Tackling America's weirdly short life expectancy should be a priority
slowboring.com
slowboring.com
“The US appears to screen more vigorously for cancer than Europe and people in the US who are diagnosed with cancer have higher 5-year survival probabilities.”
There is a similar, though not quite as strong, pattern with cardiovascular disease — it is treated more aggressively on average in the U.S., and survival odds are better.
A detailed survey of prostate cancer evidence shows that “The combination of earlier detection and aggressive treatment in the US has produced greatly improved survival chances for men diagnosed with prostate cancer.”
Similarly for breast cancer, America does more early screening and more aggressive treatment with the result that “the US has experienced a significantly faster decline in breast cancer mortality than comparison countries.”
The abstract of the paper they came from (which is linked in the article) is:
Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.
Low income = lower quality diet, less access to health care, lower quality housing and ultimately (for some) drug use and other hardship-related problems.
This is also why it will never be addressed, as low-income issues have not been a priority in America for a long time (the most recent budget bill made it harder for SNAP recipients) and right now states are kicking millions of people off medicaid because they didn't complete paperwork.
https://www.pnas.org/doi/10.1073/pnas.2104684118
Across all income levels, USA lags Europe. In 1990, the wealthiest white Americans had the same deaths/1000 Age 20-64 as Europeans, but a gap has opened up across ALL income levels since then.
The gap does get larger as poverty increases, but it doesn't explain why all income levels are worse than Europe.
I don't buy it. Most of Europe has lower income than the US but the quality of their food is just vastly superior.
Just watch this video https://www.instagram.com/reel/CtzaSnGMIEN/?igshid=MzRlODBiN...
I suspect it's a combination of low quality food and not walking.
> I don't buy it. Most of Europe has lower income than the US but the quality of their food is just vastly superior.
I don't buy it either. I don't know about the Europe comparison, but there's plenty of high quality food available for low cost in the US. I notice many people just fill up with crappy box goods or fast food though.
Low income does not per se mean lower quality diet in the US. In fact, a healthy diet based on high quality food can be less expensive than a less health lower quality food based diet.
However sources of high quality inexpensive foods are not evenly distributed. Many a low income neighborhood does not have a grocery store that caries such things. Many only have convenience stores like 7-11. Often those neighborhoods also don't have good and affordable public transit making it had for many residents to get to a real grocery store.
And so there will be a tendency for lower income to result in a lower quality diet.
These places where people have food access limits inside of countries that mostly have pretty good distribution are called "food deserts", and they are not just in the US [1].
The problem is that the people in those areas simply don’t want real grocery stores. I’m not sure how you’d go about fixing that. Maybe, and I stress the maybe, a better home economics class? Ours was a joke, but it’s hard to actually teach kids how to cook (and other things) with a limited class time. Combining with lunchtime for those taking it might make sense.
My parents cooked but kids out there without that - it’s probably hard to turn it around. Laziness is a hard nut to crack, especially combined with ignorance.
A European coming to the US on a European salary would not thrive.
Even with the slight decrease, Americans' life expectancy remains just short of 79 years, but what is it like to be that old? Modern medicine and infrastructure has extended the body's lifespan, but no such improvement has been made for the brain's lifespan.
I remember going to visit my grandfather on the dementia ward, surrounded by the equally addled. I remember the toll on my grandmother of caring for him before he went into professional care, to the point that she died before him, younger than him. I have to ask, was the money spent, the labour expended by professional carers, worth it?
I'm not sure that when my time comes, that I want money to be spent keeping my body alive while my brain degenerates. If one can't enjoy those extra years, what is the point of having them?
Famously an opinion held mostly by people for whom this choice is remote and abstract. In practice what we find is that when this reality is imminent, people overwhelmingly choose to live. Regardless of what they claimed they would want when they were younger and healthier.
IIRC, it was discovered recently just the shingles vaccine reduces the probability of dementia by 20%.
"End-of-life care accounts for about 10-12% of all healthcare spending" [1], though "spending in the last three calendar years of life reached 24.5 percent in Taiwan," suggesting "high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions" [2].
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282187/#:~:tex....
[2] https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0174
Nice call-out there!
I find statistics that try to aggregate such a huge and dynamic population very suspicious. I do know that Canadians stream across the border to America when they are told their life saving procedures are months or years in the queue.
Also, fwiw, the article talks a lot in terms of comparisons and where gains can be had in relative terms. But in absolute terms, those 4 items above are still going to be the most crucial to really moving the needle on life expectancy.
You named all the really headline grabbing ones though, so good job on that!
Improvements in cancer treatments seem like it would mostly show up in the 65+ range. Is it mostly lower air pollution + fewer traffic accidents?
1: https://www.cnn.com/2018/01/08/health/child-mortality-rates-...
2: https://worldpopulationreview.com/country-rankings/infant-mo...
3: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/...
We appear to be dying early in all walks of life, not just at birth.
And it would have to be pretty much all of them to account for the difference, right?
So it’s completely irrelevant to the question which isn’t “how could difference in infant mortality calculations abstractly impact comparisos?” but “what specific countries in Europe have a relevant difference in infant mortality calculations?”?
I don't see what the challenge is. Which European countries count infant mortality differently to the USA? You made the claim.
If you want to read papers about methodological issues with European IMR measurements, they're easy to find, for whatever that's worth to you. I don't much care.
But America's weirdly short life expectancy should be an equal priority.
The post specifically refutes this: Europeans live longer than Europeans at all income levels.
That isn't what I am claiming though. Specifically, that higher income inequality leads to poorer outcomes on average, not that all income levels would somehow have similar outcomes. In this case, it is the income inequality in the states (with a lack of a social safety net to redistribute much income as in Europe) that causes the worse outcomes, not the income level itself. In Europe, a social safety net provides you with similar healthcare at lower income levels anyways, which isn't true in the US (perhaps we should rename income inequality into wellness inequality?).
In a very Matty voice: different places have different life expectancies and that's ok.
The US has led the world in lifestyle changes, which I would argue are almost entirely economically (capitalistic business) driven.
Incomplete and in no particular order, there are the government diet guidelines which have at times been primarily driven by certain industries (agricultural organizations including corn growers, sugarcane growers, dairy producers), including pharmaceutical industries... And then the energy industry + auto industry, which has led to more time sitting in cars, combined with the explosion of the fast food industry... And the soft drink industry where Coke began by promoting its drink as a health elixir... and on and on.
Of course, the "solutions" to many of the mistakes have been more industries pushing fixes like artificial sweeteners, "health" drinks, energy/sports drinks, low-fat processed foods, diet pills and fads, and other finance-based attempts to sell a new thing rather than address the real problems.
The rest of the world will follow suit in terms of health decline. It's already evident, as other countries adopt US patterns of prepackaged foods, fast foods, sugar (and fake sugar) drinks, cars, etc.
An easy way to spot this is to go to a country (like Netherlands, where I've been for some years). The older folks tend to be generally lean; many old folks here still bicycle. The < 30 crowd, particularly the 12-20 crowd is fatter and more American shaped. Go to parts of Asia and you see the same thing.
As comfort, convenience, and easy bad (cheap) choices expand, so do the bodies of the people. The younger ones who grow up with this have a different lifestyle than their parents or grandparents. While the older populations are indeed getting less healthy (increased body mass, reduced exercise), the change is slower for a number of reasons. Meanwhile, the kids who grow up with this new lifestyle start on a bad trajectory and know no alternative.
WALL-E pretty much illustrated the final state of the current trajectory we are on, both in health and ecologic terms.
It's also a matter of quality of life vs pure "life expectancy" being worth consideration. Dying unexpectedly, even in large numbers is unfortunate. But a majority of the population living lower quality lives for reasons which can be addressed is more of a priority.
And it could be that addressing the real health issues will also involve improving some of the issues which lead to early death.
For example, with alcohol, why is alcohol use high? Could it be somewhat due to the insane amount of advertising and promotion by the alcohol industry? Could it be because, as people's lives tend to be less happy or lower quality, they seek easy distraction and escape?
Same with cars; cities built for humans instead of for cars will mean less car deaths and healthier people.
I agree with what you're saying at the end of this comment: if your policy goal is to reduce the life expectancy gap, interventions in health care and nutrition aren't likely to pay off, but interventions in urban design or economic mobility (to combat the drugs and guns) likely will. Which is why, if you believe what this article is saying, you should probably flinch when people write long comments about potato chip advertising in response to it.
Indeed, I don't see an obvious solution other than through pain and suffering (where some number of generations get worse and worse until they reach a breaking point, and after the dust settles there might be a large mind shift).
People die all the time due to other people's choices of embracing drugs and using guns. In a car with someone who's afraid of being caught with a little cocaine? Getting shot by someone who can't aim? There, you're now a victim of drugs or guns without making a lifestyle choice.
The truth is that the healthcare system in the US is a massive source of revenue. There is little preventative practices going on because those don’t make money. If you don’t think healthcare is a part of the problem in the US, you must never have participated in it.
Source? Testing and preventative care is both profitable and widespread in America. (It's not universal.)
I am going to rid my vocabulary of the word "fat" and just refer to people as "American Shaped" from now on...
By that I mean, it you are unable to take care of yourself, I think Life Expectancy should be adjusted to take account of life quality.
For example, if you are in a Nursing Home or if you are bed ridden, I would say your "life" is reduced by half the amount of time spent there.
But as other said, infant mortality is a big factor. With the US abortion bans in some places, I expect infant mortality to rise. IIRC, on ave, Right Wing controlled already have the highest infant mortality rates.