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Comment by rsynnott | Hacker News Reader

> The US had the second-highest avoidable mortality rate—deaths caused by conditions that can be prevented with primary care or treated with timely medical intervention. Only Mexico had higher avoidable mortality. Similarly, the US also had the second-highest rating on years of potential life lost, a measure used to estimate premature death. Again, only Mexico had a higher rating.

About 41k people die on the road in the US per year. While this is very high, and worse than pretty much any other developed country, it’s not going to move the needle _that_ much.

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Driving everywhere has the collateral effect of ensuring that people get less exercise. Mexico has an astonishingly high obesity rate (a bit higher than the USA last time I checked), and this increases the risks of many non-car-related causes of death (and illness).

Yeah, I’d buy that car-dependence is a problem there, especially for older people.

Though, in Ireland, for instance, the worst parts of the country for car dependency would be close to as bad as the US. Their life expectancy is a little lower than the national one, but it’s not dramatic, and certainly not as low as the US one. There’s something else going on.

In additional to the car dependency (and related issues), the USA still has many immigrants (legal and illegal) from poor countries, who likely have health issues that pre-exist their US residency.

Main headline figure is life expectancy at birth, which doesn’t _really_ account for immigration. In any case, a number of rich countries (Ireland, UK, Canada, the Netherlands, most of the Nordics) have higher immigration rates than the US, so, again, probably not that.

Not car accidents; obesity from lack of exercise.

40% of Americans are obese and 75% are overweight. This is largely outside of the control of the medical system, but has a significant impact on mortality and life expectancy.

> This is largely outside of the control of the medical system

I assure you that preventative medicine does exist, even in the USA. Moreover, healthcare interventions for people with "lifestyle" diseases such as obesity have been extremely effective in reducing mortality from downstream causes such cardiovascular disease (e.g. statins).

Statins help a bit (and are widely prescribed in the US) but they don't fix the problem.

Diet and exercise are huge health variables that doctors don't really have the tools to do anything about.

The problem we are discussing here is mortality, and statins definitely have an effect on mortality.

Obesity can be prevented, can be treated, and its effects on health can be managed. We are actually living through something of a miracle in the treatment of lifestyle diseases. For example, the proportion of total deaths among adults with diabetes from vascular causes (heart disease) declined from 48% in 1988–94 to 34% in 2010–15 (https://sci-hub.st/10.1016/S0140-6736(18)30314-3).

The USA is not some kind of global outlier with a uniquely unhealthy population. The problem is *very obviously* something to do with how healthcare is provided here.

>The USA is not some kind of outlier with a uniquely unhealthy population.

It is, actually. Our obesity rates are the highest in the world at 41%. This is nearly double many European countries, and five times higher than Japan or South Korea. Only a handful of tiny Polynesian islands have us beat.

Better treatments for diabetes are great, but what's even better is not getting diabetes at all by losing weight.

That's not accurate (in terms of obesity rates, USA ranks #18; Egypt is #17) and does not explain the lower life expectancy in the USA.

As a sibling comment pointed out, the medical community consider prevention part of the medical system. It took me a while to understand what I thought was some weird (and potentially intrusive[1]) behavior of some doctors/clinics that they indeed do feel it is within their purview.

Not just discussions with a patient, but advising the government, pushing for regulation on things related to obesity, working with schools, etc.

Arguably, the problem in the US isn't that these are outside the control of the medical system, but that most Americans believe they should be outside the control of the medical system.

In (some) other countries, your comment would be a real "WTF?"

[1] Throwing in questions like "Is there a firearm in your house?" and "Is there a swimming pool in your house" intermixed with "normal" medical questions.

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