alcohol to high heaven. Playing tons of old Erol Flynn movies (To encourage people to get into sword fights instead of gun fights.) None of that stuff is sexy though. Even the non-crazy version of that list is un-sexy. It probably doesn't cost a lot of money but it royally pisses off people. People also vote. They don't like it if you try to run their lives for them - even if you would technically do a better job then those idiots do. Except for me. And I'm going to lose that 10 lbs. really soon.
- Angostura 7y ago
  In the UK now, if you go to the GP with an ailmentr, you are quite likely to be prescribed joining the local Parkrun group, or other 'public health' measures.
  - s1artibartfast 7y ago
    GPs in the US also tell people to exercise and lose weight.
analog31 7y ago
I'm not sure the article addressed it, but it appears that we could improve the US healthcare system by making it cheaper without losing quality, simply by letting another country run it for us. If there's no gain from spending more, then there should be no loss from spending less, assuming that we get to restructure the system accordingly.

jorblumesea 7y ago

> Obesity! and other non-medical factors like automobiles Socialized medicine and other forms of "planned state healthcare" seem to do a better job promoting lifestyle changes and preventative medicine, which reduces the costs of these externalities.

jedharris 7y ago
Makes sense to me, but I would like to have specific data that would help me understand: - How much money work needs to be invested for what incremental effect? - What kinds of investments are most effective? - How much does effectiveness depend on specific cultural factors, vs. being culture independent? And many more similar questions.
virmundi 7y ago
Could it be that the socialized medical systems of which you speak are Western? Many of the European systems exist within a realm where people ate and continue to eat relatively healthy food due to historical circumstances. Further, they had and continue to have economies based around the idea of walkable cities. These two factors reduce the chances of obesity and the risk of death due to cars. The only way for America to approach either of these is to have everyone one to move into planned mega-cities.
xyzzyz 7y ago
The socialized medicine in my home country does pretty much nothing to promote healthy lifestyle. People generally are healthy and not obese, but socialized medicine have nothing to do with it, it’s rather the culture at large that’s responsible.

nradov 7y ago

Yes we are well into diminishing returns for medical interventions. Many of us are digging our graves with our teeth. While the USA seems particularly bad in that regard other wealthy, industrialized countries are on the same general trend line and will eventually face similar problems.