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Comment by tptacek | Hacker News Reader

Worth remembering some things here:

* The US is thought by some economists to have an artificially high infant mortality because the US is more rigorous about reporting live births than other countries which might write up the same events as stillbirths.

* Outcomes in the US for chronic serious illnesses are at or near the top of the rankings.

* Life expectancy figures in the US are anchored down by suicides and, more importantly, traffic fatalities, which the US leads the world in. While that's not something we should be OK with, it's also a direct consequence of the vast land mass and wide population dispersal in the US.

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This report[1] claims that the difference in reporting child mortality isn't the chief cause of the difference in infant mortality between the U.S and similarly developed countries. Instead the claim that most of this difference is due to the high percentage of pre-term births in the US compared to other developed countries.

[1] http://www.cdc.gov/nchs/data/databriefs/db23.pdf

Isn't a preterm baby which fails to survive exactly the kind of event that wouldn't be documented as an infant mortality at all in a less rigorous country?

Yes. But I'm not sure I follow here, both Sweden and the US use the same criteria to report a live birth (All live births are reported) and seem to use the same definition of Infant mortality rate, (Death before first birthday). I fail to see how reporting differences explain the difference in infant mortality between the two countries. Of course, compared to countries that use extra conditions for live births (weight limits etc.) the US would get a higher rate of infant mortality due to having more laxed conditions for what constitutes a live birth.

It would be shocking if the US had infant mortality rates that were apples-apples close to Sweden. Sweden has just 9 million people, and they're very homogenous.

The lede on stories about US infant mortality isn't that Sweden outdoes us. It's things like "the US ranks alongside Qatar and Croatia". Those are the assertions I think we need to be more careful about.

> Sweden has just 9 million people, and they're very homogenous.

The population has no impact when we're looking at per-capita statistics.

Canada and Australia have the highest immigration rates in the world, so their homogeneity is going down, yet statistics like these are not going up.

That's silly. Compare Sweden to Washington State, which is similarly sized, more diverse, and has the second best infant mortality stats in the US.

The point is that Sweden is a cherry-picked comparison.

> The point is that Sweden is a cherry-picked comparison.

Choose any other OECD country then. The results are the same.

Totally Agree with you. I would think that a big reason as to why the U.S has the rankings it has is the heterogeneity of the US population.

According to yesterday's article in the NYT, this trend of the US's not keeping up with this group of 14 wealthy countries was absent in 1950 and only really started picking up steam after 1980. Since the US population was already significantly more heterogenous in 1950, why didn't that heterogeneity show through in the life-expectancy data for 1950?

The difference in heterogeneity between the US and the other countries has probably increased from 1950 to today. But I also suspect that some of this difference in life-expectancy between the US and the 14 others is that it might be easier to implement preventive health care measures that reach the whole population in societies that have more comprehensive health care insurance by default.

It would be really interesting to see data comparing the healthiest people in the US and other similarly developed countries.

None of what you said is either backed by facts or is actually worth remembering if you're trying to fix the problem.

I always read your replies to threads about health care in the US and I'm always left with two thoughts: "what does that even mean and how does it further the conversation?"

If you bothered to actually follow the link to the data (http://sites.nationalacademies.org/DBASSE/CPOP/DBASSE_080393), you'd see that none of what you said is accurate. The US is either at the end or, sometimes, in the middle of the rankings for everything. The Violence graph is particularly interesting.

It would be helpful if you could be clearer about which of those points "isn't backed by the facts" and which are "not worth considering", assuming those are disjoint sets.

"Outcomes in the US for chronic serious illnesses are at or near the top of the rankings."

This is because we have so many people with chronic serious illnesses that we know what to do with them better (at high costs). This isn't something to be proud of.

That's a pat way to dismiss any ranking of countries for health outcomes.

If you want to come up with a way to produce a low rank for the US on some holistic indicator, you will not have a hard time doing it. Are we the "healthiest" country in the world? Certainly not! We don't even have mandatory military service.

The issue here is that we need to be clear on what lessons we're trying to draw from the rankings. People definitely want to use rankings like this in inappropriate ways. If you want to look at this and say "America has an obesity crisis", nobody credible will argue with you --- but you didn't need this ranking to do that anyways.

On the other hand, if you want to say "America has a crisis of unavailable health care", well, you're wrong. The statistics don't bear that out. We have other health services problems, like bankrupting the uninsured, but measured by effectiveness and outcome, we have a top tier system.

Is it better to have a nation with 2.5% diabetic population than 6.5% population, if it meant that the nation wouldn't have the best (but still very good) diabetic treatment outcome? Is that a good trade-off? Probably.

I replied, because often apologists for American healthcare (I'm not saying you are one) neglect to mention why we have a good treatment outcome for certain conditions.

See this is the problem. If you're making a list of "most diabetic countries", sure, stick the US at the top of the list and start thinking about public policy to reduce diabetes and obesity. But don't blindly try to use that ranking to make policy decisions about how we provide health care, which you imply by saying people are "apologizing" for US care, because making doctors and hospitals more accessible won't make people eat better.

I think quality of life is a much more important factor to include.

suicides, greatest country ever...

It does not help at all that we have overseas military commitments at a scale no other industrial country would match. The suicide rate for veterans is wildly higher than for civilians.

The US has a lower "active military per capita" than lots of OECD countries.

http://en.wikipedia.org/wiki/List_of_countries_by_number_of_...

Do you not see the difference between "active military" and deployed troops?

Of course, but I can't find statistics for that per country per capita.

I would be very surprised if countries like New Zealand and Australia do not have more deployed troops per capita than America does.

Not counting the Navy, the US has at least double the per-capita rate of deployed troops. But that's misleading too, because most of New Zealand's deployments aren't hostile; a US soldier is far more likely to see combat than an NZ soldier.

Can you back that up with links to stats please.

Well to start with New Zealand, can you name a country it has invaded?

New Zealand has many troops in the "war against terror".

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