China overtakes U.S. for healthy lifespan: WHO data | Hacker News Reader

China overtakes U.S. for healthy lifespan: WHO data

reuters.com

311 pointsElement_206 comments

Congratulations to China and the Chinese people who have managed to measurably improve their livelihoods over the last few decades.

As a developing nation, China should indeed be experiencing an increased lifespan. But under normal circumstances, China's life expectancy increases should be getting closer and close to the curve of developed nations without actually touching - because all countries should be making progress.

So the obvious story here is the actual decrease in US life expectancy, a situation broadly reflecting declining living conditions in the US.

The story looks like a credible source of facts, but any takeaway is a minefield of ways to be wrong. I assume life expectancy is vulnerable to Simpson's paradox and that the we really need detailed analysis to determine why the aggregate difference exists.

Without that the differences in the article are not large enough to really draw anything out of except vague feelings of national pride.

Life expectancy is also a dangerous QoL metric in itself because it is so influenced by so many things (particularly infant mortality) that although longer is generally better it doesn't paint a very detailed picture. In an extreme case; I know that a pretty reasonable percentage of very elderly people would argue that a prolonged life leads to lower quality. "Healthy life expectancy" might be a much better indicator, but that looks like a technical term and I don't see a definition for it.

I'm surprised there's no measure for life expectancy, given you made it to age 20.

There is!

https://en.wikipedia.org/wiki/Survival_function

I understand this is what actuaries spend their days tabulating. (I am an engineer not an actuary but in the past I been involved in efforts to apply the same maths to asset aging. However your mileage varies massively with the quality of your data).

With respect to living conditions, it appears the "everything is gettng better," and "everything is getting worse," ideas are among the most succeptible to groupthink, and to cognitive dissonance.

I also see this at reddit. Depending on the topic, and how it is framed, it seems everyone is either in agreement that life getting better, or that it is getting worse.

For a counter example to your comment, most at this popylar HN thread(1) were in agreement that life is getting much better.

I could be wrong, this has just been my observation.

1- https://news.ycombinator.com/item?id=16258434

Not in dispute - the question wasn't whether life in the U.S. was getting better but whether it was getting shorter.

It's a fact, not a question, that US life expectancies have declined. The way the decline has happened, suicide and drug overdoses compensating for medical advances that normally provide a slow, steady increase in life expectancy in most countries, give a strong indication that life in the US has also gotten worse for a significant fraction of the population.

Ok, but just personally I would say life expectancy / healthcare access are primary measures of 'is life getting better or worse' for people.

It depends on whether the factors leading to shorter life are deliberate (or just willful) or accidental.

It's hard to flesh out self determination from ennvironmental factors. Not to sound overwhelmingly 'r/iam14andthisisdeep, but consider: 1) Nomadic hunter gatherers who have shortened their lifespans due to their lifestyle choices, or lack of choice/information in determining their lifestyle; and 2) App developers who may also have shortened their lifespan due to lifestyle choices, or even also lack of choice/information (ie sedentary lifestyle to afford rent/food/taxes/legal aid, sugar consumption due to inaccurate information from leading scientists regarding health risks).

I just think we can't really know which one we'd prefer had we not experienced both.

Nomadic hunters had quite long lifespans; agriculture introduced shorter lifespans and difficult lifestyles.

We agree on point two though: Laws allowing no overtime for developers have allowed long work hours that we now know are very harmful.

> We agree on point two though: Laws allowing no overtime for developers have allowed long work hours that we now know are very harmful.

Excuse me? Keep your grubby hands off my time. I alone should decide if, when, and how I sell my mortality for cold hard cash. Whether or not you think it's bad for me is of absolutely no importance to my right to do it.

And what if both of those are caused by self-indulgence? Ballooning waistlines reducing lifespans while concomitantly causing healthcare shortages (because of high demand due to obesity-related chronic conditions) is definitely "getting worse" but it's an odd and self-inflicted sort of worse.

Shouldn't there still be diminshing returns to some extent in that model? Say for instance improving drinking water quality. Compared to dysentery tainted water a chlorination system would yield dramatic improvement. Then more sediment filterung, robust filtering to remove metal and plastic pollution, etc. But once you reach the point of "sterile mineral water quality from every tap" you will have been beyond measurable lifespan improvement even factoring in lifestyle changes resulting from high quality abundant water. Granted a country has /many/ areas to work on for public health but it may eventually hold no lifespan difference just from sheer saturation of benefits obtained through lifetimes of work.

And there is a shameful backslide in the US for life expectancy for various reasons.

There are diminishing returns for cleaner water past some point, as you say. Cheap and unhealthy foods is a well known major reason, but there are other major factors too.

American cities place low priority on walkability: it's usually cheaper for the real estate industry to build out rather than build up. Regardless of if that's intentional urban planning or not, it reduces the minimum amount of exercise people get.

Another major reason is infrastructure maintenance. I'll bet the recent leaded water issues in many cities made a non trivial dent in America's longevity stats.

Finally, my personal take is that this may be a side effect of some elements of American society. Maybe it's a combination of it being such a large and diverse country. I grew up in America, but I've been living in smaller, more homogenous Asian societies the last few years. Homogenous demographics have their problems, but it seems like they're generally less willing to screw over their fellow country people for a quick buck. (China is worse than America in this regard, so I added a large population to my hypothesis.)

>So the obvious story here is the actual decrease in US life expectancy, a situation broadly reflecting declining living conditions in the US.

True, however complicated by the obesity pandemic. Some informed estimates posit that by 2030 the majority of Americans will not be merely overweight but outright obese. [0] That alone is surely sufficient to retard and revert the US life expectancy.

[0] https://www.ncbi.nlm.nih.gov/pubmed/22608371

Recent declines are largely attributable to opioids.

After that, suicides and alcohol are major contributors.

https://www.vox.com/science-and-health/2017/9/20/16338996/dr...

But yeah, the opioid epidemic is so large it's noticeably shifting overall mortality stats.

Obesity related mortality actually improved from 2000 to 2015, though possibly as a result of better interventions, I'm not sure.

I sort of feel like the contributors are a cluster of symptomatic problems all rooted in inequality, from lack of universal healthcare, to more people in prison than any nation (where prisoners then get substandard health care), to underfunding of wages to an increasing underclass. It seems we have this storm of rising problems in the US.

Complicated, how? Obesity forming <whatever mechanism> is part of declining living conditions.

Obesity is a sign of improved living conditions that is also a sign of declining living conditions. The former conditions are largely out of the individual's control while the latter conditions are largely in his control. That is, being able to be obese is dictated by the economic vitality of one's country whereas being obese is dictated by one's actions.

There are a lot of roadblocks put in the way to controlling your weight. In the US that on the intake, junk food is readily available while healthy food is a luxury. Conversely, the US working environment suffers from increasingly medieval labor laws[+], limiting one's ability to exercise or live a well balanced lifestyle.

I wouldn't be so eager to say "being obese is dictated by one's actions". It's an equal mix of self-control and an unhealthy environment.

[+]: "Independent contractors", arbitration, union stigma/busting

I dispute that avoiding obesity requires either exercise or high-quality nutrition. It is simply a matter of maintaining a caloric balance at a healthy weight. This can be effectively controlled entirely on the intake side. (See the nutritionist who lost weight and improved his bloodwork on a gas station junk food diet. [0]) Other countries with varied labor and economic conditions (presumably among them are some you would not label medieval) are experiencing the same obesity pandemic. There is nothing unique about the US in this regard other than it has been leading the trend.

[0]: http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/

But one's actions are also largely dictated by societal living conditions. Many people are extremely time-constrained due to working + commuting + child caring hours. Finding time to exercise or to prepare healthy food is a challenge. Add to this that healthy food is often less easily available and more expensive than unhealthy choices. There is a degree of individual control, but it is society that controls what is easy or hard for the individual to choose.

I call bullshit on this. "Busy" people always seems to have plenty of time to watch TV, be on Facebook/Twitter and/or play video games.

> Add to this that healthy food is often less easily available and more expensive than unhealthy choices.

It's worth pointing out this isn't true everywhere. In America, cheap fast food is generally unhealthy, yes. As an extreme counter example, a bowl of pho in Vietnam is cheap by local wage standards, has very little grease, and can be ready within 2 minutes of you ordering.

On a macro level, I don't buy it. If the economic reality is that you live in a food desert and you are bombarded by sugar propaganda every living day of your life ... sure, there is some kind of selection process of the most fit for that environment going on. Not sure it's a good outcome though, the optimal strategy seems to be get as many kids as you can before dying of obesity in your forties.

Absolutely, but also the lobbying and campaigns vilifying fats, the lack of a competent authority explaining the benefits of sweeteners instead of sugars etc.

They deserve every bit of praise considering the fact that China was known as the 'land of famine' for majority of its history [0] -- having suffered their last major famine in the 1960s [1], that's just 60 years ago -- a blink of an eye in the grand scheme of things. The turnaround is truly impressive for a country the size of China. Makes one wonder about the power of free markets in lifting huge segments of the population from immense poverty.

[0] https://en.wikipedia.org/wiki/List_of_famines_in_China [1] http://www.sacu.org/greatleapfamine.html

> Makes one wonder about the power of free markets in lifting huge segments of the population from immense poverty.

One would argue that it was a market economy with heavy state interventions. I'm not sure I'd call that a "free market".

But then again, I think a "free market" is a purely theoretical concept that only serves as a rough outline in real life, it has no practical application.

I think that was the point. It has absolutely not been a free market (compared-ish to the US economy) and overall it's worked wonders at the macro level, whether you're looking at QoL, infrastructure, business conditions, education, or most other measures I can think of besides privacy and human rights.

If you look at that list, you could also argue the free market caused the death of around a hundred million people.

没有共产党就没有新中国

Or maybe it wouldn't have taken so long. ;p

If you consider 50 years to go from having <10% literacy to >99%, while also stabilizing an entire nation's food supply, and becoming an economic super power on par with EU/US then I hate to see what you consider fast.

Oh we should also talk about their entire coastal region we’re devistaed by land war and Japanese occupation.

There were horrible problems that derailed progress, it's pointless to deny them. On the other hand, some of the suffering came externally, like sanctions and embargoes designed to make life miserable and induce the country to fail/the regime to collapse. Also military threats that depleted meager resources and made normal investment impossible.

What can be said is that, given this set of very difficult challenges, whether self-induced or not, the outcome, such as it is, is a commendable one.

I don't have a source for this, but my understanding is that much of the improvement in China's literacy rate came from the government's redefining of "literate" down to about a 1st or 2nd grade school level.

Still, I can't help but be happy at how so many people's lives have improved so greatly in such a short time.

Simplified Chinese made a huge difference. It's one of the few undeniably good things to come from the CCP, although adopting a phonetic alphabet might have been even better.

Japan was devistates by WW2 also, but they bounced back quickly. China being one of the most powerful (and richest) countries in the world is actually not that unusual considering world history.

google translate converts this to:

Without the Communist Party, There Would Be No New China

But considering the party that the communists replaced were the Nationalists... who are in control of Taiwan.. which is even richer per capita than China (31k/person)... that seems unlikely.

Can you explain more why the Nationalists were successful in Taiwan, but you believe they wouldn't have been in China?

Edit: this is not to say that I believe the Nationalists would have been more successful than the Communists in China.. China is certainly a far larger task, both in building out a larger country and pulling more poeple out of poverty. So this is a sincere question about your opinion on the nationalists.

I say this as somebody who has had multiple-hour long debates with people on whether China would have been better off under the Nationalists. Despite ambivalence toward the Nationalists mixed with loathing for Chiang Kai Shek, I've always passionately advocated that China would be better off if the Nationalists had triumphed.

With that said, I can think of two (good) reasons people might think that China's current rise could not have happened under the Nationalists.

1. The Nationalists were extremely poor at stamping out corruption and warlordism. China appears to have been too large a region for them to competently exercise control. Their success in Taiwan therefore may be partly attributable to a smaller landmass over which they were more capable of exercising competent hegemony.

2. Taiwan's success is partly a result of their gradual liberalisation. It's hard to say whether this same liberalisation could have taken place on the mainland.

That said, like I mentioned, I think it's hard to argue that China wouldn't have been better off. Certainly in the short term. Without the Communists taking power you avoid every atrocity under Mao. That alone is hard to offset with any later (pseudo-)unity and progress.

US military and economic support for the ROC may have been a much smaller priority too if the mainland hadn't "gone red". But then again if the ROC had won the mainland, they probably wouldn't have poured resources into the Korean War.

And so on... it's a fascinating sequence of hypotheticals.

Yeah definitely. Although I've argued the US would probably have poured funds in as a buffer against Russia. Especially given the relationship between USSR and Guomintang was not 100% unambiguously hostile, so the US would want to make sure they weren't tempted to flip by USSR assistance.

I think that the role US money played in Taiwan's success is vastly overplayed anyway. The US basically abandoned them to their fate until the Korean war kicked off.

It's always a fascinating set of hypotheticals like you said.

I don’t believe they’d be successful in China because they weren’t historically.

Also we can compare how a nationalist, democratic, and capitalist country of similar size, population, colonial explotation, and natural resource wealth would fair in India. Which again makes the PRC come out rosey.

Ignoring whether I would choose 'Capitalist' as the first word to describe India's economy, India is still a bad comparison. The only reason it's even democratic is because it inherited British institutions. Taiwan built its democratic institutions from the ground up itself, after and during decades of military dictatorship, it's a completely different situation.

And given the terrible air, water and soil pollution they suffer from, this means the rest must be really, really top notch. Or that we don't have all the metrics.

Also obesity is bad for you.

Or just assume China will fix its air in 10 years while Americans (and Chinese) keep getting fatter? Lotta ways you can work these numbers!

I don’t know. They said it would be fixed in 2015 back in 2010. The fix is always 5 years away given whatever the current 5 year plan is.

Also, China has a ridiculously high smoking rate, with no end in sight for it really. On the other hand, smoking rates in the USA have fallen quite a bit in my lifetime.

So is obesity really that much worse compared to smoking and apocalyptic air pollution? An interesting question to ponder.

Then you should really think if your impression of the apocalyptic situation is actual thing or just propaganda. Smoking though is a probability thing just as the obesity is.

I lived in Beijing for 10 years (until 2016). Even the most committed wumao wouldn’t it’s pretty bad. Western media (if you mean by propaganda) if anything makes the problem sound not as bad as it really is, but how could any westerner even begin to comprehend an AQI reading over 300 let alone 500 or 1000. Actually, the only people who say the air isn’t bad are the ones who have never been before.

So bad you left in 2016, I'm in Beijing since 2012 and I can tell 2017 has been the year of change for air pollution. I really expect the next months/years to improve as well because the AQI still occasionally reach 300-350 and it's already far too high.

I guess we will have to wait another 5-7 years to reach US and Europe current air quality though.

I know it’s gotten better this year but keep in mind they were promising this for a long time, it wasn’t there first try at the problem. Regardless, I don’t want my kid getting asthma, so we really had no choice but to leave, even given the current improvement it would have still been a problem. The air might be clean for the next generation or the one after that, but it’s not going to be for us.

I’m tired of reading headlines like “Beijing to have clean air by 2015” wait no “2020” ok maybe “2025.” Glad that they’ve made progress but the government has lost all credebility otherwise.

The air quality in China is objectively terrible, but I do think that the government are serious about fixing it. China is now the biggest market for electric vehicles and photovoltaic panels by a considerable margin. The issue is being talked about quite openly on Chinese social media, which suggests that the Party have a great deal of confidence.

While I’ll admit the current thrust is promising, a lot of it is extremely fragile. The electric vehicle push is completely incentive drive of course; e.g. why Beijing has so many Tesla’s these days despite the 2X markup has to do with the separate EV allocation in its plate lottery. Is that economically sustainable? Who knows. Solar is even more precarious as the country still lacks to the grid to move it from West to East where it is needed. LanZhou has cleaned up nicely, but it isn’t helping anything in Hebei much.

The current push to cleanup air pollution has hit some walls in being too harsh. China lacks rule of law at the local level, factory owners commonly skirt regulations, so what does happen is very heavy handed (close all factories that do X vs. just the ones that are out of compliance). They actually had to let up on the campaign after CNY this year because too much production was taken offline.

True, but remember that 4,000 people died in four days in London during the "pea souper" of 1952, when visibility was about a metre or less:

https://www.bbc.co.uk/news/av/stories-42357608/death-by-smog...

https://www.pinterest.co.uk/grahamsrealm/great-smog-of-1952/...

This study is backward looking; it hasn't taken account of China's current set of factors that could skew the lifespan down tremendously for average Chinese citizens. Factors such as

1.) Air pollution. In your typical big cities, e.g Beijing, it average AQI 100-150 for the past 10+ years https://young-0.com/airquality/. In other lower tiered cities, it average between 50-100. Just to compare, WHO recommend only AQI of 25 in 24 hour span to be ok for your health. And even though recently Beijing's AQI has gone down, what the government has done is they pushed the coal-burning factories into the countryside, and moving the pollutions there.

2.) Water pollution. Cancer causing ingredients have been found in several water sources. for example: "Shanghai water supply hit by 100-tonne wave of garbage " - https://www.theguardian.com/world/2016/dec/23/shanghai-water... https://qz.com/113751/only-3-of-shanghais-river-and-lake-wat...

3.) Smoking/smokers everywhere. "Smoking Will Kill 200 Million In China This Century" https://www.huffingtonpost.com/entry/smoking-will-kill-200-m...

Not fitting your narrative doesn't mean it is backward. The healthcare infrastructure the government has invested and fast progression of technology to catch up with rest of the world after opening up help greatly. My parents now have something called 'Serious Illness Insurance' that comes only in recent years, which would cover cost for illness like cancer or big surgeries to up to 90% by the government, which I think is a good example where the progress has been made. Also Chinese healthcare system is still largely stated owned, it is bad news for the doctors, but it makes the cost to access necessary treatment relatively low, much more so than the US.

Problem remains, but generally, comparing what China used to have in 90s, it is like a heaven and earth difference.

All valid points. The good news is that China has big ideas for dealing with these, and will actually implement them.

I have no love for the CCP. I think they are an oppressive regime that unduly subjects their people to censorship and control. But I do respect that they invest in infrastructure and solving big problems for their people.

The US seems to have given up. It seems to think that the problems we face are unsolvable by cooperation and have resigned us to crumbling roads, poor health outcomes and failing schools so corporations can flourish.

The CPC has always had big plans for solving air pollution and smoking problems, ever since I started living there in 2007. Each campaign subsequently failed, so they don’t have a great track record on actually “getting things done.” Maybe it’s different this time, but a healthy dose of skepticism is definitely warranted.

Once my wife was pregnant, we had to leave Beijing, there was no way the air pollution problem would have been solved in time, even if the air got twice as clean it would still be way too much. Say what you want about the USA, but being able to open my windows everyday is incredibly liberating.

The Economist says the opposite: https://www.economist.com/the-economist-explains/2018/01/25/...

Are you saying that this article makes the claim that the government has successfully dealt with the problem or just that the current campaign seems to be effective?

Someone once told me:

China is like the kid that has to be home by 8pm because his parents want to make sure he gets his homework done after dinner.

The US is like the kid whose parents hired a nanny to make dinner for them and help the kid with his homework if he asks.

Pollution is indeed a big problem. I think it is closely related to both economy and national psychology. The economy has to develop to a point that the government decides that it is preferable to slow down economy and allocate more resources to deal with pollution. One example is the recent ban of importing garbages. It will take years to clean the pollution.

Smoking/smokers problem has been improving. (Anecdotal evidence) Most men in my hometown were smokers when I grew up. So were my friends/classmates when they turned 20s. It was a norm in social meetings. The last few years when I visited them, most quit smoking. Based on my nephews, there are much less smokers in the young generation.

How is it backward looking?

Do you think the data is wrong? Or interpreted wrong? You’ve presented some news articles about issues in China but I don’t know how these affects overall life expectancy in combination with all the other factors. Do you?

They seem to think they’ve taken account of likely future trends and ongoing health issues because they’ve said:

> Chinese newborns can look forward to 68.7 years of healthy life ahead of them

Do you think they’re mistaken somehow?

> How is it backward looking?

I don't have an opinion about China, but just in general, I'm sure they don't have data from the future :-) I would say it is okay to say that about such predictions. There are others that don't rely as much on past data, but especially this kind of prediction surely is entirely based on numbers from the past, or do we have a model that reliably predicts those outcomes from at least present data (i.e. less data from people, but that it uses data about the circumstances, like amount & quality of sanitation and food)? If the model is purely based on human population statistics it's 100% past.

> I don't have an opinion about China, but just in general, I'm sure they don't have data from the future :-)

Well then all studies are ‘backward looking’ then and it’s a stupid criticism, and why mention it since it’s obvious and there’s no other way they could have done it.

I think what you just wrote falls back on you. The parent just mentioned it, nothing special, AND it made sense as part of his argument. It was you who made a big deal of it.

You wrote

> How is it backward looking?

Which is clearly wrong! You even just admitted it.

Please don't try to make it look like it's the parent commenters fault now.

All you listed are likely urban problems. China has like 1B country population.

I assume the WHO relies on local census & medical data to generate these statistics (the Reuters piece doesn't have a citation on ths) so I'd take this data with a grain of salt until we hear more details about the methodology.

I agree. Although, it also wouldn't be terribly surprising for China to pass the US on this metric.

When you look at the obesity numbers:

US 36%, New Zealand 31%, Canada 29%, Australia 29%, UK 28%, Israel 26%, Ireland 25%

Thailand 10%, Indonesia 7%, China 6%, Philippines 6%, South Korea, 5%, Vietnam 2%

Vietnam's life expectancy will overtake the US in the next 10-15 years as well most likely (they're about three years behind). In most cases if you prevent people from starving or suffering serious malnutrition, provide a basic level of healthcare & sanitation, and have single digit obesity levels, you'll almost automatically see 75-80 year life expectancies.

South Korea's life expectancy went from 65 years, to 82 years currently, from just 1980 to 2015. They passed the US around 2003. South Korea's GDP per capita was $14,000 at that time, versus $40,000 for the US. One would expect China to have no problem replicating that.

It's a small wonder life expectancies in the developed, high obesity countries are as high as they are. The US is no doubt expending hundreds of billions of dollars extra per year on healthcare as a consequence of its obesity level (cancer, disability, diabetes, etc).

It's not just obesity that drives poor US life expectancy performance. Mexico's life expectancy is projected to rise meet the US life expectancy by 2030, and they're a nation with a fairly high obesity percentage.

https://www.cnbc.com/2017/02/22/us-life-expectancy-is-low-an...

We have to acknowledge that the lack of Universal Healthcare in the US is a big driver of our poor life expectancy showing.

Without question. The US for example had a higher life expectancy than New Zealand during the 1980s, then the US began to trail off and fall behind. Now it's ~2.7 years behind New Zealand. The US was also ahead of the UK as recently as 1983.

What changed? A few big things. Healthcare in the US became wildly expensive after the 1980s, following an extreme cost increase far beyond inflation, whereas before it was not far out of line vs other developed nations (eg share of GDP spent on healthcare; today it's commonly 2x the next closest nations on cost). And obesity exploded dramatically higher after the early to mid 1980s. Diets overloaded with sugar, carbs, high fructose corn syrup in everything, drive thrus as a routine, etc.

I do believe universal healthcare would have prevented that life expectancy gap from opening up between the US and the UK, Canada, New Zealand and Australia. Based on the expectancy increase path the US was on as recently as the early 1980s, it should be at 82-83 years now, rather than 78.x.

I also found it interesting to see what the insurance companies predicted my lifespan will be given I was born in 1980, don’t smoke, am fit & live in New Zealand.

Apparently the actuaries reckon I’ll make it to 91 and wife to 94.

I'm in favor of universal healthcare, but the state of our health is a holistic problem.

It includes our diet, restaurant culture, stress, play culture, misinformation, corporate influence, architecture, work culture, as well as our healthcare administration.

Thats a pretty big assertion.

I'm almost tempted to say it is political advertising, but I'd sooner admit it is just emotional dialogue

It's almost certainly not due to healthcare coverage, but rather obesity and the recent spike in overdose deaths.

Unfortunately, no. U.S. life expectancy has stalled O(10 years) while others steadily improve.

2013: https://www.cbsnews.com/news/report-us-life-expectancy-lowes... 2018: https://www.google.com/url?sa=t&source=web&rct=j&url=https:/...

Life expectancy has also improved in this time frame in nations such as Germany where there also have been a slow drift upwards in obesity.

So Mexico has better healthcare for the average person than the US? Hardly.

As mentioned elsewhere, overdoses are significantly impacting average lifespan figures.

I don't think "better" is the sole quantifier here. Accessibility is an important thing.

Many Americans are afraid to go to the doctor because it's incredibly expensive. Many people brush off the early symptoms of serious illnesses because "well, what if it goes away and I get into debt for a small problem?" It's why a lot of Americans with cancer aren't diagnosed until it's too late--that apprehensiveness about getting a simple exam.

When it comes to getting major surgeries or treatment for complex illnesses, yeah, America is great if you've got the cash. But most countries can handle illnesses treated by a quick run of antibiotics or other relatively simple and routine treatments. America is special because it's a wealthy country on paper, yet people brush off illnesses like that and end up dead.

"When you look at the obesity numbers" ...

Unfortunately, theses 'lifespan' measurements have a lot to do with violent crime, car accidents, suicides, war deaths etc. - i.e. things that aren't so much about health than otherwise.

It's why average lifespan isn't necessarily a very good measure of health outcomes.

I think US is down due to overdoses, which is a kind of health issues, but not necessarily a regular measure of diet and quality of regular medicine, it's an epidemic.

Heart disease is the biggest killer by far in the USA.

A epidemic, that without quarantine, is contained to the US only.

It's in Vancouver. And many other places.

legalization of weed is the worst decision IMO that not only affects the healthy life span but also intoxicate the next gen.

how does cannabis affect healthy life span?

Obesity seems to be a side effect of prosperity, so China will probably be next.

Tell that to the Nordic countries....

Or to Californians...

小胖子 is already part of Chinese vocabulary, it is already happening in the cities, though nowhere near on an American scale.

Oh and the absurd costs of healthcare in the US

Well, Asians are a different race but they also eat more rice than wheat

http://healthcorrelator.blogspot.com/2010/09/china-study-ii-...

Given the terrible state of US healthcare and social support infrastructure, I don't find this hard to believe at all.

Terrible compared to? This is absurd if you are someone with US hospital intake experience: https://www.youtube.com/watch?v=q2jijuj1ysw

I try to make it a rule to not base my opinions on YouTube videos with titles beginning with "The TRUTH about..."

I agree. Using "truth" is almost always a mistake.

https://paste.fedoraproject.org/paste/TIApj2qMvvIcmN-DkPd5RA...

I might still will watch something that makes that mistake, especially if I appreciate the previous history of the mistake maker. In this case, it's a first person experience that jives with what I know since I know a few Canadians and have plenty of US emergency room experience.

And China spends very little on healthcare, especially through its public sector: http://www.oecd.org/els/health-systems/Briefing-Note-CHINA-2...

So other factors are probably responsible.

doctors in the west get paid top $, while Chinese dentists/doctors are getting paid much lower, e.g. far lower than PHP programmers.to give you a quick example: it costs up to $1,000-$2,000 to remove a bad wisdom tooth in Sydney, it is $20-30 in the biggest dentist hospital in Shanghai.

If you click the link you'll see that China has fewer doctors and nurses per capita:

>>With 1.6 physicians per 1000 population in 2012, China had much fewer doctors per capita than the OECD average (3.2 physicians). The number of nurses per capita in China (1.8 nurses per 1000 population in 2012) is also much lower than the OECD average (8.8 nurses).

As for the affordability of dental services, would you say that's an argument for deregulation and lowering of mandatory quality standards?

> China has fewer doctors and nurses per capita

That explains why the public spending on healthcare is less - less doctors/nurses per capita, together with far less pay for doctors/nurses. the 1.6 doctors per 1000 population vs 3.2 in OECD countries is not a surprise, Chinese doctors have for decades been forced to work much longer hours.

> As for the affordability of dental services, would you say that's an argument for deregulation and lowering of mandatory quality standards?

It is the complete opposite - the cost is so low because they got over-regulated. The mind set of the government is that "dental issues are usually not life threatening, it thus shouldn't be expensive", all charges by public hospitals are exclusively set by the Price Bureau (Yes, there is Price Bureau!) and dental costs are just stupidly low.

>>all charges by public hospitals are exclusively set by the Price Bureau (Yes, there is Price Bureau!) and dental costs are just stupidly low.

But the standards that need to be met to be licensed as a dentist must be much lower for dentist pay to be that low without massive shortages of dentists.

Which goes back to my question on whether you think China's case is an argument for lowering of mandatory quality standards.

The US lifespan is decreasing due to opioid overdoses. Similar to Russia in the 90's with alcohol.

A quick google search would show this is untrue. Opioid overdoses kill 40,000 a year. 2.7 million Americans die per year.

Even if you were talking about a decrease in healthy lifespan, Opioids do not generally cause a person to transition from healthy to unhealthy (they are prescribed to treat a preexisting condition).

Sources:

https://www.cdc.gov/drugoverdose/index.html

https://www.cdc.gov/nchs/fastats/deaths.htm

That's not necessarily a disproof - if opioids are killing people who are disproportionately young, then they could have an outsize effect on life expectancy. Say life expectancy is 79 years. If a new cause of death occurs that affects 10% of the population and kills, on average, at age 78, then life expectancy goes down to 78.9. If a new cause of death occurs that affects 10% of the population and kills at age 29, then life expectancy goes down to 74. Same reason that infant mortality had a disproportionate affect on life expectancy: the numbers of deaths might be small, but the reduction in lifespan is large.

Personally I would bet on obesity being a bigger contributor to declining lifespans than opioids, but I'm just showing that raw numbers of deaths cannot automatically disprove the hypothesis that a decline in lifespan is due to opioids.

For a cause of death affecting 40000/2700000 it could only reduce life expectancy from 79 to 77.8, even if all the victims were age 0.

EDIT: I suppose it could be lowered a bit more if all those who died were those who would otherwise have lived longest.

> I suppose it could be lowered a bit more if all those who died were those who would otherwise have lived longest.

That would average out in a population size of 40k

No, I mean there could be some actual effect that selected for those people.

For example if rich people were culturally more likely to use heroin than poor people, then overdoses would lower the life expectancy more than you would expect, because rich people (when not overdosing on heroin) have better access to medical care and hence longer life expectancy.

There's a great breakdown here [0]. The first chart shows age 15-44 deaths going up ~10% from 2010 to 2016. The third chart shows drug overdose deaths going up 50%(15-24), 80% (25-34), and 60% (35-44) from 2012 to 2016.

[0] http://www.calculatedriskblog.com/2018/05/lawler-us-deaths-j...

Washington Post recent headline: "Fueled by drug crisis, U.S. life expectancy declines for a second straight year"

Quote: "Experts pointed then to the "diseases of despair" — drug overdoses, suicides and alcoholism — as well as small increases in deaths from heart disease, strokes and diabetes."

https://www.washingtonpost.com/national/health-science/fuele...

Deaths from "unintentional accidents", a large portion of which are opioid / heroin overdoses, is 4th leading cause of death in US

Many of these people die young. There are more years of life lost before age 75 due to suicide / overdose in the US than diabetes

40 of 2700 is 1.5% of deaths. If those are people decades younger than normal deaths, it will bring the numbers down. Not by several years, but by a decimal or two.

> Opioids do not generally cause a person to transition from healthy to unhealthy (they are prescribed to treat a preexisting condition).

This is a very naive view.

People start taking opioids in many different paths, legal and illegal. Some lie to get the prescription, no one can prove you don't have back pain. Some get a prescription after surgery and get addicted that week.

The super informative and well written book to read is Dreamland: https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem...

With a lot of the fentanyl flowing into the US market being made in China, it's almost like a reverse opium war between the east/west.

Make no mistake: the opioid epidemics is pretty much a self-inflicted harm. It is what happens when you underfund actually useful drug programs and let corruption (relabelled 'lobbying') by pharmaceutical companies run unchecked.

So yes, sure, China will make business if they can, but they are not "out there to get you".

in both cases, it could be said as "out to make money" not "out to get you"

it just so happens that it's always very profitable to sell opium.

I remember a businessman from Hong-Kong, 15 years ago, telling me that as soon as USA realizes China is better at business than they are, they will switch overnight to hating capitalism and free trade.

At the time I thought it was a bit exaggerated.

> as soon as USA realizes China is better at business than they are

This is jingoistic at best. Let's ignore that "goodness at business" is an ambiguous and multidimensional metric. Or that defining a "better" direction is similarly dubious. The argument is simply "anything you can do I can do better." To that, the counterfactual is Ricardian comparative advantage.

More broadly, every culture says such things in times of growth and decline. It is never true. But a changing baseline combined with localisation bias reproduces it often. It is a case where the utterance of a thing is more meaningful than the thing itself.

I think I made it clear that this was a single person's opinion. And obviously biased that is. Still an interesting opinion in light of the recent trade war saber rattlings.

But realize that cities like Guangzhou (pop. 25 M) have been trading hubs for much longer than the USA has existed. And some families have had a continuous line of business for centuries. The business culture is very strong there.

What I've experienced in China is that trade can happen without any monetary transaction or contract and the chance of getting screwed over is very low in upper strata.

This is something, I never saw in the US.

Even at the lower strata, people understand what reputation is. And to be honest, only in the US does "buyers beware" feel like a sound business strategy. Most countries understand the need to go beyond that.

Also blame the patent system, as implemented.

>actually useful drug programs

For example?

I think obesity has more to do with it. A lot of people seem to want to normalize being overweight but I really don't think that leads anywhere productive, especially when it comes to affordable health coverage.

I don't see many serious people advocating for normalizing obesity. I also don't think there's a clear productive outcome to obesity issues.

Telling fat people to burn more calories than they eat is like telling poor people to save more dollars than they spend. Yeah, it's the outcome we want, but it's not a mechanism to solve the problem.

A government program to influence calorie consumption is as distasteful as a government program to closely monitor home economics.

Pardon my utter ignorance/disbelief - are opioids killing/debilitating that many people to get this result?

No. I would guess the biggest factor is our number one killer, heart disease. Healthy lifespan.... People live a long time with heart disease, but they are never healthy again. Same with many terminal cancers, etc.

> No. I would guess the biggest factor is our number one killer, heart disease. Healthy lifespan.... People live a long time with heart disease, but they are never healthy again. Same with many terminal cancers, etc.

Those are the leading causes of death, but not the leading causes of the recent decline in life expectancy (heart disease has not contributed to a dramatic decrease is life expectancy).

The recent decrease is due to deaths from drug overdoses. They aren't the leading cause of death, but they have caused the life expectancy to decrease in the last few years.

60,000+ people are overdosing in the US. The Fentanyl China is dumping into the US killed 20,000 people in 2016, up from 3,000 just a few years prior. By comparison, Cocaine killed 10,000, Heroin killed 15,000, and prescription opiods killed 14,000.

The reason it disproportionately impacts life expectancy, is because a lot of the people overdosing are young.

If you suddenly have 250,000 people under 40 years of age overdosing over five years, you're going to see it in the life expectancy numbers even if your population is 320m. The small increases you'd expect to see in life expectancy year by year otherwise, will evaporate.

To get a picture of the overall health impact (non overdose deaths), one would need to look at how many additional addicts the opioid explosion has caused (eg in the last 10-15 years), study the health impact over time on those people, and so on.

Some quick maths. an increase of +17k Fentanyl deaths in a year. Let's say they all died at 20. Of the ~2.5million annual deaths, which average to be life expectancy (78.8 years). Life expectancy goes down to 78.4.

A net change of 0.4 years is not insignificant, but I think you're ignoring the elephant in the room (China's rapid development in the last decade).

On another vein, I'd argue overdosing on drugs is an intrinsic part to the American experience.

That matches the observed life expectancy numbers in the article - U.S. life expectancy decreased from 79 years to 78.5 years.

Fetanyl is a prescription opioid, why did you separate the two?

And what does it have to with China "dumping" it? FDA approved Fetanyl and American doctors are prescribing it. It's on us to reign it in.

In the eighties Iran used to blame its drug problems on the US - I don’t think blaming the US’ on China has any more logical footing

I'd imagine that opioid overdoses can be added to the figures of those caused by the US healthcare system, being largely driven by prescribing practices and the warped incentives that drive them.

For a developing country to increase life span in general, it makes most sense to decrease child mortality and increase vaccinations. Old and sick people don't matter much for the statistic, since a child dying with 2 years is much worse for the statistic than an old persons getting one year less out of life.

It’s not surprising. The stereotypical American is obese and not too intelligent when it comes to dealing with that problem. See the whole “fat shaming” movement for a prime example of this.

"Asian-Americans outlive whites by an average of nearly 8 years" according to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567918/ . Differences in life expectancy across countries are probably due to both genetic and social factors.

Diet might be another important factor. Asian tend to have balanced meals that include significant amounts of vegetables, fish, seafood, etc.

I think the condition is improving. More and more people realize the importance of balanced meals. It shows in grocery stores. They stock more variety of vegetables and fish than before.

Source http://www.who.int/gho/mortality_burden_disease/life_tables/...

> life expectancy at birth

This can be affected by how one defines birth. The US, for example, goes to fairly heroic lengths to save premature babies, and counts those that fail as infant mortality, whereas other countries may classify them as miscarriages.

A more portable figure would be life expectancy at one year.

.. but is apparently fairly terrible at saving mothers? https://edition.cnn.com/2017/11/15/opinions/op-ed-christy-tu...

Even assuming that this data is flawless, I have a disdain for articles with such surface coverage of a topic.

This article brings you so many questions about the methodology used that it is hard to even begin to consider implications...ie:

What defines healthy life vs non-healthy life? Are current and expected levels of pollution, drug/alcohol dependences, and depression being considered? Is this including some sort of happiness/satisfaction measure? Does this include premature births which could the skew the US numbers lower if China is not including them?

This map shows the life expectancy of different Chinese provinces in terms of other countries: https://www.economist.com/china/2015/10/31/noodles-of-longev...

The United States was one of only five countries, along with Somalia, Afghanistan, Georgia and Saint Vincent and the Grenadines, where healthy life expectancy at birth fell in 2016... Meanwhile U.S. life expectancy is falling, having peaked at 79 years in 2014, the first such reversal for many years...

This is also inequality and poverty taking their toll. May it be sign? In 1976, Emmanuel Todd announced the coming fall of USSR from its dropping life expectancy and other poor demographic results.

Poverty is one of the US’s major imports.

Drop out the recent immigrants, as China has virtually no net immigration. Do the numbers change?

No it does not. From NIH study: (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5026916/)

>We use high-quality linked Social Security and Medicare records to estimate life tables for the older U.S. population over the full range of birth regions. In 2000–2009, the foreign-born had a 2.4-year advantage in life expectancy at age 65 relative to the U.S.-born, with Asian-born subgroups displaying exceptionally high longevity. Foreign-born individuals who migrated more recently had lower mortality compared with those who migrated earlier. Nonetheless, we also find remarkable similarities in life expectancy among many foreign-born subgroups that were born in very different geographic and socioeconomic contexts (e.g., Central America, western/eastern Europe, and Africa).

As a Chinese, I should say, well, fucking CCP, just another bribe

Any idea how honestly China reports these statistics?

I don't know how China collect its public health statistics, but its economics numbers have been extensively studied. And the consensus is that its official GDP growth figures were overstated historically (by as much as 67%), but had been mostly accurate post-1996.

Study: https://www.stlouisfed.org/publications/regional-economist/s...

a very short trip in vietnam made me realise i dont want to be in the netherlands for the rest of my life. there's better places out there.

yes, China surpass US in a new sphere. When would those comparisons stop ??

Healthy and subject to a "social credits" system. I'd rather be morbidly obese than have the government force me to play a social status game.

in the united states, the means of control are hidden rather than apparent.

Case in point, the no-fly list in the US. No one publically knows if they're on it, there is similarly no means to appeal being on it. At least one would know if they held a poor Chinese social credit rating - though I don't know what resolution mechanism they might have for mistakes either.

I can't be put on the no-fly list for shoveling bigmacs down my throat.

How do you know? The criteria are not public either.

Respectfully I disagree. Some airlines will make you buy a second seat, but if there is no second seat, you could be bumped from that airplane due to incredible obesity. Likewise, with enough big Macs, you might grow to such large size that you present safety issues for other passengers. As such, you might be denied boarding.

It's fine if a business judges you on all the information they can get; for example, in hiring new employees, etc.

But the government is not an institution that should be rewarding or penalizing behavior that is within the bounds of law. Obviously, you get -10000 points let's say if you commit a felony in the US. But you don't get +5xp for praising the government or being a good neighbor, or -5xp for being rude to a waiter or something. That's like, a few orders of magnitude of closer government behavioral management.

That’s a false equivalency. The parent said that you won’t be put on a no-fly list for being morbidly obese. That’s not the same as the airline not being able to accommodate you because of your extreme body size.

That's not the no-fly list. That's just paying for your weight.

How many innocent people are in those lists? Even if it were 100,000, that’s statistically meaningless.

https://en.wikipedia.org/wiki/Manufacturing_Consent

The US has credit ratings and secret no-fly lists. I really fear what the CCP will do with their scores but so far it seems to have a lower impact on peoples' life than the US' system has.

Pretty much every single being on this planet is playing social status game, all China did is put a number on it.

A government issued number. Thats the key difference. In the real world you can move in the country and start anew somewhere else.

How is this functionally different than e.g. a criminal or financial record?

If you can escape these, you can escape other government records.

To add to those examples: standardized test scores (like those for college admissions), education records (including collegiate degrees), health records, residency records, credit scores, driving records are all permanent records that are maintained by organizations that are either governmental or no better than a govt org.

I'm not a fan of China's system either, but it's silly to act like it's something new. Nearly every citizen of any first world country has a huge set of permanent records being compiled on them, not just those in China.

My SAT score doesn’t dictate if I can board an airplane. My credit score doesn’t affect me getting a passport. Comparing China’s social credit system to US records is completely off base.

Your records certainly can affect you getting a passport. Depending on your criminal past, you may be banned from getting a passport. Similarly, some countries (Canada comes to mind) will ban you from entering the country for things as small as running a stop sign while driving. You can also be banned from getting a passport if you are behind on your taxes or child support payments.

As for getting on a plane, all of the above apply too, as well as the fact that you can be barred from flying simply by having a certain last name. Your personal records also affect things like how easy it is for you to get through customs and airport security. Global Entry/TSA PreCheck, for example, will be completely off-limits to you if you have 'questionable' travel records in your past.

Pretending the US/EU doesn't already have the Chinese social credit system in place is sticking your head in the sand. All China has done is formalize it.

I'm pretty sure China is in the real world

????

So it's fine that one of the government's responsibilities is to track each citizens social score, instead of it being implicit in the judgement's of a person's peer-group?

Yes we all play some kind of "status" or "reputation" game, but the difference is that we can determine ourselves what is socially right by finding the right audience. In China's case, your only choice of audience is the government. You are forced to play instead of being a willing participant in your relevant social stratum.

You don't think that trivialises the issue just a touch?

We're talking about an institutionised score which effectively administers your social mobility.

You're talking about SAT scores right? Or did you mean US credit scores, which are maintained by three opaque and unaccountable private corporations.

More seriously, yes, the explicit social credit system that China seeks to establish is evil. But the west isn't much different.

SAT scores decide where one can go for university. Credit scores decide interest rates and loan approvals.

Social credit score decides whether one can board a plane or a train, or whether your child can get into a school of their choice. Furthermore, your score is influenced by the people you associate with, and vice-versa.

One of those concepts is very different from the other, in practice.

> Credit scores decide interest rates and loan approvals.

They decide a lot more then that. Housing, job applications, sentencing, whether or not you can get an education...

But in the Chinese system, your number goes down if someone you're friends with on social media makes a post that the Chinese government deems politically unsavory

This is true in the west as well. Especially now in 2018, if someone you're even tangentially connected to does something deemed to be unsavory you are expected to immediately and forcefully disavow them or face the social consequences. Even then, you still may be tainted by association.

"This is true in the west as well. Especially now in 2018, if someone you're even tangentially connected to does something deemed to be unsavory you are expected to immediately and forcefully disavow them or face the social consequences. Even then, you still may be tainted by association."

No, this is generally not true.

Unless you're a public figure and only then in specific circumstances.

Almost nobody holds people accountable for what their friends do.

Bill Clinton's brother was a drug dealer.

Barak Obama's father was a kind of unsavoury deadbeat dad.

I suppose both of them would have had nary enough 'social credit' to become President.

Also - it's borderline shocking to hear a casual defence of this system. Theoretically yes, I can see a rhetorical argument, but in practice it's pretty scary. In America people do have 'credit scores' but that's generally a more open thing, and you still get to vote and ride the subway if you have low credit score.

Please point out where I am actually defending the PRC's various "social credit" systems rather than criticizing the west for having similar systems of social control.

Speaking of Clinton, is "immediately and forcefully disavow" not exactly what his Sister Souljah moment was? Ditto for Obama's Jeremiah Wright moment.

The big difference is that in the west, the public is the judge of your social standing... NOT the government. The government is an institution of power. Imagine the IRS targeting people with a low social points level because they might be more likely to cheat on their taxes. People should be able to say whatever they want and be judged by the public, but not parented by the government.

When uncle Joe in Utah posts a racist rant on Facebook, I don't get penalized. Even if he posts a political rant or conspiracy theory, I don't get penalized. I can and do still remain friends with him on this social media channel without consequence.

I've actually seen a lot of calls on social media to completely cut off racist family members in the last year. Could be a difference between our relative social circles.

More generally, if you're Facebook friends with or a Twitter follower of someone of interest to the state security services, like a radical Islamic preacher for example, do you really not think that is being recorded somewhere?

racist uncle Joe doesn't get penalised either, so I don't think it's an apt comparison

Uh, no? People who know you or the person associated may judge you negatively, but the US government will not penalize you and affect which public services you can use.

It's a tremendous difference...

depends what you mean by penalize.

the US government doesn't give sufficient services that you can live just fine without a good credit score, so in essence, it is penalizing you. it's just a distributed punishment

You realise China's current political system is merely a stage of its economic development, I hope?

That doesn't seem nearly obvious enough to take that tone without at least a little explanation.

Is this where some nasty european posts that escalator-to-a-fitness center photo from the 2000s?

So what I'm getting from this statistic is that in China, if you get old and sick, that's probably the end. In US, if you get old and sick, you might have a few more years. Albeit with lower QoL. I'm actually ok with that.

And in any other Western country, you'll both live longer and have a higher quality of life.

How is this article related to Hacker News?

>Hacker News Guidelines

>What to Submit

>On-Topic: Anything that good hackers would find interesting. That includes more than hacking and startups. If you had to reduce it to a sentence, the answer might be: anything that gratifies one's intellectual curiosity.

>Off-Topic: Most stories about politics, or crime, or sports, unless they're evidence of some interesting new phenomenon. Videos of pratfalls or disasters, or cute animal pictures. If they'd cover it on TV news, it's probably off-topic.

https://news.ycombinator.com/newsguidelines.html

"If they'd cover it on TV news, it's probably off-topic."

That might have been a relevant metric 10 years ago, but all sorts of tech and health news now gets screen time.

I posted a BBC article about mental health and it received complaints about being off-topic and it was removed.

Probably an article's involving the USA increases its perceived on-topicness. Although a large majority of people on here aren't from or in the USA, 'Americans' on here often talk as if it's a 99.5% US discussion taking place on US soil.

The article was not specific to any country

I meant, just being a BBC article might make it more susceptible to being flagged for seeming off-topic than if it was from some US website.

Many of us go to China on a regular basis. Some people may even consider living there. Knowing that it is now not that bad of a place to raise kids is interesting.

And US has universal health insurance, while China doesn't

Do you mean a penalty that one pays if they DON'T pay for some private insurance every month? Because that's actually what we have and it should not be confused with universal health insurance

Actually we don’t. The individual mandate was repealed.

The US does not have universal health insurance, but it makes up for it with atrocious diets and sedentary lifestyles.

US does not have universal health insurance.

I think he's being sarcastic...

Isn't medicare de-facto universal?

no.

Then I apologise

Reply on news.ycombinator.com