
U.S. life expectancy will soon be on par with Mexico’s and Croatia’s - JumpCrisscross
https://www.washingtonpost.com/news/to-your-health/wp/2017/02/21/us-life-expectancy-will-soon-be-on-par-with-mexicos-and-croatias/
======
refurb
There have been many analyses as to what could be causing the lower life
expectancy in the US. Some of it comes down to how deaths are counted.

\- In the US, a baby is more like to get intensive medical care if it's born
with a condition vs. other countries where they are often labelled as
"stillborn"

\- The US has a higher than expected premature birth rate. These babies are
more like to die, so that pulls down the average life expectancy.

 _For example, in the United States, arrivals of all living infants are
counted as births, but a few European countries (the Czech Republic, France,
Ireland, the Netherlands, Norway and Poland) have more restrictive
definitions. For example, France and the Netherlands report live births only
if the infant weighs at least 500 grams — a little more than a pound — or were
born at 22 weeks’ gestation or later._

~~~
JauntTrooper
Interesting, but if you continue the same article you quote, it refutes that
as a major cause of the difference:

 _" But these reporting differences cannot account for the full extent of the
gap between countries, says Paul Wise, MD, a pediatrician at Packard
Children’s and a health policy analyst at Stanford. “The reporting differences
are a minor part of the story but not an excuse for why the U.S has such a
high mortality rate.”

Because even when researchers look only at births that meet the criteria for
all European countries — 500-gram babies born at 22 weeks and later — the
United States doesn’t fare any better. In 2009, Marian MacDorman, PhD, a
statistician at the Centers for Disease Control and Prevention’s National
Center for Health Statistics drew up a new ranking list, comparing the United
States with 20 European countries and excluding the deaths of all babies born
before 22 weeks’ gestation. The United States still ranked below most European
countries."_

[http://sm.stanford.edu/archive/stanmed/2013fall/article2.htm...](http://sm.stanford.edu/archive/stanmed/2013fall/article2.html)

~~~
refurb
If you read the rest of the article it also talks about the higher-than-
average rate of premature births. No one really knows why.

Also, whether or not you count a pre-mature birth as a "life" is only one of
several differences in how counting is done.

I guess my take is that some of the difference is due to counting and some is
due to differences in healthcare.

------
rodionos
The topic discussed in the article is important, but the data is not
convincing. Based on the lead chart itself, which shows relative improvement,
the USA as a whole is in the company of Japan, Sweden, Norway - all countries
doing well, with universal healthcare, high life expectancy, etc. It makes you
think that the situation is not as dire as the article makes it to appear.

    
    
      > If you have good insurance and you live on the East Coast and the West Coast, 
      > you probably get the best health care in the world... 
      > In many parts of the country, top health care simply isn't available. 
    

I personally think that's one of the key drivers. There are certain parts of
the country that are not doing well. Consider the case of Youngstown, OH where
mortality rate in 2015 was 54.5 compared to 8.2 in the U.S. as a whole.

[https://github.com/axibase/atsd-use-
cases/blob/master/USMort...](https://github.com/axibase/atsd-use-
cases/blob/master/USMortality/README.md#detailed-sql-example-3---calculating-
mortality-rates)

~~~
hackuser
> Based on the lead chart itself ... the situation is not as dire as the
> article makes it to appear.

The lead chart shows the U.S. ranked 32nd of 35 nations, for both women and
men. (My quick count might be off by a little.)

In addition, this sounds bad to me:

 _[The U.S.] has the highest infant and maternal mortality rates of any of the
countries in the study, and the highest obesity rate. It is the only one
without universal health insurance coverage and has the “largest share of
unmet health-care needs due to financial costs,” the researchers wrote.

Tellingly, the United States was the first high-income country to see a halt
to the pattern of increasing height in adulthood, a reliable indicator of
improving public health, according to Majid Ezzati, a professor of public
health at Imperial College London, who led the research team.

Some Americans get a “bad start to life in nutrition and education” and suffer
“high rates of homicide,” Ezzati said. “And then lack of universal insurance.
Some people probably get diagnosed too little and too late._

------
jorblumesea
[https://en.wikipedia.org/wiki/List_of_U.S._states_by_life_ex...](https://en.wikipedia.org/wiki/List_of_U.S._states_by_life_expectancy)

Taken as a whole, the US is low on the list. Taken by state, it really depends
on where you live.

~~~
3131s
Interesting (and perhaps emblematic) that DC has the highest life expectancy
for whites, yet the lowest for blacks compared to any states that keep that
statistic.

~~~
purple-again
Not surprising for whites. D.C. Is home to many of the richest and most
powerful families in the nation, most of which are still whites. It's long
been studied that the rich have much better access which leads to a higher
life expectancy on average.

The blacks is a head scratcher. You would expect Baltimore or Chicago to crush
DC thanks to their famous gang violence but maybe those states don't provide
statistics.

~~~
dragonwriter
> You would expect Baltimore or Chicago to crush DC thanks to their famous
> gang violence but maybe those states don't provide statistics

D.C. has a high violent crime rate, but Republican politicians recently don't
trumpet it to attack the local government and the party behind it the way they
do Baltimore or, particularly, Chicago's, perhaps because while D.C. has an
elected (and Democrat-dominated) city government that is allowed some
latitude, it's government is Constitutionally a Congressional power, and
Congress regularly exercises that power to prescribe local policy or veto
local government acts, so they'd end up pointing the finger at their own
failures if they were to blame government in D.C.

------
tremendo
Notice that is because Mexico and Croatia are expected to have a higher rate
of improvement towards 2030, vs. the U.S. only improving by a couple of years.
It's not that U.S. life expectancy will decline (although it did last year for
the first time), just that others will improve more.

~~~
hackuser
> It's not that U.S. life expectancy will decline (although it did last year
> for the first time), just that others will improve more.

Is that acceptable? Other wealthy nations are improving much more rapidly.
Certainly the U.S. could be doing better. It's immoral, a tragedy, and an
embarrassment.

From the article;

 _The reasons for the United States ' lag are well known. It has the highest
infant and maternal mortality rates of any of the countries in the study, and
the highest obesity rate. It is the only one without universal health
insurance coverage and has the “largest share of unmet health-care needs due
to financial costs,” the researchers wrote.

Tellingly, the United States was the first high-income country to see a halt
to the pattern of increasing height in adulthood, a reliable indicator of
improving public health, according to Majid Ezzati, a professor of public
health at Imperial College London, who led the research team.

Some Americans get a “bad start to life in nutrition and education” and suffer
“high rates of homicide,” Ezzati said. “And then lack of universal insurance.
Some people probably get diagnosed too little and too late._

~~~
sandworm101
And has anyone compared the rates of drug use? Not illegal drugs, the
prescriptions. When i lived in the US i was shocked by how many people lived
lives soaked in various drugs year after year, _young people_. That isn't
normal in other countries. At some point this trend, paticularly the opiods,
has to start shortening average lifespans.

~~~
hackuser
I've seen research saying healthcare providers in the U.S. are much more
likely to prescribe drugs than in other wealthy countries.

> At some point this trend, paticularly the opiods, has to start shortening
> average lifespans.

I don't know what effects drugs, including opiods, have on lifespan.
Certainly, taking the right prescription drugs extends lifespan in many cases.
But even the wrong one might affect quality of life more than lifespan.

~~~
girvo
Opiates taken recreationally (or prescribed, but taken at doses above what is
directed) can reduce life-span due to the lowering of oxygen intake,
interestingly. That's ignoring all the _other_ problems inherent in them
(overdose, etc.)

------
theparanoid
Paul Krugman rather famously rate about this a couple years ago [1]. Much of
the disparity is from an increase in middle aged whites dying from alcohol and
similar causes.

[1] [https://krugman.blogs.nytimes.com/2015/11/04/heartland-of-
da...](https://krugman.blogs.nytimes.com/2015/11/04/heartland-of-darkness/)

------
KKKKkkkk1
Well, it's not just US health care that has a problem. Consider this: ETH has
19.2K students and a $1.68B annual budget, while Stanford (a comparable
university) has 16.3K students and a $5.5B annual budget.

~~~
jmgrosen
Ignoring whether it's related to healthcare or not, ETH Zurich is a public
institution, whereas Stanford is private. Perhaps a more comparable university
would be UC Berkeley (which many would consider to be on par with ETH), which
has 38.2k students and a ~$2.5B annual budget.

~~~
JumpCrisscross
In case you don't want to do the math, ETH Zürich's per-student cost (~88,000)
is 33% higher than UC Berkeley's (~65,000). Stanford's (~340,000) is 5.2x
Berkeley's and 3.9x ETH Zürich's.

------
riprowan
It's almost as if quality of life and longevity are not primarily due to
having the latest, most expensive technology; but rather by having access to
practical, affordable solutions.

------
sologoub
The article references the healthcare at the costs, but doesn't provide any
details.

Does anyone know of studies showing life expectancy at the coasts or by state
instead of country aggregate?

~~~
sologoub
Found some interesting stats:

\- [http://kff.org/other/state-indicator/life-
expectancy/?active...](http://kff.org/other/state-indicator/life-
expectancy/?activeTab=map&currentTimeframe=0&selectedDistributions=life-
expectancy-at-birth-years)

\-
[https://en.m.wikipedia.org/wiki/List_of_U.S._states_by_life_...](https://en.m.wikipedia.org/wiki/List_of_U.S._states_by_life_expectancy)

TLDR; Coasts being always superior isn't really an accurate depiction. Hawaii
(1), CA and Connecticut (tie for 3 and 4) definitely are coastal, but also
rich. Minnesota (2) is definitely a surprise for me. NC, SC, and Georgia
aren't rank that high and FL is marginally higher.

~~~
abvdasker
It's shocking to me how closely related life expectancy seems to be with a
state's political alignment based on those lists. I'd love to see the
correlation coefficient of percent of conservative voters vs life expectancy.

[http://politicsthatwork.com/graphs/life-expectancy-by-
state](http://politicsthatwork.com/graphs/life-expectancy-by-state)

~~~
sologoub
What's also interesting, CA ranked one of the worst in uninsured in that same
article [http://politicsthatwork.com/graphs/uninsured-by-
state](http://politicsthatwork.com/graphs/uninsured-by-state)

------
helthanatos
My goodness. This article is written backyards. It uses positive phrases in
negative ways that make it much harder to read...

------
gojiberry
How about a comparison of health quality between Republican and Democratic
areas?

~~~
justin66
I'm not sure why you'd want to do that, but given the country's current
demographics, there's an obvious problem. "Democratic" areas are also to a
large extent the areas with money, and population density, and crime, and
industry, and higher education, and all sorts of variables you'd want to be
able to control for. This enables all sorts of deceptive political
infographics...

~~~
hackuser
> "Democratic" areas are also to a large extent the areas with money, and
> population density, and crime, and industry, and higher education, and all
> sorts of variables you'd want to be able to control for.

Maybe you wouldn't control for them; for example, some of those variables may
be consequences of being Democratic areas. I'd guess higher education is, as
the GOP often wants to cut funding for it.

~~~
adventured
Consequences such as Democrats ruling over the most violent and highest murder
rate areas (both per capita) of the nation for decades? Along with Democrats
controlling the areas of the nation with by far the highest infant mortality
rates. There's no question it's a direct consequence of their governance.

~~~
hackuser
I'm sure there are positive and negative consequences to both parties'
governance; it would be interesting and valuable to discuss, learn about, and
figure out.

That's not what the parent comment is doing, unfortunately. It's sad that yet
another HN discussion is derailed.

------
snambi
Why is it a bad thing?

~~~
3131s
The title alone does not necessarily imply anything negative, I guess. You
could take it to mean that Mexico and Croatia will achieve astonishing gains
in life expectancy in the near future that will put them on par with the
richest nation on earth. Of course, if you read the article and know any
further details of the situation around health care in the US (that life
expectancy actually declined recently, that the US spends more on health care
per capita than any other nation by far without a corresponding improvement in
health outcomes), then it's pretty obvious why this is a bad thing. Unless you
mean that people living as long as possible is not worth pursuing...

------
WildUtah
Shouldn't be surprising. Mexico is an emerging first world nation with
universal health care, one of the best run systems in the world. Mexican-
Americans live longer than white Americans indicating a long lived biology.
And non-smoking Mexicans already live longer than non-smoking Americans while
the smoking rate is dropping.

Croatia is also an emerging first world nation (though coming via the second
world rather than the third as Mexico is) closely related to nations like
Italy and Hungary with admirable levels of health and education. It has the
support of the EU and all the experience in developing quality social services
that implies.

Croatia and Mexico are good countries to share company with in the longevity
statistics.

Of course people will try to scare you by implying those are backward
countries. It's like when people compare your education statistics to Finland
(#1 in elementary education) and Hungary (home of John von Neumann, known as
the smartest man of the atomic and computer ages by the great minds that
founded both sciences, and the Polgar sisters). Just because you aren't
familiar with a nation doesn't mean it isn't great in some way.

~~~
EduardoBautista
I live in Mexico and pay for private health insurance because I want nothing
to do with the government ran health system. Don't know what makes you think
it's one of the best ran in the world.

~~~
sasper
I have also lived in Mexico (as an expat) and was blown away by the free
public healthcare system. After seeing the doctor, I asked how much the
diagnosis and treatment would be. The nurses laughed at me, said "Aye guerito,
que lindo", handed me a prescription and sent me on my way.

If the same issue were to come up here in the US, I would have 2 options:

1 - with current ACA insurance - pay $200 + 50% of cost = $700

2 - with no insurance - about $1200 out of pocket

Which option do you think I (and most other people) would prefer?

------
tomohawk
Here's an interesting discussion of life expectancy and what it may mean or
not mean with regards to how health care is provided.

[http://www.nationalcenter.org/NPA547ComparativeHealth.html](http://www.nationalcenter.org/NPA547ComparativeHealth.html)

~~~
jtedward
This is neither a discussion nor interesting.

~~~
tanderson92
Indeed. And in particular, consider the thesis of the argument:

> Any statistic that accurately measures health-care systems across nations
> must satisfy three criteria. First, the statistic must assume actual
> interaction with the health care system. Second, it must measure a
> phenomenon that the health care system can actually affect. Finally, the
> statistic must be collected consistently across nations.

Says who? The authors use these benchmarks to determine if life expectancy and
infant mortality are valid units of measurement. Their actual claim,
implicitly, is that life expectancy is unrelated or unaffected by quality of
the health care system. And the infant mortality's numbers are biased against
the US (here their argument is better but why would the UN knowingly include
such biases?). The argument they present is weak...to put it charitably.

~~~
jtedward
The thing is it's not even really an argument, it's a rationalization. It's so
strange to me that someone would even try to argue that life expectancy
doesn't reflect the quality of health care. what conceivably could be gained
by attempting to prove such a counter-intuitive thing?

~~~
tanderson92
My reading between the lines is that the health care system is set up
perfectly well to accommodate long lives, _if and only if you can afford to
access it_. The authors actually controlled for GDP per capita, so they made
their aims plain. Their explanations for poor health outcomes for
disadvantaged minorities was also income related.

Not once did they ask the question "why are health outcomes so stratified by
income and wealth in the U.S.?", because their ideology is that that is
acceptable.

------
the_economist
Obesity is the problem. And it's so easy to improve: Stop allowing people to
use food stamps on unhealthy foods, particularly soda and other sugary drinks.

~~~
jfoutz
That's kind of a weird approach. Wealthier men tend to be more obese. White
women seem to be the only group who's income and obesity levels seem related.

It's right there in bold: "Most obese adults are not low income (below 130% of
the poverty level)."

But maybe food stamps aren't allocated the way i think they are.

[1]
[https://www.cdc.gov/nchs/products/databriefs/db50.htm](https://www.cdc.gov/nchs/products/databriefs/db50.htm)

~~~
the_economist
We spend ~5 billion/year giving people free soda. Cutting back on is an
extremely easy way to reduce obesity. Maybe it won't solve it. Maybe it won't
even make a big difference. But it will certainly help the cause.

~~~
jfoutz
According to the NYT, "SNAP households spent 9.3 percent of their grocery
budgets on sweetened beverages. That was slightly higher than the 7.1 percent
figure for households that do not receive food stamps."

I mean, soda might be a weird thing for you, but it's clearly something that's
a standard part of the American diet. It's a 100 billion dollar industry. I
don't really understand how removing soda for poor people would have a
substantial impact on obesity.

[1] [https://www.nytimes.com/2017/01/13/well/eat/food-stamp-
snap-...](https://www.nytimes.com/2017/01/13/well/eat/food-stamp-snap-
soda.html)

 _edit_

"removing soda for poor people" isn't really even the case. it's just not
allowing food stamps to pay for soda. I think, effectively, people will just
use cash for that, and not change their habits. So $5 less for gas, or rent,
or whatever they might actually use the cash for.

~~~
the_economist
9.3 is 31% higher than 7.1. That's a pretty significant increase. I wouldn't
call that "slightly higher"

Also, sugar is a standard part of the American diet. But Americans are obese.
Here is at least one expert who thinks sugar is the problem:
[https://www.ucsf.edu/news/2009/06/8187/obesity-and-
metabolic...](https://www.ucsf.edu/news/2009/06/8187/obesity-and-metabolic-
syndrome-driven-fructose-sugar-diet)

~~~
jkmcf
It might 9.3% of their budget because their budget is much smaller. I would
bet the 7.1% is possibly skewed due to a lot more people with spare cash
finding better ways to fulfill the pleasure aspect (but it's probably craft
beer/etc). In the end, buying soda is a combo of poor
education/willpower/contemplation.

FWIW, I'm pushing 50 and besides the occasional party, I've never had soda in
the house from birth to present, and I probably only treat myself to a soda a
1-2 times a month.

------
danjoc
A Texas hospital sent a west African man home with a bottle of antibiotics to
treat his viral infection. Turns out, he had Ebola.

Life expectancy is dropping in the US? Shocking. Do tell.

