Why is life expectancy in the US lower than in other rich countries? (2020)

It's very surprising to see so little mention of race/ethnicity forces in this article, since I understand that to be a large part of the answer to the headline question. There is a gap of a couple years between Americans from Asian, Latino, White, and Black/Native ethnicities (in that descending order). https://nationalequityatlas.org/indicators/Life_expectancy#/...

For Asian- or Latin Americans, life expectancy is comparable or favorable vs respective countries of ethnic background. This remains true for richer countries; Chinese-Americans have a life expectancy of 86.8 vs 85 in Hong Kong and 75 in mainland China.

Meanwhile, Black and Native Americans live several years fewer than other Americans, and (at only 14% of population) account for ~1.6 years of the ~3.4 year life expectancy difference between the US and the G7. White Americans, esp rural, seem significantly worse off than European countries. These differences in racial outcomes seem to persist when controlling for SES: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849870/

(Not that any of my comment is in conflict with the causes pointed to in the article -- smoking, obesity, homicides, etc.)

These articles always tend to focus on small and/or homogenous countries. Comparing the US to many of these countries (Japan, Iceland, Israel, Finland) is comparing apples and oranges.

A better example is Brazil, which is very diverse, like the US, with people from different cultures all over the world, and also large geographically and in terms of population. Like the US, Brazil has high wealth inequality, high homicide rates, low social cohesion, etc.

These kinds of countries have to find new solutions. Sao Paulo or New York is not going to become Tokyo overnight -- they're just fundamentally different.

One glaring omission from that article seems to me to be lack of environmental protection e:g in USA all manner of food additives are allowed that EU for example would ban. Bovine growth hormone is allowed. I'm not sure if it's that, or soft drinks, that makes some Americans so huge. There are many people in other countries that are sedentary , live unhealthy lifestyles, drive everywhere, but the true hugeness of some people seems to me uniquely American. Pesticides like glyphosphate are allowed in USA. Waste water from fracking poured on the road and finds its way into the water system. When I, as a Brit, worked in USA for a while 25 yrs ago, I noticed people constantly complaining about allergies, and also a rather large number of people that had had cancer (albeit the health system seemed to have sorted them out and got them better). This wasn't something I heard so widely discussed back home and I surmised it was due to chemicals. Since then, I think the UK has got worse and more people here complain of allergies now, presumably due to imported food or domestic use of chemicals.

Since the conclusions are at the end of the article, there's no need to guess

Every country should and can do better in this respect, but a particular weakness of the US is a lack of success in preventing poor health. Many of the important factors – smoking, obesity, violence, poverty – are not about providing better healthcare for those that need it, but about preventing poor health outcomes in the first place.

The failure to prevent poor health is a factor that is contributing to both developments shown in the first chart. They worsen the health of the American population and they are expensive for the healthcare system.

How does life expectancy compare between, say, the Pacific Northwest, and the Deep South? I'd like to see that first before I homogenize the entire US and compare to a small country in Europe. E.g. obesity rates vary considerably around the US.

Here is a life expectancy breakdown by state with comparison to other countries. Interestingly Hispanics have higher life expectancy than whites.

https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ...

A few comments opine upon the seeming unfairness of comparing the US to countries considered more “homogeneous”.

OK, let’s compare the US to its similar North American neighbour, Canada, using the info in the article.

The US still lags by a considerable margin. Thems of us north of the border are somewhere between surprised and appalled at how little the US population and leadership seems to care about how much worse off Americans are than their peers in other countries.

Y’all have a lot more wealth, sure, but a lot more poverty, a lot more deathfrom treatable conditions, and a lot more incarcerated, for what it’s worth.

Interesting. Thanks for posting.

If true, one could reasonably conclude that anything that makes money (smoking, guns, opioids) is allowed to continue even if it has bad effects, and anything that costs (pre-natal care) is neglected, even if it has good effects.

Ordered by rough annual differences per 100,000:

Infant mortality: 540-340=200 (only considering infant population)

Obesity: 69-29=40

Smoking: 92-58=34

Opioids: 14-1=13

Road accidents: 11-4=7

Suicide: 16-11=5

Homicide: 5-1=4

Infant mortality is either by far the largest rate difference if you consider the relevant population to be only infants or the smallest rate difference if you consider the relevant population to be the population at large

https://ourworldindata.org/grapher/infant-mortality

https://ourworldindata.org/grapher/suicide-mortality-rate

Shocking how quickly opioids became a major life expectancy difference in a couple decades while every other rate other than suicide is decreasing over time, especially since it's nowhere as prevalent in the other countries

Promising how much smoking rate has dropped in America, obviously some lag so hopefully that brings smoking mortality down a lot in the future

The rich areas of the US do have high life expectancy. New York, New Jersey, Massachusetts, etc. But there are a lot of very poor regions too that drag the average down. For a european equivalent, take western europe and group it with eastern europe and that's basically the United States. But you can absolutely compare Switzerland with New Jersey (Switzerland is twice as big, but the populations are shockingly almost the same).

Comparing the US average life expectancy to the average of other rich countries is tricky because the US population is so much bigger and more diverse than most other countries. If US data were broken down by state, we'd probably see life expectancy in some states more like rich northwestern European countries, and some states more like poor southeastern European countries.

For all that, US healthcare is still uniquely optimized to maximize cost.

Lack of access to free healthcare?

We all know in the us. Lack of universal affordable health care for all, a social safety network that treats people with illness, loss of income, life challenges, etc. Plenty of people see the lack of these things are great things about America.

Excess... drive by one of your local dialysis centers. I wonder what percentage of diabetics are type 1 in the US? Has to be a tiny percent, just using my eyeballs and looking around.

Guns, drugs, and rock n roll? Basically Hunter S Thompson effect...

(2020)

Previous discussion from 2 years ago:

https://news.ycombinator.com/item?id=25193796

drugs and the standard American diet - its not rocket science. over 36% of the country is obese, compared to germany at 22%, finland at 22%, belgium at 22% norway at 23%, spain at 24%, poland at 23% etc.

Maybe other reason as well, but improving the american diet would improve health more than anything else. Food companies should be sued like tobacco companies were for the poison they peddle.

/offtopic What happened to the ranking of this post? It was top 3 (yeah!) and now it’s suddenly 40+ … How can this happen? Dang?

Is American life expectancy lower after controlling for obesity and malnutrition ?

The 2 most affected communities are also the 2 most obese.

I have never seen an old fat person.

We fat

I love how they completely ignore demographics - show me other "rich countries" that have the influx of immigration - especially to those with immigration skewed towards the lower end of the economic spectrum - that is at epidemic proportions as we are facing in the US now.

access to affordable health care.

When looking at statistics like this, it’s somewhat unhelpful to consider the US one country. Because of the low density of the population + essentially no federal government, the US is really a few different regions with vastly different outcomes.

One issue is having an open border that allows trafficking of deadly drugs.

"Between 2020 and 2021, nearly 79,000 people between 18 and 45 years old — 37,208 in 2020 and 41,587 in 2021 — died of fentanyl overdoses, the data analysis from opioid awareness organization Families Against Fentanyl shows."

We also push vaccines during a pandemic that was primarily killing the obese in the greatest numbers but no mention of exercise and a reasonable diet.

It's foolish to compare statistics about all Americans to small homogenous countries like Norway or Japan, as though the difference comes from policy.

The people are completely different.

How do the outcomes of Norwegians compare to those of Norwegian-Americans? How do the outcomes of Japanese compare to those of Japanese-Americans? Here we can start seeing the effects of policy.

If you drop a bunch of Danes, Swiss, or many of these other people in the US their life expectancy in the US would be almost as good. This life expectancy graph should include nations from which US draws much more disproportionately, such as Mexico, Africa (former slaves), Central American nations, etc. For instance, Hispanics have much greater life expectancy in the US vs many of the nations from which they draw. US provides a lot of these opportunities where nations like Switzerland less proportionately provide.

And to the person who pretended like they didn't understand that most slaves came from African regions with low life expectancy, they know they're playing the disingenuous game where they try to pretend the US hasn't greatly risen the life expectancy (presently) of these offspring vs had they been born in their forefather's nation. Including these African nations on the chart would show that, but someone (perhaps racist since they chose not to include Africa) with an agenda left them out.

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>Also what does being descended from someone who worked as a slave have to do with anything

A nice attempt to play dumb and act like these slaves didn't disproportionately come from nations with low life expectancy, in which their descendants quite likely would now live had they not been unjustly removed from their homes. Of course commenter knew this all along, but tried to bait the question.