4 ms·

I want to agree with this, but these studies usually make a big mistake - they don't control out for the non healthcare reasons for low life expectancy. Americ

I want to agree with this, but these studies usually make a big mistake - they don't control out for the non healthcare reasons for low life expectancy. Americans drive cars and most live in unwalkable places. These impart significant risks that the healthcare system, no matter how good, wouldn't impact. Has anyone dug into this to identify whether they tried to account for built environment? Or food system?

rsynnott 5mo ago
> The US had the second-highest avoidable mortality rate—deaths caused by conditions that can be prevented with primary care or treated with timely medical intervention. Only Mexico had higher avoidable mortality. Similarly, the US also had the second-highest rating on years of potential life lost, a measure used to estimate premature death. Again, only Mexico had a higher rating. About 41k people die on the road in the US per year. While this is very high, and worse than pretty much any other developed country, it’s not going to move the needle _that_ much.
- nickff 5mo ago
  Driving everywhere has the collateral effect of ensuring that people get less exercise. Mexico has an astonishingly high obesity rate (a bit higher than the USA last time I checked), and this increases the risks of many non-car-related causes of death (and illness).
  - rsynnott 5mo ago
    Yeah, I’d buy that car-dependence is a problem there, especially for older people. Though, in Ireland, for instance, the worst parts of the country for car dependency would be close to as bad as the US. Their life expectancy is a little lower than the national one, but it’s not dramatic, and certainly not as low as the US one. There’s something else going on.
    - nickff 5mo ago
      In additional to the car dependency (and related issues), the USA still has many immigrants (legal and illegal) from poor countries, who likely have health issues that pre-exist their US residency.
      - rsynnott 5mo ago
        Main headline figure is life expectancy at birth, which doesn’t _really_ account for immigration. In any case, a number of rich countries (Ireland, UK, Canada, the Netherlands, most of the Nordics) have higher immigration rates than the US, so, again, probably not that.
- Legend2440 5mo ago
  Not car accidents; obesity from lack of exercise. 40% of Americans are obese and 75% are overweight. This is largely outside of the control of the medical system, but has a significant impact on mortality and life expectancy.
  - t0mpr1c3 5mo ago
    > This is largely outside of the control of the medical system I assure you that preventative medicine does exist, even in the USA. Moreover, healthcare interventions for people with "lifestyle" diseases such as obesity have been extremely effective in reducing mortality from downstream causes such cardiovascular disease (e.g. statins).
    - Legend2440 5mo ago
      Statins help a bit (and are widely prescribed in the US) but they don't fix the problem. Diet and exercise are huge health variables that doctors don't really have the tools to do anything about.
      - t0mpr1c3 5mo ago
        The problem we are discussing here is mortality, and statins definitely have an effect on mortality. Obesity can be prevented, can be treated, and its effects on health can be managed. We are actually living through something of a miracle in the treatment of lifestyle diseases. For example, the proportion of total deaths among adults with diabetes from vascular causes (heart disease) declined from 48% in 1988–94 to 34% in 2010–15 (https://sci-hub.st/10.1016/S0140-6736(18)30314-3 https://sci-hub.st/10.1016/S0140-6736(18)30314-3). The USA is not some kind of global outlier with a uniquely unhealthy population. The problem is *very obviously* something to do with how healthcare is provided here.
        Legend2440 5mo ago
        >The USA is not some kind of outlier with a uniquely unhealthy population. It is, actually. Our obesity rates are the highest in the world at 41%. This is nearly double many European countries, and five times higher than Japan or South Korea. Only a handful of tiny Polynesian islands have us beat. Better treatments for diabetes are great, but what's even better is not getting diabetes at all by losing weight.
t0mpr1c3 5mo ago
If you research "amenable", "avoidable", "preventable", and "treatable" mortality, you will find similar conclusions from studies that focus on specific aspects of the effects of healthcare on mortality. The results are not all that different. The USA lags other rich nations, and even middle income nations like Costa Rica and Chile. https://www.oecd.org/en/publications/health-at-a-glance-2023_7a7afb35-en/full-report/avoidable-mortality-preventable-and-treatable_e7407977.html#title-ab071a3f22 https://www.oecd.org/en/publications/health-at-a-glance-2023...
- Schiendelman 5mo ago
  Those all include obesity - this is kind of my point. The healthcare system isn't what's making people get a lot of these illnesses.
  - defrost 5mo ago
    Part of the Australian public healthcare system is public health and well living announcements and controls on the worst of the worst junk food that various corps attempt to sell. Macca's in Australia has healthier food than McDonalds in the US, exercise is very common place, etc. Speaking of Obesity - Australian PSA (1975): https://www.youtube.com/watch?v=GNjEge3Awl8 https://www.youtube.com/watch?v=GNjEge3Awl8
    - Schiendelman 5mo ago
      Our public health system does similar, many cities have soda taxes for instance and we put public health money into encouraging activity and subsidizing organizations that make people get active. But those investments or lack thereof aren't the root cause of our obesity crisis. That's land use, urban planning, subsidies to corn, completely outside the healthcare system. If you made the healthcare system as perfect as you wanted it to be, you would be fighting an uphill battle with these problems, it's very questionable whether you'd have any real impact. There are studies of healthcare system efficacy. Rate of diagnosis relative to likely incidents of particular illnesses. Treatment effectiveness after diagnosis. And frankly, the US does much better than most countries when you measure just the healthcare system. But people don't like that, they challenge it immediately, because it's not what they want to believe.

rsynnott 5mo ago

> The US had the second-highest avoidable mortality rate—deaths caused by conditions that can be prevented with primary care or treated with timely medical intervention. Only Mexico had higher avoidable mortality. Similarly, the US also had the second-highest rating on years of potential life lost, a measure used to estimate premature death. Again, only Mexico had a higher rating. About 41k people die on the road in the US per year. While this is very high, and worse than pretty much any other developed country, it’s not going to move the needle _that_ much.

nickff 5mo ago
Driving everywhere has the collateral effect of ensuring that people get less exercise. Mexico has an astonishingly high obesity rate (a bit higher than the USA last time I checked), and this increases the risks of many non-car-related causes of death (and illness).
- rsynnott 5mo ago
  Yeah, I’d buy that car-dependence is a problem there, especially for older people. Though, in Ireland, for instance, the worst parts of the country for car dependency would be close to as bad as the US. Their life expectancy is a little lower than the national one, but it’s not dramatic, and certainly not as low as the US one. There’s something else going on.
  - nickff 5mo ago
    In additional to the car dependency (and related issues), the USA still has many immigrants (legal and illegal) from poor countries, who likely have health issues that pre-exist their US residency.
    - rsynnott 5mo ago
      Main headline figure is life expectancy at birth, which doesn’t _really_ account for immigration. In any case, a number of rich countries (Ireland, UK, Canada, the Netherlands, most of the Nordics) have higher immigration rates than the US, so, again, probably not that.
Legend2440 5mo ago
Not car accidents; obesity from lack of exercise. 40% of Americans are obese and 75% are overweight. This is largely outside of the control of the medical system, but has a significant impact on mortality and life expectancy.
- t0mpr1c3 5mo ago
  > This is largely outside of the control of the medical system I assure you that preventative medicine does exist, even in the USA. Moreover, healthcare interventions for people with "lifestyle" diseases such as obesity have been extremely effective in reducing mortality from downstream causes such cardiovascular disease (e.g. statins).
  - Legend2440 5mo ago
    Statins help a bit (and are widely prescribed in the US) but they don't fix the problem. Diet and exercise are huge health variables that doctors don't really have the tools to do anything about.
    - t0mpr1c3 5mo ago
      The problem we are discussing here is mortality, and statins definitely have an effect on mortality. Obesity can be prevented, can be treated, and its effects on health can be managed. We are actually living through something of a miracle in the treatment of lifestyle diseases. For example, the proportion of total deaths among adults with diabetes from vascular causes (heart disease) declined from 48% in 1988–94 to 34% in 2010–15 (https://sci-hub.st/10.1016/S0140-6736(18)30314-3 https://sci-hub.st/10.1016/S0140-6736(18)30314-3). The USA is not some kind of global outlier with a uniquely unhealthy population. The problem is *very obviously* something to do with how healthcare is provided here.
      - Legend2440 5mo ago
        >The USA is not some kind of outlier with a uniquely unhealthy population. It is, actually. Our obesity rates are the highest in the world at 41%. This is nearly double many European countries, and five times higher than Japan or South Korea. Only a handful of tiny Polynesian islands have us beat. Better treatments for diabetes are great, but what's even better is not getting diabetes at all by losing weight.

t0mpr1c3 5mo ago

If you research "amenable", "avoidable", "preventable", and "treatable" mortality, you will find similar conclusions from studies that focus on specific aspects of the effects of healthcare on mortality. The results are not all that different. The USA lags other rich nations, and even middle income nations like Costa Rica and Chile. https://www.oecd.org/en/publications/health-at-a-glance-2023_7a7afb35-en/full-report/avoidable-mortality-preventable-and-treatable_e7407977.html#title-ab071a3f22 https://www.oecd.org/en/publications/health-at-a-glance-2023...

Schiendelman 5mo ago
Those all include obesity - this is kind of my point. The healthcare system isn't what's making people get a lot of these illnesses.
- defrost 5mo ago
  Part of the Australian public healthcare system is public health and well living announcements and controls on the worst of the worst junk food that various corps attempt to sell. Macca's in Australia has healthier food than McDonalds in the US, exercise is very common place, etc. Speaking of Obesity - Australian PSA (1975): https://www.youtube.com/watch?v=GNjEge3Awl8 https://www.youtube.com/watch?v=GNjEge3Awl8
  - Schiendelman 5mo ago
    Our public health system does similar, many cities have soda taxes for instance and we put public health money into encouraging activity and subsidizing organizations that make people get active. But those investments or lack thereof aren't the root cause of our obesity crisis. That's land use, urban planning, subsidies to corn, completely outside the healthcare system. If you made the healthcare system as perfect as you wanted it to be, you would be fighting an uphill battle with these problems, it's very questionable whether you'd have any real impact. There are studies of healthcare system efficacy. Rate of diagnosis relative to likely incidents of particular illnesses. Treatment effectiveness after diagnosis. And frankly, the US does much better than most countries when you measure just the healthcare system. But people don't like that, they challenge it immediately, because it's not what they want to believe.