
What happened to US life expectancy? - lkrubner
http://theincidentaleconomist.com/wordpress/chart-what-happened-to-us-life-expectancy/
======
alexeisadeski3
Ask and ye shall receive!

Answer: Americans engage in more risky behavior than other OECD members
(driving, we also drive worse than some OECD members, etc):

[http://www.forbes.com/sites/theapothecary/2011/11/23/the-
myt...](http://www.forbes.com/sites/theapothecary/2011/11/23/the-myth-of-
americans-poor-life-expectancy/)

[http://b-i.forbesimg.com/theapothecary/files/2013/11/Nationa...](http://b-i.forbesimg.com/theapothecary/files/2013/11/National-
Life-Expectancy12.png)

~~~
a8da6b0c91d
It's funny how oblivious Americans are to the dangers of driving. This despite
generally knowing people who have been badly injured or killed in vehicular
accidents.

Car exhaust is also a big deal. Air pollution kills.

Instead of talking about the very concretely understood dangers of car
culture, people want to spout total nonsense about sugar or freak out about a
little second hand smoke.

~~~
alexeisadeski3
Hell is other people.

------
akgerber
Another big difference in the American way of life is that, in most cities,
we've managed to engineer a wholly car-dependent transportation system, such
that the average American walks half as much people in other countries:
[http://well.blogs.nytimes.com/2010/10/19/the-pedometer-
test-...](http://well.blogs.nytimes.com/2010/10/19/the-pedometer-test-
americans-take-fewer-steps/?_r=0)

All that driving also puts the average American at huge risk for dying young
in a car crash.

~~~
robin_reala
Especially as US driving tests are anecdotally much easier than tests in other
developed countries. [1]

[1]
[http://www.theguardian.com/world/shortcuts/2013/oct/11/brita...](http://www.theguardian.com/world/shortcuts/2013/oct/11/britain-
make-its-driving-test-harder-18-curfew)

~~~
Zigurd
The proverbial two-edged sword there.

------
saosebastiao
I know it is hard to control for culture, but seeing as how mormon men are
still American but have a 10 year gap in life expectancy over other American
men [1], any analysis on the effects of health care across nations should at
least try to control for cultural differences. That singular cultural
difference is _twice the magnitude of the difference between the OECD and the
US_. And when you realize that culture could be a far stronger predictor than
health care quality/availability, you start wondering how much of that gap is
due to us being fatasses.

[1] [http://www.washingtonpost.com/blogs/she-the-
people/post/morm...](http://www.washingtonpost.com/blogs/she-the-
people/post/mormonism-good-for-the-body-as-well-as-the-
soul/2012/06/20/gJQARk3IqV_blog.html)

~~~
codex
Mormons typically fast one day a week, no? What other concrete examples of
culture do Mormons manifest?

CORRECTION: It's actually one day a month.

~~~
Loughla
No smoking, no drinking alcohol, coffee or tea (I think it may be caffeine).
They also tend to have a stronger focus on homemade food (rather than pre-
cooked/boxed/canned) and habits/hobbies that aren't dangerous.

In other words, all of the fun, yummy, or convenient, but terrible for you
things that tend to be in our lives, they're not allowed to do.

~~~
_delirium
A few others that come to mind not related to food/drinks:

* Absolutely no work on Sundays (not even checking work email)

* A strong social safety net. Mormons are expected to tithe (pay 10% of their income to the church), and this is used in part to provide for members in need. Extensive volunteering is also expected, and used for some of the same purposes (e.g. caring for elderly or disabled).

------
300bps
The U.S. is #1 in common cancer 5-year survival rates:

[http://b-i.forbesimg.com/theapothecary/files/2013/11/CONCORD...](http://b-i.forbesimg.com/theapothecary/files/2013/11/CONCORD-
table12.jpg)

Further, remove fatal injuries from life expectancy data and U.S. is #1 in
life expectancy. Source:

[http://b-i.forbesimg.com/theapothecary/files/2013/11/Nationa...](http://b-i.forbesimg.com/theapothecary/files/2013/11/National-
Life-Expectancy12.png)

~~~
Steko
Spoilers: that chart ends in 1999.

~~~
jakobsen
This. Plus why would anyone want to remove fatal injuries from life
expectancy? It certainly looks like a legit concern to me.

------
rayiner
The U.S. has greater income and healthcare inequality, and has a larger
population of poor people living without access to reasonable medical care.
The major impact of this on life-expectancy shows up in infant mortality
rates, which is 6.14 per 1,000 versus 4 per 1,000 OECD average:
[http://www.nbcnews.com/health/us-infant-mortality-rate-
drops...](http://www.nbcnews.com/health/us-infant-mortality-rate-drops-only-
little-2D11763970).

The graphs in the article showslife expectancy at birth, which is a number
dominated by infant mortality rate. For life expectancy at age 65, the US is
slightly above the OECD average. Comparable to Germany or Norway. See Page 19
of this PDF: [http://www.oecd-
ilibrary.org/docserver/download/8109111ec004...](http://www.oecd-
ilibrary.org/docserver/download/8109111ec004.pdf?expires=1389124518&id=id&accname=guest&checksum=D26C4DD088EA8D0A1A891658B6A8AAAD).

The other OECD countries started pulling away on infant mortality starting in
the 1970's:
[http://www.conferenceboard.ca/Files/hcp/health/health2012_in...](http://www.conferenceboard.ca/Files/hcp/health/health2012_infMort_tbl.png).

~~~
yummyfajitas
_...and has a larger population of poor people living without access to
reasonable medical care._

This is unlikely to affect the stats. Giving poor people access to health care
does not improve physical health in any measurable way. It does make them feel
better, however.

[http://www.nber.org/oregon/](http://www.nber.org/oregon/)

~~~
rayiner
It certainly does make a difference for infant mortality, which is alleviated
with proper pre-natal and post-natal care: [http://www-
personal.umich.edu/~baileymj/Bailey_Goodman-Bacon...](http://www-
personal.umich.edu/~baileymj/Bailey_Goodman-Bacon.pdf) ("Improved access to
medical care resulting from the desegregation of hospitals and the initiation
and expansion of Medicaid significantly reduced infant mortality (Almond, Chay
and Greenstone forthcoming; Goodman-Bacon 2013; Currie and Gruber 1996b).
During the 1980s, acute neonatal care (neonatal intensive care units) helped
less healthy infants survive. Improvements in access to medical care also
reduced the mortality of older children, especially mortality due to common
childhood diseases such as pneumonia and meningitis (11 percent of all
childhood deaths). Medicaid coverage played an important role for poor
children as it increased care for conditions easily treatable with antibiotics
(Goodman- Bacon 2013, Currie and Gruber 1996a).").

Of the various public health concerns, infant mortality is one of those that
are most directly addressable with medical care directed at the poor. Improved
access to health services won't get a poor person to change his diet, but can
be very effective in catching potential complications from pregnancy, treating
infections in neonates, etc.

Also, the study you linked-to doesn't support the claim you're making ("Giving
poor people access to health care does not improve physical health in any
measurable way."). The study looked at just three physical health outcomes,
after two years: blood pressure, cholesterol, and glycated hemoglobin (a
measure related to blood sugar level control). These are lifestyle-related
measures unlikely to be affected in merely two years.

Moreover, the study is inappropriately designed to test the conclusion you
assert. First, it is based on giving a random sampling of people access to
Medicaid ("In 2008, the state of Oregon drew names by lottery for its Medicaid
program for low-income, uninsured adults."). But to address lifestyle
diseases, you need to build a culture of intervention over a long period of
time. You can't do this in just a few years targeting a few members of the
community. Second, the study doesn't measure the impact of "access to health
care" but rather access to Medicaid. The non-control group still received
healthcare services, they just did so through the emergency room and by
doctors' visits that went unpaid ("Medicaid decreased the probability of
having an unpaid medical bill sent to a collection agency by 25 percent.").

------
drzaiusapelord
While I'm sure the lack of medical access and quality of are major
contributors, I think this OECD document on obesity and overweight rates are
telling as well:

[http://www.oecd.org/health/49716427.pdf](http://www.oecd.org/health/49716427.pdf)

~~~
ams6110
The sugar- and grain-rich diet that has been aggressively promoted by the USDA
for decades is responsible for a large part of this. The "low fat" mantra
resulted in a lot of "fat free" but sugar-laden and/or grain based foods being
the primary component of many diets, resulting in epidemic obesity and
diabetes.

~~~
cowsandmilk
The USDA marketed equally to everyone, yet we see a wide gap in growth in life
expectancy shows wide disparities between the poor and wealthy[1]. The growth
of life expectancy of those with money has kept up with the OECD growth, while
the life expectancy of the poor has largely stagnated.

[1] [http://www.washingtonpost.com/business/economy/economic-
ineq...](http://www.washingtonpost.com/business/economy/economic-inequality-
contributing-to-gap-in-life-
expectancy/2013/03/10/54b5d21c-89df-11e2-98d9-3012c1cd8d1e_graphic.html)

~~~
wutbrodo
It's easy to imagine that the damage from following a poor diet is harder on
those with lower levels of income and education.

------
RankingMember
The Amish present another interesting divergence from the general populace's
life expectancy:

"[T]he Amish have had a 72-year life expectancy not only for the past few
decades, as have most Americans, but for the last 300 years—since they settled
in the United States in the 1700s, when most people living in America were
dying in their 40s."

[http://gerontology.umaryland.edu/documents/Advances_in_Aging...](http://gerontology.umaryland.edu/documents/Advances_in_Aging_fall031.pdf)

~~~
chc
Was there really a time when most Americans were dying in their 40s (as
opposed to 40 being the life expectancy from birth, which is a _wildly_
different thing)?

~~~
RankingMember
I had no idea the two were different, so thanks for making that distinction.
For anyone else's sake, I'll share what I learned:

Life expectancy from birth weights times of poor medicine and prenatal care
towards the low end of the life expectancy scale because of much higher infant
mortality rates, whereas in modern times life expectancy from birth would be
weighted the opposite.

So basically, if you filter out infant mortality and other "first years of
life" deaths, you get a more accurate picture of how long someone could
actually expect to live if they make it past the initial thresholds to human
existence.

At least that's what I've grasped thus far.

~~~
chc
Yeah, the problem is basically that historically you're most likely to die
either very young or fairly old, but averaging out the ages at which people
die creates the opposite impression — that you're likely to die sometime in
your late 30s to early 40s, which was never actually the case.

------
curtis
I wonder if the non-US OECD life expectancy might -- for some decades prior to
1990 or so -- have been excessively depressed by a couple of years. There are
two major reasons I can think of for this. The first is that for at least the
first half of the 20th century the U.S. population on average was probably
substantially wealthier than European counterparts (European countries make up
a substantial part of the OECD). The second is that the civilian population of
much of Europe suffered much more during World War II. This might have
resulted in lingering effects on life expectancy that gradually disappeared
over the ensuing decades.

~~~
vasilipupkin
that would explain convergence between U.S. and OECD, but it wouldn't explain
a continuously widening gap going forward in favor of OECD vs US

~~~
curtis
I think that it might explain part of the divergence. There are a couple of
obvious reasons that the U.S. might trail the OECD -- the greater number of
deaths due to higher car accident rates and a higher murder rate, as well as a
well known disparity in the life expectancies of Americans of primarily
European descent and those of people of primarily African descent.

I'm still trying to figure out how to say this. I'm wondering if the "natural"
life expectancy in the U.S. has always trailed the "natural" life expectancy
of the rest of the OECD (judged collectively, anyway) but because of some
systemic effects in Europe this natural disparity was offset for some decades.
The effect might have been something that gradually faded, exposing the
natural life expectancy differential.

I don't want to overstate things here -- there are some clear candidates for
things that might have gone wrong with health in the United States in the last
couple of decades that we want to look at. But I suspect this is not the only
thing we're seeing in this data.

~~~
Nitramp
This sounds plausible, though there might be many factors playing into this.
Most of Eastern Europe has probably experienced a massive increase in wealth
and life expectancy after the Cold War, perfectly lining up with the graph
diverging starting at 1990. If you travel around Poland or the Baltics these
days, the difference is remarkable. On the other hand, Russia has experienced
a massive decrease in life expectancy at the same time.

And stats like these here suggest that Western European states that presumably
changed less after the wall came down drifted away from the US, too:
[http://www.indexmundi.com/g/g.aspx?v=30&c=fr&c=gm&c=uk&c=us&...](http://www.indexmundi.com/g/g.aspx?v=30&c=fr&c=gm&c=uk&c=us&l=en)

Couldn't find graph-able stats that'd go back to the 90s or are totaled by
Eastern Europe, sadly, but poking around here suggests that several Eastern
European states experienced a significant increase in life expectancy between
1990 and 2000, three years for e.g. Slovakia.

~~~
curtis
I had completely forgotten about Eastern Europe and the end of the Cold War.

------
javert
Undoubtedly has something to do with the fact that patients and doctors are
not free to make the best decisions for personal care.

You can actually do better in that regard in a German-style nationalized
healthcare system than an American-style quasi-national corruptocracy.

But there is only one way to guarantee it completely and in principle:
separation of state and medicine, just as we have separate of state and church
and should have separation of state and economics.

~~~
dragonwriter
> just as we have separate of state and church and should have separation of
> state and economics.

That's a nice series of words that doesn't really have coherent meaning:
"politics" and "economics" are different names for essentially the same thing,
the manner in which a society distributes power. You can't separate them --
state action is inherently economic.

~~~
javert
That's simply not true. Under laissez-faire capitalism, the state is separated
from economics except in that it must tax and spend to maintain a night-
watchman state (military, courts, and police).

The only thing that state action inherently is, is coercive. (Though I'm not
advocating anarchy; coersion can be moral.)

------
azernik
This bit struck home for me:

    
    
        Some have also suggested that unfavorable US
        performance is explained by higher risk of iatrogenic
        disease, drug toxicity, hospital-acquired infection,
        and a cultural preference to “do more,” with a bias
        toward new technology, for which risks are understated
        and benefits are unknown.
    

I know some people who use both the US and the Israeli health systems to some
degree, and one contrast I've heard is that Americans (patients as well as
doctors) tend to prefer newer, less well-tested (because newer), and more
expensive (because still patent-protected and brand-name) drugs _even when the
new drugs have the same or worse performance_ than decades-old alternatives.
I'm not sure if the health drawbacks of this approach are significant, but the
economic ones are stupendous; the newer brand-name drugs can be ten times more
expensive than the old ones.

------
astalwick
I would love to see a comparison graph from Canada.

The US and Canada are not the same country, but they're similar in a lot of
ways. If Canada's graph shows the same drop, it'd be an indication that maybe
the problem isn't with the US healthcare system, maybe it's something about
culture/diet/environment/etc.

~~~
dghughes
From my perspective as a child of the 70s in a province not on the US Canada
has been flooded with US culture.

At worst in my childhood were maybe a McDonalds and a Dairy Queen. No cable TV
and few other cultural influences.

Now we're fat, WalMart shopping, gun toting, rap music/urban culture, even
dialects are more US sounding.

~~~
buckbova
My childhood exposure of Canada was through the movie strange brew. Still a
favorite of mine.

[http://www.imdb.com/title/tt0086373/](http://www.imdb.com/title/tt0086373/)

I figured all Canadians were hosers who scarfed donuts and drank beer.

Then I watched Kids In the Hall and I figured they were mostly funny gay
fellows.

Then I watched South Park . . .

~~~
mhurron
South Park is the most honest portrayal of Canada in the media today.

------
diogenescynic
We lack basic access to __affordable __health care, we drive too much which
causes more fatal accidents /injuries, we don't walk enough so we don't get
enough exercise, and we eat highly processed foods. Pretty simple.

------
hackbinary
Universally available public health care, or lack there of. Americans spend a
disproportionate amount of their GDP on inflated (private) health care costs,
and are therefore more reluctant to seek treatment before conditions become
acute.

------
Ologn
"perhaps doing and eating what we want (to the extent we’re making choices) is
more valuable than lower mortality and morbidity"

It seems more systemic to me. I go to my supermarket and decide to eschew
snacks like candy or potato chips for dried fruit or the like. But even the
dried fruit has extra sugar added to it. I look at the vitamins and such on
some yogurts and there is very little healthy about them. Normal dinner type
foods are loaded with sodium, cholesterol, saturated fat etc. Even when one
wants to be eat healthy, it can be a trial, because so much food is loaded
with junk, even "healthy" type foods.

~~~
beachstartup
i don't agree with this, at least for people who can afford it or live in non-
food desert areas (you didn't make the distinction in your assertion)

if you walk into a any grocery store, there's fresh/unprocessed meat, poultry,
eggs, fish, vegetables, fruit everywhere. you don't need to buy anything that
comes in a box or wrapped in plastic or has added sugar or salt or anything.

you don't need to eat anything beyond that selection to be healthy. whether or
not you want to go through the trouble of preparing it is another matter.

~~~
DanBC
What you say is true, but don't forget that most people have rudimentary at
best cooking skills and haven't learnt how to use a shopping list.

Combine that with misleading labels and massive advertising budgets of ready
meals and it's easy to understand how people fall into the trap.

~~~
adventured
Most people haven't learned how to use a shopping list? What people are you
talking about exactly (emphasis, as I'd like to know who you're describing
here)?

I grew up in poor Appalachia. Every single person I knew, understood perfectly
well how to use a shopping list, and how to cook. I simply can't imagine who
these people are that don't know such things, given my comparison group is in
theory low on the education chart.

~~~
tekalon
I rented a room from a woman who had her mother cook or she ate out. I had to
show her how to turn on her own oven. She owned the house, had a beautiful
kitchen (open, good appliances, lots of cupboard/prep space) but never used
it. Her brother, also living in the house, was AMAZED when I would cook and
make my own meals.

~~~
maxerickson
I recently noticed a third Subway in a town of less than 15,000 people. How
many people do they have to serve to be breaking even? Times three.

It wasn't so long ago that the second one went in (and that was at least
partly to capture foot traffic from the high school).

------
OregonJon
It strikes me that "Life Expectancy at Birth" is the wrong measure. I suspect
(and would like to see the stats) that the USA has a higher mortality rate
below age 40 than other western countries but that it levels out after that.

But is life expectancy the end all and be all. At age 98 my aunt, who was of
sound mind and body, was informed she'd probably live to be a 100. Her
response? "Oh, God, I hope not." She lived to 102, aware and cognizant to the
end.

~~~
jakobsen
>I suspect (and would like to see the stats) that the USA has a higher
mortality rate below age 40 than other western countries but that it levels
out after that

The USA has a lower than average life expectancy at age 65, and the life
expectancy has also grown less than average for that group, according to the
OECD[1]

EDIT: >But is life expectancy the end all and be all I agree there. The same
document includes a "healthy life years at age 65" (only for European
countries though), but it is arguably a much less objective measurement and
hence less useful.

[1] [http://www.oecd-
ilibrary.org/docserver/download/8111101ec066...](http://www.oecd-
ilibrary.org/docserver/download/8111101ec066.pdf?expires=1389206996&id=id&accname=guest&checksum=8971B0DE70B924813D5691E2D119601C)

------
sgustard
US needs to step up its effort to export lower life expectancy:
[http://en.wikipedia.org/wiki/List_of_countries_by_cigarette_...](http://en.wikipedia.org/wiki/List_of_countries_by_cigarette_consumption_per_capita)

------
Communonymous
The scary thing is that if you break it down by income top earners are
improving. Similar findings if you look at infant mortality rates.

"The life of a single person is worth more than all the money of the richest
man on earth." \- Che Guevara

------
dewiz
food, pollution, poverty, war.. many aspects where US does "more" than others

~~~
melling
All nice guesses but I don't suppose you have any data to support them?

Yes, war for examples, sounds logical, but how many Americans have died in
wars in the past 30 years? 10,000? Does that really move the needle?

~~~
aetherson
Word. And remember, the OECD isn't "The US, France, Germany, and the UK."

This link is (on table 2) the PPP adjusted incomes for each decile of the OECD
countries:
[http://www.oecd.org/site/piaac/Additional%20tables.xlsx](http://www.oecd.org/site/piaac/Additional%20tables.xlsx)

The US median 1st decile hourly earnings are $7.40. Austria, the Czech
Republic, Estonia, Germany, Italy, Japan, Korea, the Netherlands, Poland, the
Slovak republic, and Spain are all below there.

Australia, Canada, Denmark, Finland, France, Ireland, Norway, Sweden, and the
UK are above there.

So I don't think that poverty is causing the US to underperform compared to
the OECD mean or median.

~~~
Someone
I think a honest comparison should use something like the Big Mac index
([http://en.wikipedia.org/wiki/Big_Mac_Index](http://en.wikipedia.org/wiki/Big_Mac_Index)),
but for healthcare.

If one does that I bet that first decile American scores way lower on the
number of hours he can afford to spend in a hospital per year, or on the
number of days he has to work for a visit to the dentist.

On the other hand, I think he will be able to buy more over the counter
medicines.

~~~
aetherson
Well, it's possible that I'm misinterpreting the parent commenter, but I don't
think it's a very strong or interesting statement to say, "I think that lower
healthcare outcomes are due to worse healthcare."

I assumed that when dewiz listed "poverty" in a group of confounding variables
like "war" or "pollution" (which, by the way, is another thing that the US is
probably not particularly bad about) in explaining lower life expectancies, he
wasn't trying to use "poverty" as a proxy for "low access to healthcare," so
much as something that independently worsens healthcare outcomes even
controlling for healthcare access.

(And, by the way, while I don't think that it explains the difference in life
expectancies raised by the parent article, I do agree with dewiz that poverty
almost certainly has a negative effect on healthcare outcomes, even if you
perfectly control for access to healthcare.)

------
vasilipupkin
I would be curious to see not just the median but the mean. The median isn't
super informative in the sense that U.S. is much more heterogeneous / unequal
than OECD

~~~
jessaustin
In the absence of high infant mortality, it isn't clear to me why median and
mean for lifespan would diverge in any meaningful way. In the presence of high
infant mortality, the mean would just be lower than the median: how would that
be particularly informative?

~~~
vasilipupkin
Median and mean could and most likely do diverge because poor people live
significantly shorter lives than rich/middle class people. Europe in general
is more equal than the U.S.

------
AnimalMuppet
One might guess that around 1995, something happened to the US food supply.
Maybe the big surge of GMOs (which didn't happen in Europe because they're
banned)?

~~~
jakobsen
GMOs are not banned in Europe as a whole, but it looks like only Spain have a
significant GMO output [1]. Coincidentally Spain has a nice life expectancy,
so there doesn't seem to be an obvious correlation (one might argue that Spain
might produce but not consume most of it GM crops, which I don't know).

[1] [http://www.ipsnews.net/2013/03/spain-leads-the-eu-in-gm-
crop...](http://www.ipsnews.net/2013/03/spain-leads-the-eu-in-gm-crops-but-no-
one-knows-where-they-are/)

------
vasilipupkin
I also wonder if population density makes a difference. An ambulance should
take less time to get to you in Manhattan than 80 miles outside of Houston.

------
JakeJackson
One question: Are the OECD averages weighted by population, or does each
country get equal weight?

------
FrankenPC
If you tweaked the chart to show relative lifespan based on income, I wonder
what you'd see?

------
shaunrussell
Corn subsidies and good marketing.

