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Comment by joe_the_user | Hacker News Reader

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.

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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.

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.

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.

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

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.

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

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.

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.

> 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.

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.

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/

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.

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