Comment by yummyfajitas | Hacker News Reader

Comment by yummyfajitas | Hacker News Reader

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Poor scientists. Their conclusions are correct, but a significant portion of the reasoning which would allow them to get there is politically off limits.

That's ok, I'm politically incorrect. I'll stick to the comparison between the US and Japan, since numbers are easy to come by[1]. On the face of it, it looks as if Japan has us beat: 82.6 years to 78.4 years.

Now lets break things down by subgroup:

People of Japanese descent: 84.5 years in the US, 82.6 years in Japan. This long lived group makes up <5% of the US (too lazy to look up exact #, but east Asians in total are about 5% of the US), and about 99.4% of Japan.

http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2...

People of European descent: 78 in the US, unknown (but irrelevant) in Japan. This group makes up about 80% of the US, and < 0.6% of Japan.

People of African descent: 72 in the US, unknown/irrelevant in Japan. This short lived group makes up about 12% of the US, and as far as I'm aware Japan only knows about this group via video games.

http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_15.pdf

So if the US had the same demographics as Japan, our life expectancy would be 2 years longer.

[1] Japan is the only industrialized nation with the property that the (possibly great great) grandchildren of Japanese immigrants is classified by the census a "Japanese American".

The trouble isn't political so much as the inherent complexity of the causal relationship between life expectancy and virtually every lifestyle/demographic factor you can think of. Not all lifestyle factors are isolated from the quality of healthcare either - there may be many significant cultural reasons why the US diet is more unhealthy than the Japanese one, but it's easy to argue that there is a [weak] causal link between quality of healthcare and healthier eating habits.*

Probably the best measure of heathcare quality you're going to get is looking at survival rates from specific treatable diseases whose incidence is largely uncorrelated with climate/genetics/lifestyle.

*i) [free] accessibility to specialist advice from medical practitioners should improve the number of people willing and able effectively managing their weight/cholesterol level etc (ii) healthcare spending can include preventative measures such as campaigns to encourage healthy behaviour (which depending on their efficacy may be be an optimal use of resources, particularly for a heathcare provider that views treatments as an overhead rather than a revenue source)

>>People of Japanese descent: 84.5 years in the US, 82.6 years in Japan.

What if someone was to add something like "People of Japanese descent: $85 000 average family income in the US, $50 000 in Japan." (I've made up the numbers from personal experience) Obviously richer ppl live longer.

If you assume Japanese Americans are average for Asian Americans, the actual number is $65,000 (see my link).

In any case, I agree with you. Income is a major effect, although it's far from clear that this is due to income buying health care. In fact, most of the evidence suggests health care has nothing to do with it. For instance, during the RAND experiment, richer people were healthier than the poor regardless of which category they were randomly dropped into. (Observational studies since then draw less clear conclusions, since observational studies are crappy in comparison to randomized experiments.)

Another fun fact. The shortest lived people in the US are the Lakota, who live 35 years less than Japanese Americans (not a typo, life expectancy = 50). This group gets free health care via IHS (I believe it is structured similarly to Britains NHS), so it seems that there are other factors at work.

Huh, imagine that. Life expectancy is, in fact, not a great measure of health care, since it is affected by so many other factors.

> This group gets free health care via IHS (I believe it is structured similarly to Britains NHS)

IHS is pretty much a horrorshow. It's one of the best arguments against govt-run healthcare.

It doesn't much matter if some govt somewhere can run healthcare well. The US govt runs healthcare badly. Fix that first.

Ah yeah, I know that argument ;-)

Look, this is not to say that it is invalid, far from it. It’s just that I think you have to be a lot more careful. It could be that Japanese vs Japanese Americans is one of those Apples vs Oranges comparisons. Are Japanese Americans really like Japanese?

Genetically yes, Japanese Americans are like Japanese [1]. Their diets are also closer to Japanese diets than standard American diets.

I may only be comparing lemons to oranges, which I agree is only marginally better than apples to oranges. But that's ok - I'm certainly NOT trying to make the claim that US health care is better than Japanese health care as a result [2]. I'm simply pointing out that if you include slightly better controls, the effect completely reverses itself. This strongly suggests the original comparison is crappy.

[1] Genes matter. A fact I've heard - Indians have narrower blood vessels than non-Indian Whites, leading them to be more vulnerable to hypertension. The UK NHS takes this into account when giving medical advice, though supposedly US doctors do not (that would be racist).

[2] To draw conclusions like that, you need to take groups of statistically similar people with the same disease and measure health outcomes. No one does this, it's very hard.

Point #1 is not quite true. US doctors certainly take ethnicity into account when it is a medically relevant indicator of genetic risk.

Using immigrants as a proxy for anything is very suspect since emigrants to the US are a self-selected subset of a country's population. Compare the average intelligence, ambition, and work ethic of an Indian-American immigrant, that immigrant's American-born child, and the average resident of India.

I wasn't talking about immigrants. Most Japanese Americans are the grandchildren of manual laborers who immigrated to the US between the Chinese Exclusion Act and the Asian Exclusion Act.

Why don't you go up to a Japanese American and ask, "hey, how long have you been in the US?" (Be sure to duck immediately after saying it.)

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