US has the highest rate of maternal deaths among rich nations. Norway has zero

That is correct.

I am making that claim without backing it up by references.

My point is that there are other correlated factors that explain death rates than pregnancy.

Another one might be that the death rate in the fertile age group could simply be higher, too, although I don't know if that is true.

> But researchers should do their due diligence on the way international statistics are compiled.

Do you have some evidence they didn't?

> This shows they didnt just take a yes\no for pregancy and +1ed the statistic, like you suggested.

I didn't suggest that.

What I said was how numbers were reported. The US reports all deaths in pregnant women, regardless of cause. Norways only reports maternal deaths when the cause is pregnancy complications.

So you want to use only the richest and most sophisticated EU countries but then compare them against a federation of US states that includes the likes of Mississippi and West Virginia?

I applaud the enthusiasm but I'm not that interested in Norway's medical system. I'm making a point about the larger issue of using foreign data. I spend a lot of time arguing with people on the internet for fun and education; and it is extremely common to get a cheerful comment which - after a few hours of investigation - appears to be an incorrect interpretation of data.

It is hard enough to do for systems that are part of the English speaking world or big, easy to track metrics. It is substantially harder to do for fiddly data series from foreign systems where the primary source material is in a different language.

> And if you're after methodology, analysis or understanding medical data, they follow WHO standards and publications are all in English on pubmed.gov

This goes to the main point - if it turns out that they don't follow WHO standards in an area or there is critical data not on pubmed.gov, what is the expected path for finding that out?

Because in English I have a much better chance of being able to figure that out. The countries are familiar and there is a better chance that the criticisms of the major institutions are well known. In a Norwegian context that already rather challenging task is even harder.

EDIT

An example occurs to me a few minutes later; there was an interesting theory that Japan had a lot of old people because there were unusually strong pension & tax incentives to lie about elderly relatives being alive when they were in fact dead.

The Japanese stats office could be following WHO standards and publishing all their information on pubmed.gov and the series would still be incomparable with other countries if there is an unusual incentive for the stats to deceive coming form an unexpected angle.

Keeping on top of that sort of thing in foreign legal systems is simply hard.

I thought you'd made a bad point. Is that so hard to believe?

Nobody wants their car infrastructure taken away or reduced. But everyone loves living in the places where car infrastructure was taken away or reduced. It's a well-known conundrum. One that takes strong political will, leaders, a crisis or all of that.

I live in the Netherlands, which in the '70s and '80s was just as car infested as any place. Part luck, part timing and part political caused it to turn away from that, invest in bikes. And not top-down, nor bottom-up, just an accidental "perfect storm". We're now a in a situation where PT, car and bike infrastructure are a complex network that co-exists and is highly efficient. Where virtually everyone has (at least) one bike, takes that to work/school on average almost daily and also travels by car, train and other PT a lot. But where, above all, this is commonly seen as something good and people do feel really happy in it.

And even here, still, removing stroads or parking lots to turn them into parks, restaurant-areas or pedestrianized areas, will always meet a lot of resistance from people who think the cars are crucial to their lives/businesses/shops/schools. Yet when it's pushed through, generally, even those opposing it, often are much happier with the space after cars were removed from it.

I was not taking about specifically Tai Chi. But I remember from public health classes in medschool that it is known for increasing flexibility and mobility, as well as improving balance and reducing falls in elderly. I also remember something about backwards walking/sageru exercises in Japan, but it is difficult for me to find much online about it.

I was talking about the broader culture that values Tai Chi. Tai Chi is one of “morning exercises” in China. Others include just walking. But my point was about a culture that incorporates morning exercises as a norm. Japan has “radio taiso”, which is a similar phenomenon. I think the West had a similar culture in the 80s and 90s. I was actually growing up in the Central Europe then, and it was normal in elementary and middle school to start the day with a 30-minute exercise lead by school staff.

I don’t know how to label this culture but “culture where it is the norm to exercise daily”.

Yes, as you say, obesity also has many, many other causes. And many other cures. It’s definitely not so one-dimensional. But exercise is very effective, and a culture that promotes exercise daily for everyone, at all paces, would benefit us a lot in the West.

I think people tremendously underestimate what 30 minutes of daily body weight exercises like push-ups, squats, and sit-ups, plus a little bit of walking can do for the said weight. There are many, many technology workers that now just work from home and barely walk at all. Not the majority, but many. There are many more office workers that just commute to work with their cars and never walk more than that demands. In that context, 30 minutes of morning exercise is quite a lot.

Yes, exactly right. Because they don’t work that well in this interventionist mode when they are prescribed to already treated patients.

The study you shared talks about primary and secondary prevention in a clinical setting. So this is for people who either have heart disease or are likely going to develop it. At that point, it seems like it is already too late and I would say primordial prevention[0] is better. When I say prevention, I speak as not a medical professional, and I mean it in the common sense of the word, which aligns with primordial prevention.

There seems to be extensive research that they work well if prescribed preventatively decades in advance, and it’s covered in a few recently popular books by doctors on the topic of lifespan vs. healthspan. For example, Outlive: The Science and Art of Longevity by L. Attia.

Moreover, the study you quoted shows a 9-29% relative reductions of the outcomes. About 1% is absolute. For the entire population, 1.3% fewer will die from a myocardial infarction. But it is a 29% reduction in the sub-population that would die from it. And those are fantastic results with only primary and secondary prevention. Unless I misunderstand something.

The study you provided is relevant and valuable for critical reading of such books as the aforementioned. Thank you.

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349501/

The "simple measures" you name are things that require political will, and America doesn't have it. That's why these things are infeasible: American voters have to want them, and have to elect people who will enact them. They're not going to do that, outside of a few select municipalities (where obesity probably isn't a big problem anyway, because the people there are wealthy and educated). Even worse, America is almost certainly going to elect Trump for a 2nd term; the country is swinging conservative, so these "simple measures" you name definitely aren't happening any time soon. Look at NYC for instance: the Democratic state governor just scrapped their congestion charge program, so living in blue states and electing Democrats isn't any kind of guarantee of positive change either.

Also exercise really doesn't burn as many calories as people think. You usually need to work out as much as a pro athlete or olympian to burn a noticeable amount of calories from exercise. The reality is that a lot of Americans just eat too much.

Building walkable cities (at large scale) in the US is impossible. Not because of physics or resources, but because of politics and American voters' preferences.

Sure, there's a small portion of the electorate that wants this, but they're a minority and not powerful enough to get real change outside of a few localities.

100 years ago the US had ~76m inhabitants - a fifth of what we have today - plus horses and buggies were used broadly throughout the country. The streets in our older cities weren't born from nothing but aether when cars were invented.

Indeed.

I'd dig one deeper and look at the reasons why it's "not feasible" and the change that first. If people propose "national emergency" as a solution, clearly such options should be on the table.

Describe as you see it the process and ideal timeline that sees every 500lb and under American lose weight and regain the health benefit that comes from it.

Do you support the use of statins and diabetes medications in this population for this process or do you consider that cheating as well?

So, socioeconomic status vs personality traits it is?

How does personality develop?

Is it somehow inherent to sub-humans or a product of ones environment?

Of course its a socioeconomic factor. If you try to argue against this one, you have essentially only the other option left and derserve to be ripped apart in the comments.

Others have asked for the root cause before, here is my grand take: better education <- fair taxation <- social mobility <- wealth distribution <- matured laicists and a healthy democracy. I tried to put capitalism in there but it just lingers all over it. That socialist take is also my broad explanaition why other developed countries habe better health metrics. Guess what happens when you argue against this one :)

That's true, but that's not saying that Mexican culture is going to the US and making people die from drugs. If it were Mexican culture to take fentanyl and Mexicans weren't dying from it, we'd probably look outside of fentanyl to explain the US deaths from that hypothetical culture.

Anecdotally and from my own experience living in a couple of small towns in Mexico. Cartels don’t allow the sale of fentanyl in their hometowns because they know what it does to a population.

It is bonafide 100% government paid coverage for anything pregnancy or pediatrics related.

From: https://www.medicaid.gov/medicaid/cost-sharing/cost-sharing-...

> Out of pocket costs cannot be imposed for emergency services, family planning services, pregnancy-related services, or preventive services for children. Generally, out of pocket costs apply to all Medicaid enrollees except those specifically exempted by law and most are limited to nominal amounts. Exempted groups include children, terminally ill individuals, and individuals residing in an institution

We were both in college when my first child was born with one $13/hr summer internships's worth of income. Medicaid covered 100% of everything; I paid $0 out of pocket.

This was in 2010.

There are hostile outsiders of course but the extreme vast majority of people play the game.

Do you really think the US (aka #1 economy in the world aka #1 power in the world) has the same life expectancy as Sri Lanka because """diversity""" ? There are a dozen of things that have more impacts. Like half of the US being obese, or 15%+ have diabetes, &c. (which are both factors in maternal death btw). Time to wake up and take a good hard look in the mirror