12 ms·

Why is life expectancy in the US lower than in other rich countries?

129 points by troydavis 6y ago

deleted 6y ago
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reidjs 6y ago
For those short on time: “smoking, obesity, homicides, opioid overdoses, suicides, road accidents, and infant deaths. In addition to this, deeper poverty and less access to healthcare mean Americans at lower incomes die at a younger age than poor people in other rich countries.” Still a good article
- meowster 6y ago
  I wonder what someone's life expectancy would be without the personally-avoidable things such as smoking, obesity, overdoses, and suicides. Homicides, road accidents, and infant deaths are harder to control as an individual.
  - apexalpha 6y ago
    Personally avoidable, yes. Product of society, also.
    - meowster 6y ago
      Basically, I'm wondering: if someone makes good decisions, or the best of their circumstances, how does their average life expectancy stack up to other developed nations?
  - WealthVsSurvive 6y ago
    There's a causal relationship between the things you're calling "personally-avoidable" and the class wealth gap. People are emotionally predictive; if they don't see an ideal prosperous future outcome, they settle for prosperity where they can get it because it beats a lifetime of suffering, even if the end result is additional suffering.
xenihn 6y ago
TLDR: The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants.
- xwdv 6y ago
  Blood is blood.
TuringNYC 6y ago
There really are two Americas - wealthy america and the rest of america. I'll bet if you split America into two sets of counties, the graph would be much different -- one would be a super-outlier and the other a super-laggard. I know this personally, as I've spent 21yrs of my life in one half, and another 20 in the other half. I've also lived overseas for several years, and they also have stratas, but much less pronounced than here in the US.
- xwdv 6y ago
  Which half made you happier?
  - TuringNYC 6y ago
    TLDR: i'd take unhappy-rich over hungry-poor any day. But the best thing would be the happy medium where you are comfortable enough to afford food/schooling but not in a social class where there are obscene social expectations to spend -- so your question is a fair one. I think the key thing was getting past the lower rungs of the Maslow hierarchy. It is very difficult to concentrate on schooling (or anything) when you are hungry or sick. I was constantly hungry when we didnt have free public school meals. A close relative had TB, due to poor healthcare where the hospital/system didn't seem to give a darn. The worst thing is how horrible normal people treated you (even teachers at public school.) I was constantly sick, probably due to poor nutrition. College was great, I will still poor, but the prospects were getting better and all the basics were covered (no longer hungry; decent healthcare). This allowed more happiness because you knew it would be over soon. With better jobs comes more stress -- the expectations (perhaps justified) that one should have a home, that one should have a school for children w/o crime/gangs -- and bigger mortgages, bigger spending. I live fairly conservatively despite decent career success, but I can see how I could "become unhappy trying to reach happiness" ... all that said, i'd take unhappy-rich to hungry-poor any day.
    - medium_burrito 6y ago
      Yeah, that's exactly it- once you have safety, food, shelter and good health and the expectation those will remain, that's amazing. Personally I've decided to forgo as many personal luxuries as possible (ie don't fly first class, no boat besides a shitty canoe, no peasant steel case rolex, no car worth > $20k in an effort to retire with a few million in liquid assets on top of my house by my early 40s. Having no worries is the ultimate luxury. Alternatively, if I lived in California where the weather is mild perhaps I would just go full Diogenes.
narrator 6y ago
We spend double, as a percentage of GDP, what any other rich country spends on health care, so that's not it.
- heavyset_go 6y ago
  Other first world nations spend half of what we do, and they have better outcomes and quality of care[1]. They are able to insure all of their citizens with it while the US doesn't. [1] https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/ https://www.healthsystemtracker.org/chart-collection/quality...
  - julienb_sea 6y ago
    Well, the US has better outcomes for employed, insured and non-overweight folks; dramatically lower wait times, better cancer survival rates and less competition for care. Expense is also a nonissue on employer insurance. Unfortunately the US aggregate outcomes are dragged heavily down by an unhealthy population and high barriers to care for the uninsured.
    - rsynnott 6y ago
      > Expense is also a nonissue on employer insurance. My impression was that many if not most Americans would have to pay an excess (not sure of the American term; money paid by an insured party on using insurance) for any medical care with their work insurance. Is this not the case?
      - deleted 6y ago
        [deleted]
      - trefoiled 6y ago
        This is true but complex. It depends on the type of service you receive. As a general rule, you'll need to pay a yearly deductible before receiving insurance benefits for non preventative care. This can be anywhere from $500 to $8000. High deductible plans are commonly referred to as "catastrophic" plans, because the deductible is so high, and the kind of people who purchase them are typically not wealthy, that their owners would only seek care in a true emergency where the service would exceed the cost of the deductible. After paying your deductible you will often also have a "co-pay" which is typically a flat rate based on the type of service. Something in the realm of $25 to $500. After that, many plans have something called "co-insurance" which is a percentage of the bill you are responsible for even if you have met your deductible. Say, 20%. Add all these charges and fees up, you'll keep paying them until you hit your "maximum out of pocket." So as an example, I was hospitalized a few years back in December while on what would be considered a "good" healthcare plan. I paid my $1000 deductible, a $250 co-pay for emergency room care, and co-insurance of several hundred dollars. I stayed a single night in the hospital and received a CT scan. I was given Tylenol, released the next day, and referred to a specialist. I wound up seeing the specialist in January, so my deductible reset. I was given another CT scan, so I had to pay my $1000 deductible again. The total bill for the entire process pre-insurance was in the realm of $80,000. After insurance, I paid $5000, which was my entire life savings at the time. I didn't hit my maximum out of pocket for either year, so I got lucky in a way. I could have had to pay double what I did.
Havoc 6y ago
wow - wasn't expecting that chart to be quite that pronounced
admiralspoo 6y ago
Comparing ethnically homogenous countries to the US is meaningless and downright deliberately misleading at best. There is significant variation in every state by race. https://en.wikipedia.org/wiki/List_of_U.S._states_and_territories_by_life_expectancy https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ...
- Retric 6y ago
  West Virginia is 92% non-Hispanic white (2018) and has the lowest life expectancy of any US state (74.8). Which clearly disproves that common hypothesis. https://en.wikipedia.org/wiki/List_of_U.S._states_and_territories_by_life_expectancy https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ... Life expectancy and overall heath in the US is strongly correlated to wealth. It’s a feedback loop, being poor directly results in worse access to healthcare etc, but also because it’s much harder for sick people to hold down a job etc. Edit: Bottom 5 states by life expectancy vs their median household income rank (#). West Virginia 74.8 years (#50) Mississippi 74.9 years (#49) Alabama 75.4 years (#44) Kentucky 75.4 years (#43) Arkansas 75.9 years (#48). It’s not perfectly correlated but the relationship is very strong. PS: Great Britain actually has significantly more ethnic diversity than WV and lower median household income than WV yet life expectancy is more than 5 years longer.
  - codyb 6y ago
    I suppose you could be charitable to gp and think they were making the reverse racist good genes argument for Black people? At least it’d be a new twist on an old racist trope.
  - deleted 6y ago
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- JimTheMan 6y ago
  Are other races somehow not American? I never understood this argument. "If it weren't for all those black people and immigrants we'd actually be really good! Those other countries are just too 'homogenous'. " And then somehow this fact apparently dismisses other countries efforts at providing universal/preventative healthcare and initiatives that the US simply does not.
JimTheMan 6y ago
"It's a poor nation with rich people in it."
- missedthecue 6y ago
  Yet the median disposable income per person, after adjustments for government provided healthcare and education is enormously higher than any other nation, according to the OECD. https://data.oecd.org/hha/household-disposable-income.htm https://data.oecd.org/hha/household-disposable-income.htm
  - umanwizard 6y ago
    Yes, hence the quip about "rich people in it". A more serious way of putting it might be that the US is in raw dollar terms one of the richest countries in the world (certainly by far the richest large one), yet in many ways (infrastructure, quality of administration, political culture, etc.) it feels more similar to a middle-income one.
    - samatman 6y ago
      Yes but that quip doesn't work when we're comparing the median. The US does have an absolutely nosebleed wealthy 0.1%, yes, but if you split the population exactly in half, and pick the bloke in the middle, he has really rather a lot of assets, relative to most anywhere else. "The richest poor country in the world" might be closer to it. As the rest of the threads under this post will reveal, we mostly agree that something is wrong with this country — but putting our finger on what that is can be challenging.
      - vkou 6y ago
        It doesn't work when you're comparing incomes, but it does work when you compare incomes minus costs. Having a higher median income is all well and good, until you find it all eaten by education, healthcare, and transportation costs... In addition to less financially denominated costs. [1] But eh, if you didn't need to take care of your kids, or yourself, you could theoretically afford more iPhones. [1] Having lived in Canada, and the US, I can't put an exact dollar value on the stress of, for example, having to deal with the American healthcare system, but its non-zero.
SlipperySlope 6y ago
USA food marketing scientifically and effectively puts the best tasting processed food in front of American families. Lack of income is no barrier to consuming the worst foods. Freedom in the USA is a wonderful thing. But Americans are thereby free to poison themselves to an early grave by the consumption of processed foods that taste great, are extremely convenient and available to any income.
mchanson 6y ago
Capitalism run amok.
perardi 6y ago
Wow, the difference between the US and Canada is a surprise, in particular the opioid overdoses and road accidents. I am a US->Canada transplant, and the cultural and economic differences here just don’t seem that stark. Yes, there is universal health care, obviously…but there is definitely not an abundance of easily available mental health care here, especially outside the major metro areas. And the health care in the most economically disadvantaged areas (First Nations reservations) certainly isn’t platinum care. Really, the road deaths chart stands out to me. Canada is very car centric, and huge, and full of plenty of large animals to hit. I simply cannot hazard a guess as to why it’s that different.
- julienb_sea 6y ago
  There are dramatically more high density, high risk driving environments in the US versus Canada. I could also make some questionable generalizations about Canadian drivers versus US drivers.
  - perardi 6y ago
    And Torontonians could make questionable generalizations about Brampton drivers. Though, now that I think about it, residential street speed limits are way lower here.
  - quicklime 6y ago
    Is this true? It seems like Canadians drive less than Americans do, which I'm guessing is because Canadians live and drive in higher-density environments where they can make shorter trips and kill fewer people along the way: https://internationalcomparisons.org/environmental/transportation/ https://internationalcomparisons.org/environmental/transport... Just eyeballing it, it looks to me like the death rate from road accidents in each country correlates strongly with vehicle-kilometers driven per capita. Americans die at a higher rate because they spend more time on the roads covering more distance.
    - perardi 6y ago
      Excellent catch. And that makes some sense. A huge percentage of the country lives in a fairly narrow band near the US border in large cities. With not a lot of driving to other cities. Because they’re too far away.
quicklime 6y ago
I also thought it was interesting to see when the US branched away from the rest of the rich countries. For example: 1. All the other rich countries have steadily increased health expenditure per capita, and for some reason this really accelerated in the US around the early '80s. But the money looks like it mostly went to things that didn't increase life expectancy. Maybe this was a Reagan thing? 2. The US had the highest cigarette sales until the mid '70s, but is now one of the lowest per capita. This is actually one of the things that the US has done better than its counterparts, e.g. Japan and Germany have higher cigarette sales per capita. However the death rate from smoking remains the highest, probably due to a combination of other factors such as poor healthcare. 3. Around the late '90s, the US really started to pull away from the rest of the rich countries in terms of death rate from opioid overdoses. Some of this spilled over into Canada, but they were able to keep it somewhat under control. 4. For deaths from both obesity and road accidents, the US just hasn't made the same sort of gains as the others since 1990.
- pseudoramble 6y ago
  About point #2, I wonder if the deaths caused by smoking remains high in the US because it's measured effect can be really delayed. Even if sales of cigarettes went down in the mid-70's, they were probably still high for quite a while. On top of that, the effects of smoking can take decades to appear. I could imagine somebody starting smoking in the mid 70's and not seeing effects until recently. EDIT: It turns out reading even not-so-carefully results in fruit! From the article: > But the chart also shows that smoking peaked earlier in the US. Since there is a lag of two to three decades between the peak of smoking and the peak of smoking mortality, this should be positive news for the US going forward. The country is over this mortality peak and we should expect the decline in lung cancer death rates in the US to continue in the coming years.
viking1066 6y ago
Compare wealth and life expectancy of any ethnicity living in USA with the population living in their previous habitat, and the US population comes out on top. Japanese Americans for example have higher life expectancy than Japanese in Japan, and I expect the same would be true for Ethiopians. This shows the superiority of the American system. I need to second the previous comment that this article is either based on deception or ignorance.
- orwin 6y ago
  But any black person coming legally from the Nigeria/Mali Area to the US will have a lower life expectancy than if he came to Europe? Maybe this is crazy, but here is an explanation: legal immigrants are richer and more educated than average in their country of origin and thus have better outcomes after having immigrated. My grandfather is living in Lincoln county WV (since before i even knew him), i know a lot of people in Huntington and Charleston, in fact most Americans i know live between there and Fayetteville, WV. I would be shocked if life expectancy there is higher than 70, especially if you're not in a fringe group.
- lmm 6y ago
  Immigrants are a heavily selected group. What's the life expectancy of American-Japanese people compared to Americans in America?
- Damorian 6y ago
  It's not just wealth and life expectancy, it's pretty much every metric. Homicide rate and test scores are two big ones in my eyes, given the prevalence of firearms and a (seemingly?) subpar public school system. That being said, I think it's less so the American system, and more that the US "steals" the best of every other country.
- TMWNN 6y ago
  >Compare wealth and life expectancy of any ethnicity living in USA with the population living in their previous habitat, and the US population comes out on top. >Japanese Americans for example have higher life expectancy than Japanese in Japan, and I expect the same would be true for Ethiopians. Similarly, Americans do well on PISA compared to their ethnic relatives. (https://www.unz.com/isteve/the-new-2018-pisa-school-test-scores-usa-usa/ https://www.unz.com/isteve/the-new-2018-pisa-school-test-sco...) Asian Americans do better than Asians; whites do better than Europeans; Latinos do better than Latin Americans; and blacks do better than Africans. Hispanics and especially blacks' scores drag the US average down. Both white and Asian Americans score higher than Canada (and white+Asian is essentially Canada's racial makeup), and higher than New Zealand, Australia, the Netherlands, Belgium, Germany, France, Norway, and the UK; Estonia is below US Asians but above white Americans. Norway is by far the wealthiest Nordic state but its average is only two points higher than the US national average, despite not having a demographic that is 13% of the population and scores 85 points below the white American average.
troupe 6y ago
Last time I looked closely at infant mortality in the US, it looked like the US was doing horribly. However, after talking with some doctors at a neonatal ICU I found out that in the US, we will often identify an unborn child that is in trouble and get it out of the mother in an attempt to save it. Since these types of cases are considered a birth, they count against the mortality rate whereas in some other countries they would be stillborn and not count against infant mortality statistics. That isn't to disagree with the causes given in the article, but after talking to those doctors it made me realize how complicated it is to get accurate comparisons between countries.
- OJFord 6y ago
  That's interesting, but for 'life expectancy' my understanding is that it's the expectation for an X year old, where X is something like 12 or 20 that I can't remember - designed to eliminate such effects, and instead indicate the environmental impact. Edit: apparently I'm wrong, Wikipedia states that 'life expectancy at birth (LEB) is the most commonly used measure'.
  - nraynaud 6y ago
    Just to confirm, if it's not qualified, it's implied "at birth".
- socialdemocrat 6y ago
  As far as I recollect discussing this before one will actually save younger children in most of Nordic countries e.g. than in the US, and infant mortality rate is still much lower. There are several reasons the US rate is so much higher than in other developed countries. The US does not have universal health care, which means large sections of the US population does not get adequate follow up during pregnancy. If you look at health care for the poor in the US, it is generally geared towards emergency care. They will stitch you up if you are about to die. However it generally does not cover regular doctor visits and checkups. Hence in the US a lot of expensive effort goes into saving babies when born, when the problem could far more easily have been resolved early in the pregnancy with better checkups. The US system is simply not very geared towards simple preventative care. Where other health care systems tend to focus on simple cheap system. American health care is overly focused on advance equipment, complicated procedures and basically anything which gives a lot of prestige or profits. Problem is that such a health care system does not perform very well in the real world. You end up with very high costs and poor results. E.g. a lot of health problems in the US is actually caused by over-treatment. That is the irony of the US system. Poor people who need help don't get it. People with expensive health care plans OTOH are subject to invasive procedures they don't need because it brings in profit. E.g. the US has overuse of surgery. So basically people who don't need surgery are cut open in the US. And that does take a toll on your health. The opioid crisis killing Americans is a variation of this. Basically it is overmedication for the sake of profits. The health care system is actually a contributor to the bad health problems in the US. It really should lead people to question for-profit health care, but it seems impossible to question anything about capitalism in the US. You speak to deaf ears.
chenpengcheng 6y ago
unhealthy diet, drug addiction, wealth disparity.
plandis 6y ago
I am always curious how data are compared between countries which will pretty much always have different reporting standards. For example, how does one doctor in Germany attribute a death to smoking vs. a doctor in the US? The reason why I bring this up is I know of at least one metric where the definitions being used are quite disparate: child mortality. The US is very inclusive in counting pre-mature births as infant mortality whereas a lot of other countries would conclude these were not viable births and thus are not counted in the statistic.
- gwright 6y ago
  This is something I've seen called out before when these comparisons are trotted out but I don't see it mentioned in this article. Here is a blurb I found quickly (from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058/) > First, many countries also have reporting requirements related to birth weight and may not report infants under 500 grams as live births (MacDorman and Mathews 2009). Second, the presence of assisted reproductive technologies has increased the frequency of multiple births, which have higher mortality rates.
ZDurmPhoto 6y ago
Just like @TuringNYC,I spent the early part of my life in the lower half of socio-economic ladder. With a bit of luck (and yes, work), I extracted myself from this group. I'm not rich, but I have zero debt. I own a house, multiple vehicles, and an 4 season expedition camper - free and clear. I have a rewarding and unusual career. By contrast, the entirety of my close and extended family lives in poverty. Bankruptcy, car repos, eviction, and mortgage default are almost a game. MY father died at the age of 40. My grandfather: 36. My brother died at 42 (after a lethal encounter with police after speeding). I'm 56 (The oldest of any male in two generations). I have multiple retirement accounts. First class healthcare. I take care of my Mom. I can't predict the future, but I suspect my economic success will allow me a longer, more fulfilling life. I'm convinced that access to healthcare, decent work, and basic housing would have allowed my short lived male family members to live longer with a better quality of life.
- throwaway98797 6y ago
  Or maybe not having a kid is why you’re still alive.
- souprock 6y ago
  I don't agree that "access to healthcare, decent work, and basic housing" would have changed the outcome of a "lethal encounter with police after speeding". Doing that in a Bugatti Veyron is still lethal.
  - lostlogin 6y ago
    It’s not hard to imagine why someone might take a risk and run from the police if they have outstanding warrants, unpaid fines etc. The level of stress that comes from living like that has all sorts of negatives that exacerbate the problems. Having a safety net in terms of safety, health and shelter doesn’t seem too much to ask in my view. I’m pretty sure ZDurmphoto has a good idea of their brothers situation.
  - krysp 6y ago
    That depends on the cause of death. If a "lethal encounter with police after speeding" is gunshot wound whilst being detained, a Bugatti veyron might allow you to avoid that outcome. No police vehicle could keep up, unless they brought in air support. Also, the police are less likely to violently arrest you if you're driving a supercar, I'd wager
x87678r 6y ago
Page missed #hrs worked, holidays/vacation days. Actually just the general stress that you have to work hard your whole life just to get-to/stay in middle class. Maybe that is related to the inequality part.
- dragonsky 6y ago
  So what is the average number of days holiday for an American full-time worker? Is anybody aware of any studies that compare hours worked per year against life expectancy? Is this valid: https://www.openaccessgovernment.org/long-working-hours-shorten-life-expectancy/71756/ https://www.openaccessgovernment.org/long-working-hours-shor...
  - rweir 6y ago
    saved you a search: https://www.cnbc.com/2018/08/15/statista-how-far-behind-us-is-in-paid-time-off-compared-to-the-world.html https://www.cnbc.com/2018/08/15/statista-how-far-behind-us-i... . includes this depressing factoid, "American workers took an average of just over 17 days of vacation in 2017, the highest level in seven years".
    - x87678r 6y ago
      That's higher than I'd expect. Lots of people get zero days off.
jandrewrogers 6y ago
If you dig into the statistics, the reason is not what most people assume. The US has anomalously high death rates due to unintentional injury (accidents) in the young adult age groups, which skews the average for the overall population. If young people died in accidents at similar rates to the rest of the world, the average life expectancy would look quite good. This is the 3rd most common cause of death in the US, generally. The primary source of injury in young people creating this situation? Car accidents. And remembering how me and my friends were behind the wheel at that age, this is completely unsurprising. Young people in many other countries do not drive nearly as much. Everyone looks for medical reasons but it is largely fatal accident rates.
- lotsofpulp 6y ago
  People vastly underprice the mortality/morbidity costs of driving in the US (or mostly anywhere). I wince when I hear 1 hour commute times. The risk of injury and death from driving 10k miles per year versus 25k miles per year is material in my opinion.
- eyelidlessness 6y ago
  Even if this is a fundamental part of the explanation, there are features of US culture and geography at work. Most of the rest of the wealthy countries have smaller geographies and denser population centers, and a corresponding lower rate of car travel. With our huge suburban sprawl, many youngs find their entry into adulthood coupling excessive commute responsibility for entry level jobs with the new freedom and responsibility of a vehicle. (I grew up in the DC suburbs, this was my life.)
- alexlikeits1999 6y ago
  Sorry, car accidents won't cut it. Here are the life tables: https://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_03.pdf https://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_03.pdf which link to this spreadsheet: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/NVSR/68_07/Table01.xlsx https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/... Here are traffic deaths by age group: https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a8.htm https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a8.htm. Let's pad those numbers up by a significant amount and assign 20 per 100,000 from birth, and remove those deaths from the life tables (ie let's say noone dies from traffic accidents in the USA). That still only lifts life expectancy by 1 year (from 78.6 to 79.6) You can keep adding other parts of accidental deaths but: 1) they don't fit the story of USA dying more from driving 2) the leftovers are already below the accidental death rate from countries with much higher life expectancy 3) a big chunk of the rest is accidental falls which predominantly affects very old people so doesn't have a big impact on life expectancy
braindongle 6y ago
For some reason, I have a PhD in Health Policy and clinical practice, so, I'm inclined to look at the healthcare system when thinking about this question. IMO it's simple (and this is of course a common view): healthcare in the United States is a failed market. It's not about free market fundamentalism vs socialism, it's just that in this case, this market is totally broken. Costs are completely out of control, and accordingly, access, that is, access without incurring crippling debt, is a huge problem. Obama tried to address both cost and access. He went up against the insurance companies, and lost. He got somewhere on access, but even that is just access to insurance; insurance that may leave you with thousands of dollars to pay out-of-pocket if you walk into the ED with a complaint. So maybe you don't go. Socialized medicine, it seems, certainly won't fly in this country. But socialized insurance, "Medicare for all"? We, the little people, have many reasons to support a multi-decade experiment with that. There's no ideology here. It's just insane (unless you're profiting!) given history for us to continue imagine that in this case the Invisible Hand is going to fix things.
- pessimizer 6y ago
  > Socialized medicine, it seems, certainly won't fly in this country. But socialized insurance, "Medicare for all"? The same endless propaganda and sloganeering brought to bear against socialized medicine in every medium and from every mainstream politician to make us think that it's obviously an impossibility in the US (because reasons), is used against Medicare for all. The possibility of changing US healthcare has never had a relationship with any potential improvement in health outcomes or lowering of costs - the chance for any new plan relies on how well it preserves the profits of an industry that consumes twice the proportion of GDP here as it does in any other country. One of the reasons M4A is criticized has been that it doesn't directly lower anything except administrative overhead (which is massive, but trivial in comparison to the difference between US health care costs and the costs of the civilized world, which would have kept the US in budget surpluses year after year.) It relies on government to put pressure on prices. As the industry's only customer, it would obviously have the leverage, but with most individual politicians being funded by the industry, there's no expectation that it would suddenly have the will. M4A is criticized for not being socialized medicine (i.e. an NHS-like program) by interests who are also against socialized medicine. The reason Obama passed ACA is because it preserved industry profits, stalled the growth in the rise of healthcare costs, and would hopefully delay the next mass challenge to the status quo. At the beginning of the 2020 election cycle, popular pressure led to virtually all of the early Democratic primary lineup to feign support for M4A, and by the end of the cycle it wasn't even in the platform as an aspirational goal, despite the VP-elect owing her entire initial media presence from her (later-reversed) support of Sanders' bill. Getting M4A passed will likely be as difficult as getting socialized medicine passed, and would require immense and focused public pressure. We had the most popular candidate in the country run on it as a central issue twice, and during the second time, a new virus changed everyone's daily lives in the middle of the election. Still, through the media, it became a referendum on the personality of a reality show host, Russian spies, and secret pedophile networks. Rational healthcare policy has no hope.
whiddershins 6y ago
Did we lose a smaller percentage of our population in WWII and that somehow goofs up our death rates which then somehow feeds bad data in to life expectancy because the way they calculate it is off? I’m asking because this is the sort of thing which gets discovered all the time. Even, or especially, because it sounds so implausible.
roenxi 6y ago
This is an interesting study, but there are so many influences that the article can't cover (probably due to its length) that it is a struggle to even draw questions from it. Everyone dies of something. The fact that US people die from things at a different ratio from other countries is interesting, relevant and uninformative on the topic of life expectancy. Picking out obesity - the fact that US obesity rate deaths are higher than the comparison countries doesn't tell us anything about life expectancy. Are they old fat people, or young fat people? The article also can't rule out Simpson's paradox style effects. Hypothetically, say the US is just much better at bringing sickly babies into the world and nursing them on into their 70s it would have better care and worse life expectancy. I doubt that theory could even begin to explain what is going on here, but when comparing average statistics of huge and diverse populations effects like that can creep in very subtly. Statistics can be completely misleading if the treatment is short and only deals with part of the picture. I'm feeling good about reading an article with lots of data, but this didn't do a good job of addressing the title matter.
- mr_luc 6y ago
  It does a good job. It asks “why?” and then shows the causes, with numbers for each cause. Of course, there’s a deeper and more contentious kind of “why?” and it doesn’t go as deeply into that, other than to show some things that seem to correlate. But I think it is useful, because one can’t defensively say the US doesn’t have a problem compared to other rich countries. The Nordic countries save early, sickly babies and nurse them along just as much as the US does, for instance. The only thing I wish they’d have changed would be to indicate relative weight of the causes. Because obesity is an order of magnitude more lethal than homicide, for instance.
- jobigoud 6y ago
  > Are they old fat people, or young fat people? Do old obese people exist in the first place? What is the longevity record for an obese person?
mensetmanusman 6y ago
Obesity
socialdemocrat 6y ago
I lived about 1.5 years in the US several years ago. Ironically I had planned on settling but instead came to realize what a great country I came from, Norway. America has many qualities but I had to see America to realize all the qualities of my own home country. Health care was one of them. I never really liked health care in Norway. I didn't think doctors was all that eager to help often. In the US I kind of experience the opposite, but I slowly realized there was a very dark side to this. All too often I saw that it was just a show to please the "customer." Basically in the US I saw little patient and health thinking and much more of a profit and customer thinking in health care. So often suggestions and procedures where obviously followed for pure profit motive. I discovered on may occasions how I would be given useless drugs and suggestions just to drive profits. I think all health care systems are flawed in some way. Norwegian health care is no exception. But in the US I saw that it was possible to do much worse. The sad irony of this is that this happened while US doctors from my impression are exceptionally skilled. Problem is that they are in a system which push them to think about money rather than health care. A US system where incentives go realigned to serve people rather than profits could quite possibly turn into one of the best health care systems in the world.
karmasimida 6y ago
US residents have a huge obesity problem, and very little has been done to improve the situation
- war1025 6y ago
  In fact we've even started celebrating it. The "Body positive" movement [1]. [1] https://en.wikipedia.org/wiki/Body_positivity https://en.wikipedia.org/wiki/Body_positivity
williamsharris 6y ago
I guess people in other developed countries take more time to relax than people in US. In US, most people work more than 40 hours a week.
rayiner 6y ago
It’s interesting to break this down by state: https://en.wikipedia.org/wiki/List_of_U.S._states_and_territories_by_life_expectancy https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ.... As a benchmark, life expectancy in Germany is about 81 years, while Sweden is a bit over 82. In Minnesota, it’s 80.9, which isn’t far off. New York is over 81, Massachusetts is 80.5. Even less wealthy states like Arizona, North Dakota, and Utah are at 79.9. It’s also interesting to break this down by ethnicity. Asians in the US are longer lived than people in rich Asian countries like Japan. Asians in California and New York have life expectancies over 87, even though they have slightly higher than average rates of lacking health insurance.
- fakedang 6y ago
  I wouldn't call Arizona, ND and Utah less wealthy. Sure they may not have NY/SF style wealth, but their purchasing power still exists. I would use the South or Rust Belt as a better reference.
- danielscrubs 6y ago
  Probably more immigrants in the Asian subgroup that brings good eating habits and if they could move there it probably means wealth. Have been quite a few studies showing that if you move to any country, you get quite a lot of positive effects comparing to staying as you select for a driven personality.
sleepysysadmin 6y ago
Life expectancy vs healthcare expenditure isn't a good measure. I find it interesting that Smoking is way down and in the conclusion it's first as an important factor. Smoking clearly not impacting life expectancy at all. In fact if you look at their data. Obesity/Overweight is the only factor. Not surprising given >70% are overweight. Flipside, nothing here surprises me. The US governments actively subsidize unhealthy foods. Not to mention outright inform their people to eat unhealthy diets. Worse than that, just look at your options for food in the USA. If you banned unhealthy foods and all current unhealthy food workers are banned for life from working in the food industry. You would be left with >90% of their food industry unemployed and practically unemployable. What do you do with those >20 million people? Welfare system cant handle them. You might say unsubsidize these unhealthy foods and what happens? Fast food prices go way up and more people go unemployed. Same problem.

129 points by troydavis 6y ago

deleted 6y ago

[deleted]

For those short on time: “smoking, obesity, homicides, opioid overdoses, suicides, road accidents, and infant deaths. In addition to this, deeper poverty and less access to healthcare mean Americans at lower incomes die at a younger age than poor people in other rich countries.” Still a good article

meowster 6y ago
I wonder what someone's life expectancy would be without the personally-avoidable things such as smoking, obesity, overdoses, and suicides. Homicides, road accidents, and infant deaths are harder to control as an individual.
- apexalpha 6y ago
  Personally avoidable, yes. Product of society, also.
  - meowster 6y ago
    Basically, I'm wondering: if someone makes good decisions, or the best of their circumstances, how does their average life expectancy stack up to other developed nations?
- WealthVsSurvive 6y ago
  There's a causal relationship between the things you're calling "personally-avoidable" and the class wealth gap. People are emotionally predictive; if they don't see an ideal prosperous future outcome, they settle for prosperity where they can get it because it beats a lifetime of suffering, even if the end result is additional suffering.

xenihn 6y ago

TLDR: The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants.

xwdv 6y ago
Blood is blood.

TuringNYC 6y ago

There really are two Americas - wealthy america and the rest of america. I'll bet if you split America into two sets of counties, the graph would be much different -- one would be a super-outlier and the other a super-laggard. I know this personally, as I've spent 21yrs of my life in one half, and another 20 in the other half. I've also lived overseas for several years, and they also have stratas, but much less pronounced than here in the US.

xwdv 6y ago
Which half made you happier?
- TuringNYC 6y ago
  TLDR: i'd take unhappy-rich over hungry-poor any day. But the best thing would be the happy medium where you are comfortable enough to afford food/schooling but not in a social class where there are obscene social expectations to spend -- so your question is a fair one. I think the key thing was getting past the lower rungs of the Maslow hierarchy. It is very difficult to concentrate on schooling (or anything) when you are hungry or sick. I was constantly hungry when we didnt have free public school meals. A close relative had TB, due to poor healthcare where the hospital/system didn't seem to give a darn. The worst thing is how horrible normal people treated you (even teachers at public school.) I was constantly sick, probably due to poor nutrition. College was great, I will still poor, but the prospects were getting better and all the basics were covered (no longer hungry; decent healthcare). This allowed more happiness because you knew it would be over soon. With better jobs comes more stress -- the expectations (perhaps justified) that one should have a home, that one should have a school for children w/o crime/gangs -- and bigger mortgages, bigger spending. I live fairly conservatively despite decent career success, but I can see how I could "become unhappy trying to reach happiness" ... all that said, i'd take unhappy-rich to hungry-poor any day.
  - medium_burrito 6y ago
    Yeah, that's exactly it- once you have safety, food, shelter and good health and the expectation those will remain, that's amazing. Personally I've decided to forgo as many personal luxuries as possible (ie don't fly first class, no boat besides a shitty canoe, no peasant steel case rolex, no car worth > $20k in an effort to retire with a few million in liquid assets on top of my house by my early 40s. Having no worries is the ultimate luxury. Alternatively, if I lived in California where the weather is mild perhaps I would just go full Diogenes.

narrator 6y ago

We spend double, as a percentage of GDP, what any other rich country spends on health care, so that's not it.

heavyset_go 6y ago
Other first world nations spend half of what we do, and they have better outcomes and quality of care[1]. They are able to insure all of their citizens with it while the US doesn't. [1] https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/ https://www.healthsystemtracker.org/chart-collection/quality...
- julienb_sea 6y ago
  Well, the US has better outcomes for employed, insured and non-overweight folks; dramatically lower wait times, better cancer survival rates and less competition for care. Expense is also a nonissue on employer insurance. Unfortunately the US aggregate outcomes are dragged heavily down by an unhealthy population and high barriers to care for the uninsured.
  - rsynnott 6y ago
    > Expense is also a nonissue on employer insurance. My impression was that many if not most Americans would have to pay an excess (not sure of the American term; money paid by an insured party on using insurance) for any medical care with their work insurance. Is this not the case?
    - deleted 6y ago
      [deleted]
    - trefoiled 6y ago
      This is true but complex. It depends on the type of service you receive. As a general rule, you'll need to pay a yearly deductible before receiving insurance benefits for non preventative care. This can be anywhere from $500 to $8000. High deductible plans are commonly referred to as "catastrophic" plans, because the deductible is so high, and the kind of people who purchase them are typically not wealthy, that their owners would only seek care in a true emergency where the service would exceed the cost of the deductible. After paying your deductible you will often also have a "co-pay" which is typically a flat rate based on the type of service. Something in the realm of $25 to $500. After that, many plans have something called "co-insurance" which is a percentage of the bill you are responsible for even if you have met your deductible. Say, 20%. Add all these charges and fees up, you'll keep paying them until you hit your "maximum out of pocket." So as an example, I was hospitalized a few years back in December while on what would be considered a "good" healthcare plan. I paid my $1000 deductible, a $250 co-pay for emergency room care, and co-insurance of several hundred dollars. I stayed a single night in the hospital and received a CT scan. I was given Tylenol, released the next day, and referred to a specialist. I wound up seeing the specialist in January, so my deductible reset. I was given another CT scan, so I had to pay my $1000 deductible again. The total bill for the entire process pre-insurance was in the realm of $80,000. After insurance, I paid $5000, which was my entire life savings at the time. I didn't hit my maximum out of pocket for either year, so I got lucky in a way. I could have had to pay double what I did.

Havoc 6y ago

wow - wasn't expecting that chart to be quite that pronounced

admiralspoo 6y ago

Comparing ethnically homogenous countries to the US is meaningless and downright deliberately misleading at best. There is significant variation in every state by race. https://en.wikipedia.org/wiki/List_of_U.S._states_and_territories_by_life_expectancy https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ...

Retric 6y ago
West Virginia is 92% non-Hispanic white (2018) and has the lowest life expectancy of any US state (74.8). Which clearly disproves that common hypothesis. https://en.wikipedia.org/wiki/List_of_U.S._states_and_territories_by_life_expectancy https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ... Life expectancy and overall heath in the US is strongly correlated to wealth. It’s a feedback loop, being poor directly results in worse access to healthcare etc, but also because it’s much harder for sick people to hold down a job etc. Edit: Bottom 5 states by life expectancy vs their median household income rank (#). West Virginia 74.8 years (#50) Mississippi 74.9 years (#49) Alabama 75.4 years (#44) Kentucky 75.4 years (#43) Arkansas 75.9 years (#48). It’s not perfectly correlated but the relationship is very strong. PS: Great Britain actually has significantly more ethnic diversity than WV and lower median household income than WV yet life expectancy is more than 5 years longer.
- codyb 6y ago
  I suppose you could be charitable to gp and think they were making the reverse racist good genes argument for Black people? At least it’d be a new twist on an old racist trope.
- deleted 6y ago
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- deleted 6y ago
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JimTheMan 6y ago
Are other races somehow not American? I never understood this argument. "If it weren't for all those black people and immigrants we'd actually be really good! Those other countries are just too 'homogenous'. " And then somehow this fact apparently dismisses other countries efforts at providing universal/preventative healthcare and initiatives that the US simply does not.

JimTheMan 6y ago

"It's a poor nation with rich people in it."

missedthecue 6y ago
Yet the median disposable income per person, after adjustments for government provided healthcare and education is enormously higher than any other nation, according to the OECD. https://data.oecd.org/hha/household-disposable-income.htm https://data.oecd.org/hha/household-disposable-income.htm
- umanwizard 6y ago
  Yes, hence the quip about "rich people in it". A more serious way of putting it might be that the US is in raw dollar terms one of the richest countries in the world (certainly by far the richest large one), yet in many ways (infrastructure, quality of administration, political culture, etc.) it feels more similar to a middle-income one.
  - samatman 6y ago
    Yes but that quip doesn't work when we're comparing the median. The US does have an absolutely nosebleed wealthy 0.1%, yes, but if you split the population exactly in half, and pick the bloke in the middle, he has really rather a lot of assets, relative to most anywhere else. "The richest poor country in the world" might be closer to it. As the rest of the threads under this post will reveal, we mostly agree that something is wrong with this country — but putting our finger on what that is can be challenging.
    - vkou 6y ago
      It doesn't work when you're comparing incomes, but it does work when you compare incomes minus costs. Having a higher median income is all well and good, until you find it all eaten by education, healthcare, and transportation costs... In addition to less financially denominated costs. [1] But eh, if you didn't need to take care of your kids, or yourself, you could theoretically afford more iPhones. [1] Having lived in Canada, and the US, I can't put an exact dollar value on the stress of, for example, having to deal with the American healthcare system, but its non-zero.

SlipperySlope 6y ago

USA food marketing scientifically and effectively puts the best tasting processed food in front of American families. Lack of income is no barrier to consuming the worst foods. Freedom in the USA is a wonderful thing. But Americans are thereby free to poison themselves to an early grave by the consumption of processed foods that taste great, are extremely convenient and available to any income.

mchanson 6y ago

Capitalism run amok.

perardi 6y ago

Wow, the difference between the US and Canada is a surprise, in particular the opioid overdoses and road accidents. I am a US->Canada transplant, and the cultural and economic differences here just don’t seem that stark. Yes, there is universal health care, obviously…but there is definitely not an abundance of easily available mental health care here, especially outside the major metro areas. And the health care in the most economically disadvantaged areas (First Nations reservations) certainly isn’t platinum care. Really, the road deaths chart stands out to me. Canada is very car centric, and huge, and full of plenty of large animals to hit. I simply cannot hazard a guess as to why it’s that different.

julienb_sea 6y ago
There are dramatically more high density, high risk driving environments in the US versus Canada. I could also make some questionable generalizations about Canadian drivers versus US drivers.
- perardi 6y ago
  And Torontonians could make questionable generalizations about Brampton drivers. Though, now that I think about it, residential street speed limits are way lower here.
- quicklime 6y ago
  Is this true? It seems like Canadians drive less than Americans do, which I'm guessing is because Canadians live and drive in higher-density environments where they can make shorter trips and kill fewer people along the way: https://internationalcomparisons.org/environmental/transportation/ https://internationalcomparisons.org/environmental/transport... Just eyeballing it, it looks to me like the death rate from road accidents in each country correlates strongly with vehicle-kilometers driven per capita. Americans die at a higher rate because they spend more time on the roads covering more distance.
  - perardi 6y ago
    Excellent catch. And that makes some sense. A huge percentage of the country lives in a fairly narrow band near the US border in large cities. With not a lot of driving to other cities. Because they’re too far away.

quicklime 6y ago

I also thought it was interesting to see when the US branched away from the rest of the rich countries. For example: 1. All the other rich countries have steadily increased health expenditure per capita, and for some reason this really accelerated in the US around the early '80s. But the money looks like it mostly went to things that didn't increase life expectancy. Maybe this was a Reagan thing? 2. The US had the highest cigarette sales until the mid '70s, but is now one of the lowest per capita. This is actually one of the things that the US has done better than its counterparts, e.g. Japan and Germany have higher cigarette sales per capita. However the death rate from smoking remains the highest, probably due to a combination of other factors such as poor healthcare. 3. Around the late '90s, the US really started to pull away from the rest of the rich countries in terms of death rate from opioid overdoses. Some of this spilled over into Canada, but they were able to keep it somewhat under control. 4. For deaths from both obesity and road accidents, the US just hasn't made the same sort of gains as the others since 1990.

pseudoramble 6y ago
About point #2, I wonder if the deaths caused by smoking remains high in the US because it's measured effect can be really delayed. Even if sales of cigarettes went down in the mid-70's, they were probably still high for quite a while. On top of that, the effects of smoking can take decades to appear. I could imagine somebody starting smoking in the mid 70's and not seeing effects until recently. EDIT: It turns out reading even not-so-carefully results in fruit! From the article: > But the chart also shows that smoking peaked earlier in the US. Since there is a lag of two to three decades between the peak of smoking and the peak of smoking mortality, this should be positive news for the US going forward. The country is over this mortality peak and we should expect the decline in lung cancer death rates in the US to continue in the coming years.

viking1066 6y ago

Compare wealth and life expectancy of any ethnicity living in USA with the population living in their previous habitat, and the US population comes out on top. Japanese Americans for example have higher life expectancy than Japanese in Japan, and I expect the same would be true for Ethiopians. This shows the superiority of the American system. I need to second the previous comment that this article is either based on deception or ignorance.

orwin 6y ago
But any black person coming legally from the Nigeria/Mali Area to the US will have a lower life expectancy than if he came to Europe? Maybe this is crazy, but here is an explanation: legal immigrants are richer and more educated than average in their country of origin and thus have better outcomes after having immigrated. My grandfather is living in Lincoln county WV (since before i even knew him), i know a lot of people in Huntington and Charleston, in fact most Americans i know live between there and Fayetteville, WV. I would be shocked if life expectancy there is higher than 70, especially if you're not in a fringe group.
lmm 6y ago
Immigrants are a heavily selected group. What's the life expectancy of American-Japanese people compared to Americans in America?
Damorian 6y ago
It's not just wealth and life expectancy, it's pretty much every metric. Homicide rate and test scores are two big ones in my eyes, given the prevalence of firearms and a (seemingly?) subpar public school system. That being said, I think it's less so the American system, and more that the US "steals" the best of every other country.
TMWNN 6y ago
>Compare wealth and life expectancy of any ethnicity living in USA with the population living in their previous habitat, and the US population comes out on top. >Japanese Americans for example have higher life expectancy than Japanese in Japan, and I expect the same would be true for Ethiopians. Similarly, Americans do well on PISA compared to their ethnic relatives. (https://www.unz.com/isteve/the-new-2018-pisa-school-test-scores-usa-usa/ https://www.unz.com/isteve/the-new-2018-pisa-school-test-sco...) Asian Americans do better than Asians; whites do better than Europeans; Latinos do better than Latin Americans; and blacks do better than Africans. Hispanics and especially blacks' scores drag the US average down. Both white and Asian Americans score higher than Canada (and white+Asian is essentially Canada's racial makeup), and higher than New Zealand, Australia, the Netherlands, Belgium, Germany, France, Norway, and the UK; Estonia is below US Asians but above white Americans. Norway is by far the wealthiest Nordic state but its average is only two points higher than the US national average, despite not having a demographic that is 13% of the population and scores 85 points below the white American average.

troupe 6y ago

Last time I looked closely at infant mortality in the US, it looked like the US was doing horribly. However, after talking with some doctors at a neonatal ICU I found out that in the US, we will often identify an unborn child that is in trouble and get it out of the mother in an attempt to save it. Since these types of cases are considered a birth, they count against the mortality rate whereas in some other countries they would be stillborn and not count against infant mortality statistics. That isn't to disagree with the causes given in the article, but after talking to those doctors it made me realize how complicated it is to get accurate comparisons between countries.

OJFord 6y ago
That's interesting, but for 'life expectancy' my understanding is that it's the expectation for an X year old, where X is something like 12 or 20 that I can't remember - designed to eliminate such effects, and instead indicate the environmental impact. Edit: apparently I'm wrong, Wikipedia states that 'life expectancy at birth (LEB) is the most commonly used measure'.
- nraynaud 6y ago
  Just to confirm, if it's not qualified, it's implied "at birth".
socialdemocrat 6y ago
As far as I recollect discussing this before one will actually save younger children in most of Nordic countries e.g. than in the US, and infant mortality rate is still much lower. There are several reasons the US rate is so much higher than in other developed countries. The US does not have universal health care, which means large sections of the US population does not get adequate follow up during pregnancy. If you look at health care for the poor in the US, it is generally geared towards emergency care. They will stitch you up if you are about to die. However it generally does not cover regular doctor visits and checkups. Hence in the US a lot of expensive effort goes into saving babies when born, when the problem could far more easily have been resolved early in the pregnancy with better checkups. The US system is simply not very geared towards simple preventative care. Where other health care systems tend to focus on simple cheap system. American health care is overly focused on advance equipment, complicated procedures and basically anything which gives a lot of prestige or profits. Problem is that such a health care system does not perform very well in the real world. You end up with very high costs and poor results. E.g. a lot of health problems in the US is actually caused by over-treatment. That is the irony of the US system. Poor people who need help don't get it. People with expensive health care plans OTOH are subject to invasive procedures they don't need because it brings in profit. E.g. the US has overuse of surgery. So basically people who don't need surgery are cut open in the US. And that does take a toll on your health. The opioid crisis killing Americans is a variation of this. Basically it is overmedication for the sake of profits. The health care system is actually a contributor to the bad health problems in the US. It really should lead people to question for-profit health care, but it seems impossible to question anything about capitalism in the US. You speak to deaf ears.

chenpengcheng 6y ago

unhealthy diet, drug addiction, wealth disparity.

plandis 6y ago

I am always curious how data are compared between countries which will pretty much always have different reporting standards. For example, how does one doctor in Germany attribute a death to smoking vs. a doctor in the US? The reason why I bring this up is I know of at least one metric where the definitions being used are quite disparate: child mortality. The US is very inclusive in counting pre-mature births as infant mortality whereas a lot of other countries would conclude these were not viable births and thus are not counted in the statistic.

gwright 6y ago
This is something I've seen called out before when these comparisons are trotted out but I don't see it mentioned in this article. Here is a blurb I found quickly (from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058/) > First, many countries also have reporting requirements related to birth weight and may not report infants under 500 grams as live births (MacDorman and Mathews 2009). Second, the presence of assisted reproductive technologies has increased the frequency of multiple births, which have higher mortality rates.

ZDurmPhoto 6y ago

Just like @TuringNYC,I spent the early part of my life in the lower half of socio-economic ladder. With a bit of luck (and yes, work), I extracted myself from this group. I'm not rich, but I have zero debt. I own a house, multiple vehicles, and an 4 season expedition camper - free and clear. I have a rewarding and unusual career. By contrast, the entirety of my close and extended family lives in poverty. Bankruptcy, car repos, eviction, and mortgage default are almost a game. MY father died at the age of 40. My grandfather: 36. My brother died at 42 (after a lethal encounter with police after speeding). I'm 56 (The oldest of any male in two generations). I have multiple retirement accounts. First class healthcare. I take care of my Mom. I can't predict the future, but I suspect my economic success will allow me a longer, more fulfilling life. I'm convinced that access to healthcare, decent work, and basic housing would have allowed my short lived male family members to live longer with a better quality of life.

throwaway98797 6y ago
Or maybe not having a kid is why you’re still alive.
souprock 6y ago
I don't agree that "access to healthcare, decent work, and basic housing" would have changed the outcome of a "lethal encounter with police after speeding". Doing that in a Bugatti Veyron is still lethal.
- lostlogin 6y ago
  It’s not hard to imagine why someone might take a risk and run from the police if they have outstanding warrants, unpaid fines etc. The level of stress that comes from living like that has all sorts of negatives that exacerbate the problems. Having a safety net in terms of safety, health and shelter doesn’t seem too much to ask in my view. I’m pretty sure ZDurmphoto has a good idea of their brothers situation.
- krysp 6y ago
  That depends on the cause of death. If a "lethal encounter with police after speeding" is gunshot wound whilst being detained, a Bugatti veyron might allow you to avoid that outcome. No police vehicle could keep up, unless they brought in air support. Also, the police are less likely to violently arrest you if you're driving a supercar, I'd wager

x87678r 6y ago

Page missed #hrs worked, holidays/vacation days. Actually just the general stress that you have to work hard your whole life just to get-to/stay in middle class. Maybe that is related to the inequality part.

dragonsky 6y ago
So what is the average number of days holiday for an American full-time worker? Is anybody aware of any studies that compare hours worked per year against life expectancy? Is this valid: https://www.openaccessgovernment.org/long-working-hours-shorten-life-expectancy/71756/ https://www.openaccessgovernment.org/long-working-hours-shor...
- rweir 6y ago
  saved you a search: https://www.cnbc.com/2018/08/15/statista-how-far-behind-us-is-in-paid-time-off-compared-to-the-world.html https://www.cnbc.com/2018/08/15/statista-how-far-behind-us-i... . includes this depressing factoid, "American workers took an average of just over 17 days of vacation in 2017, the highest level in seven years".
  - x87678r 6y ago
    That's higher than I'd expect. Lots of people get zero days off.

jandrewrogers 6y ago

If you dig into the statistics, the reason is not what most people assume. The US has anomalously high death rates due to unintentional injury (accidents) in the young adult age groups, which skews the average for the overall population. If young people died in accidents at similar rates to the rest of the world, the average life expectancy would look quite good. This is the 3rd most common cause of death in the US, generally. The primary source of injury in young people creating this situation? Car accidents. And remembering how me and my friends were behind the wheel at that age, this is completely unsurprising. Young people in many other countries do not drive nearly as much. Everyone looks for medical reasons but it is largely fatal accident rates.

lotsofpulp 6y ago
People vastly underprice the mortality/morbidity costs of driving in the US (or mostly anywhere). I wince when I hear 1 hour commute times. The risk of injury and death from driving 10k miles per year versus 25k miles per year is material in my opinion.
eyelidlessness 6y ago
Even if this is a fundamental part of the explanation, there are features of US culture and geography at work. Most of the rest of the wealthy countries have smaller geographies and denser population centers, and a corresponding lower rate of car travel. With our huge suburban sprawl, many youngs find their entry into adulthood coupling excessive commute responsibility for entry level jobs with the new freedom and responsibility of a vehicle. (I grew up in the DC suburbs, this was my life.)
alexlikeits1999 6y ago
Sorry, car accidents won't cut it. Here are the life tables: https://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_03.pdf https://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_03.pdf which link to this spreadsheet: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/NVSR/68_07/Table01.xlsx https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/... Here are traffic deaths by age group: https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a8.htm https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a8.htm. Let's pad those numbers up by a significant amount and assign 20 per 100,000 from birth, and remove those deaths from the life tables (ie let's say noone dies from traffic accidents in the USA). That still only lifts life expectancy by 1 year (from 78.6 to 79.6) You can keep adding other parts of accidental deaths but: 1) they don't fit the story of USA dying more from driving 2) the leftovers are already below the accidental death rate from countries with much higher life expectancy 3) a big chunk of the rest is accidental falls which predominantly affects very old people so doesn't have a big impact on life expectancy

braindongle 6y ago

For some reason, I have a PhD in Health Policy and clinical practice, so, I'm inclined to look at the healthcare system when thinking about this question. IMO it's simple (and this is of course a common view): healthcare in the United States is a failed market. It's not about free market fundamentalism vs socialism, it's just that in this case, this market is totally broken. Costs are completely out of control, and accordingly, access, that is, access without incurring crippling debt, is a huge problem. Obama tried to address both cost and access. He went up against the insurance companies, and lost. He got somewhere on access, but even that is just access to insurance; insurance that may leave you with thousands of dollars to pay out-of-pocket if you walk into the ED with a complaint. So maybe you don't go. Socialized medicine, it seems, certainly won't fly in this country. But socialized insurance, "Medicare for all"? We, the little people, have many reasons to support a multi-decade experiment with that. There's no ideology here. It's just insane (unless you're profiting!) given history for us to continue imagine that in this case the Invisible Hand is going to fix things.

pessimizer 6y ago
> Socialized medicine, it seems, certainly won't fly in this country. But socialized insurance, "Medicare for all"? The same endless propaganda and sloganeering brought to bear against socialized medicine in every medium and from every mainstream politician to make us think that it's obviously an impossibility in the US (because reasons), is used against Medicare for all. The possibility of changing US healthcare has never had a relationship with any potential improvement in health outcomes or lowering of costs - the chance for any new plan relies on how well it preserves the profits of an industry that consumes twice the proportion of GDP here as it does in any other country. One of the reasons M4A is criticized has been that it doesn't directly lower anything except administrative overhead (which is massive, but trivial in comparison to the difference between US health care costs and the costs of the civilized world, which would have kept the US in budget surpluses year after year.) It relies on government to put pressure on prices. As the industry's only customer, it would obviously have the leverage, but with most individual politicians being funded by the industry, there's no expectation that it would suddenly have the will. M4A is criticized for not being socialized medicine (i.e. an NHS-like program) by interests who are also against socialized medicine. The reason Obama passed ACA is because it preserved industry profits, stalled the growth in the rise of healthcare costs, and would hopefully delay the next mass challenge to the status quo. At the beginning of the 2020 election cycle, popular pressure led to virtually all of the early Democratic primary lineup to feign support for M4A, and by the end of the cycle it wasn't even in the platform as an aspirational goal, despite the VP-elect owing her entire initial media presence from her (later-reversed) support of Sanders' bill. Getting M4A passed will likely be as difficult as getting socialized medicine passed, and would require immense and focused public pressure. We had the most popular candidate in the country run on it as a central issue twice, and during the second time, a new virus changed everyone's daily lives in the middle of the election. Still, through the media, it became a referendum on the personality of a reality show host, Russian spies, and secret pedophile networks. Rational healthcare policy has no hope.

whiddershins 6y ago

Did we lose a smaller percentage of our population in WWII and that somehow goofs up our death rates which then somehow feeds bad data in to life expectancy because the way they calculate it is off? I’m asking because this is the sort of thing which gets discovered all the time. Even, or especially, because it sounds so implausible.

roenxi 6y ago

This is an interesting study, but there are so many influences that the article can't cover (probably due to its length) that it is a struggle to even draw questions from it. Everyone dies of something. The fact that US people die from things at a different ratio from other countries is interesting, relevant and uninformative on the topic of life expectancy. Picking out obesity - the fact that US obesity rate deaths are higher than the comparison countries doesn't tell us anything about life expectancy. Are they old fat people, or young fat people? The article also can't rule out Simpson's paradox style effects. Hypothetically, say the US is just much better at bringing sickly babies into the world and nursing them on into their 70s it would have better care and worse life expectancy. I doubt that theory could even begin to explain what is going on here, but when comparing average statistics of huge and diverse populations effects like that can creep in very subtly. Statistics can be completely misleading if the treatment is short and only deals with part of the picture. I'm feeling good about reading an article with lots of data, but this didn't do a good job of addressing the title matter.

mr_luc 6y ago
It does a good job. It asks “why?” and then shows the causes, with numbers for each cause. Of course, there’s a deeper and more contentious kind of “why?” and it doesn’t go as deeply into that, other than to show some things that seem to correlate. But I think it is useful, because one can’t defensively say the US doesn’t have a problem compared to other rich countries. The Nordic countries save early, sickly babies and nurse them along just as much as the US does, for instance. The only thing I wish they’d have changed would be to indicate relative weight of the causes. Because obesity is an order of magnitude more lethal than homicide, for instance.
jobigoud 6y ago
> Are they old fat people, or young fat people? Do old obese people exist in the first place? What is the longevity record for an obese person?

mensetmanusman 6y ago

Obesity

socialdemocrat 6y ago

I lived about 1.5 years in the US several years ago. Ironically I had planned on settling but instead came to realize what a great country I came from, Norway. America has many qualities but I had to see America to realize all the qualities of my own home country. Health care was one of them. I never really liked health care in Norway. I didn't think doctors was all that eager to help often. In the US I kind of experience the opposite, but I slowly realized there was a very dark side to this. All too often I saw that it was just a show to please the "customer." Basically in the US I saw little patient and health thinking and much more of a profit and customer thinking in health care. So often suggestions and procedures where obviously followed for pure profit motive. I discovered on may occasions how I would be given useless drugs and suggestions just to drive profits. I think all health care systems are flawed in some way. Norwegian health care is no exception. But in the US I saw that it was possible to do much worse. The sad irony of this is that this happened while US doctors from my impression are exceptionally skilled. Problem is that they are in a system which push them to think about money rather than health care. A US system where incentives go realigned to serve people rather than profits could quite possibly turn into one of the best health care systems in the world.

karmasimida 6y ago

US residents have a huge obesity problem, and very little has been done to improve the situation

war1025 6y ago
In fact we've even started celebrating it. The "Body positive" movement [1]. [1] https://en.wikipedia.org/wiki/Body_positivity https://en.wikipedia.org/wiki/Body_positivity

williamsharris 6y ago

I guess people in other developed countries take more time to relax than people in US. In US, most people work more than 40 hours a week.

rayiner 6y ago

It’s interesting to break this down by state: https://en.wikipedia.org/wiki/List_of_U.S._states_and_territories_by_life_expectancy https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ.... As a benchmark, life expectancy in Germany is about 81 years, while Sweden is a bit over 82. In Minnesota, it’s 80.9, which isn’t far off. New York is over 81, Massachusetts is 80.5. Even less wealthy states like Arizona, North Dakota, and Utah are at 79.9. It’s also interesting to break this down by ethnicity. Asians in the US are longer lived than people in rich Asian countries like Japan. Asians in California and New York have life expectancies over 87, even though they have slightly higher than average rates of lacking health insurance.

fakedang 6y ago
I wouldn't call Arizona, ND and Utah less wealthy. Sure they may not have NY/SF style wealth, but their purchasing power still exists. I would use the South or Rust Belt as a better reference.
danielscrubs 6y ago
Probably more immigrants in the Asian subgroup that brings good eating habits and if they could move there it probably means wealth. Have been quite a few studies showing that if you move to any country, you get quite a lot of positive effects comparing to staying as you select for a driven personality.

sleepysysadmin 6y ago

Life expectancy vs healthcare expenditure isn't a good measure. I find it interesting that Smoking is way down and in the conclusion it's first as an important factor. Smoking clearly not impacting life expectancy at all. In fact if you look at their data. Obesity/Overweight is the only factor. Not surprising given >70% are overweight. Flipside, nothing here surprises me. The US governments actively subsidize unhealthy foods. Not to mention outright inform their people to eat unhealthy diets. Worse than that, just look at your options for food in the USA. If you banned unhealthy foods and all current unhealthy food workers are banned for life from working in the food industry. You would be left with >90% of their food industry unemployed and practically unemployable. What do you do with those >20 million people? Welfare system cant handle them. You might say unsubsidize these unhealthy foods and what happens? Fast food prices go way up and more people go unemployed. Same problem.