
U.S. life expectancy varies by more than 20 years from county to county - fmihaila
https://www.washingtonpost.com/news/to-your-health/wp/2017/05/08/u-s-life-expectancy-varies-by-more-than-20-years-from-county-to-county/?hpid=hp_hp-top-table-main_life-expectancy-11am%3Ahomepage%2Fstory
======
generj
One possible partial explanation for this is the same reason why the Bill
Gates Foundation wasted a bunch of money fostering small high schools. Smaller
high schools were some of the best performing schools...but also some of the
worst [0].

The answer is just that small counties have high variance. By chance some
small counties will be a lot higher or lower than the national average.

I would be interested in seeing a Cox Proportional Hazards Model would show if
the remaining changes are related to pollution, meth, economics, etc.

[0][http://marginalrevolution.com/marginalrevolution/2010/09/the...](http://marginalrevolution.com/marginalrevolution/2010/09/the-
small-schools-myth.html)

~~~
flexie
But even the small counties have populations in the several hundreds or
thousands, right? Outliers that die at 33 or 103 affect the average little
when you have a population of 2,000.

~~~
tmalsburg2
(See edit below.)

Intuitively what you say makes sense. However, I just ran a simulation in R
based on census data (actual county sizes from [1]) and the result is that you
do get by-county age differences of up to ~17 years just by chance. These
bigger differences do not occur often but the assumptions I made in the
simulation are fairly conservative and the true random variation could easily
be bigger. So 20 years does not seem absurd.

[1]
[https://factfinder.census.gov/faces/tableservices/jsf/pages/...](https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2015_PEPANNRES&src=pt)

In the spirit of open science, the code for the simulation:

    
    
      library(tidyverse)
    
      read_csv("co-est2016-alldata.csv") %>%
        filter(SUMLEV=="050") %>%
        select(county=CTYNAME, pop=POPESTIMATE2016) %>%
        group_by(county) %>%
        mutate(age = mean(rbinom(pop, 100, 0.7))) ->
        d
    
      range(d$age)
    
      ggplot(d, aes(age)) + geom_histogram()
    

Running the simulation repeatedly yields maximal differences between counties
between 16 and 19 years.

EDIT: False alarm. I incorrectly assumed that census data sets uses unique
identifiers for counties and that introduced a bug in the simulation. After
correcting it, the simulation shows that random variation indeed explains only
very small differences in life expectancy of about one year. Corrected
simulation code below:

    
    
      read_csv("co-est2016-alldata.csv") %>%
        filter(SUMLEV=="050") %>%
        mutate(county_id = 1:n()) %>%
        select(county_id, county=CTYNAME, pop=POPESTIMATE2016) %>%
        group_by(county_id) %>%
        mutate(age = mean(rbinom(pop[1], 100, 0.7))) %>%
        ungroup -> d
    
      range(d$age)
    

Life expectancy as a function of county population:
[http://imgur.com/a/0LgGZ](http://imgur.com/a/0LgGZ)

~~~
MR4D
Thanks for sharing!

It would be interesting to know the standard deviation for counties less than
say, 10,000 people, as well as the for counties larger than 10,000 people.

~~~
tmalsburg2
See the plot that I linked in the post above.

------
binarymax
Not only county-to-county. My friend did his PhD dissertation on how (at least
in Rochester, NY), life expectancy varies by decades between _zip codes_. His
research focused on urban Food Deserts and studied how the lack of access to
healthy food nearby restricted diets to that available in convenience stores
(chips, soda, etc). I wish I had access to his dissertation, but he just
defended a month ago and cannot find it in any publications right now.

EDIT: Not my friend's paper, but here is a similar study:
[https://hrs.isr.umich.edu/publications/biblio/8355](https://hrs.isr.umich.edu/publications/biblio/8355)

~~~
nostromo
> His research focused on urban Food Deserts and studied how the lack of
> access to healthy food nearby restricted diets to that available in
> convenience stores (chips, soda, etc).

I hear this often but always wonder which way the causation arrow flows.

Do "food deserts" cause unhealthy eating? Or do groups of consumers that
prefer unhealthy eating create "food deserts" with their purchasing decisions?

~~~
simulate
In the past 10 years or so, the notion that unhealthy eating and food deserts
are related has been refuted in multiple articles and studies. Here are links
to some of the more popular ones.

[1] NPR "The Myth of the Food Desert":
[http://www.npr.org/2010/12/15/132076786/the-root-the-myth-
of...](http://www.npr.org/2010/12/15/132076786/the-root-the-myth-of-the-food-
desert)

[2] New York Times "Pairing of Food Deserts and Obesity Challenged in
Studies": [http://www.nytimes.com/2012/04/18/health/research/pairing-
of...](http://www.nytimes.com/2012/04/18/health/research/pairing-of-food-
deserts-and-obesity-challenged-in-studies.html)

[3] The Atlantic "Do Food Deserts Cause Poor Eating?":
[https://www.theatlantic.com/business/archive/2015/11/food-
de...](https://www.theatlantic.com/business/archive/2015/11/food-
deserts/414534/)

~~~
elliotec
It does seem fairly obvious that it is lifestyle choice and like-minded
cultural group bubbles as opposed to not having anything but garbage to eat
nearby.

------
davidf18
A very similar article by many of the same authors was reported in JAMA in Dec
2016.

From JAMA Arch Int Med article from today, p. E6: "...At the same time, 74% of
the variation was explained by behavioral and metabolic risk factors alone,
while one marginally more variation was explained by socioeconomic and
race/ethnicity factors, behavioral and metabolic risk factors, and health care
factors combined."

From the WaPo article: "Mokdad said countries such as Australia are far ahead
of the United States in delivering preventive care and trying to curb such
harmful behaviors as smoking. “Smoking, physical inactivity, obesity, high
blood pressure — these are preventable risk factors,” Mokdad said."

In NYC, and not just Manhattan, New Yorkers are doing better because of a
number of interventions initiated in 2001, when Mayor Bloomberg and Dr. Tom
Frieden took over as Mayor and Health Commissioner.

Adult smoking is 14% in NYC, 24% in Louisiana. Raising the cost of tobacco
contributes more than half the effect of getting smokers to quit and to stop
teens from ever starting.

NYS tobacco tax is $4.35 per pack and the city is an additional $1.50.
Cigarette sell for at least $12 per pack here.

The tax is $1.08 in Louisiana.

Mokdad mentions Australia, where the tobacco tax is $14 per pack plus an
additional $2 sales tax.

The ACA made a huge mistake in not raising the about $1 US Federal tax to a
much higher number for the 13 billion packs smoked each year.

Raising the Federal tax by $4 would raise at least $30 billion each year for
helping those with high risk preexisting conditions.

~~~
chimeracoder
> Raising the cost of tobacco contributes more than half the effect of getting
> smokers to quit and to stop teens from ever starting.

Yes, though it's also created a thriving black market for cigarettes, often
trafficked from other states or otherwise sold without paying end-consumer
taxes[0].

Separately, it's worth noting that the age for purchasing tobacco in NYC is
21, as opposed to 18 in most other places.

Furthermore, it's also just really damn hard to smoke in NYC. It's been banned
in restaurants and bars for fifteen years, long before that was commonplace in
other places. More and more buildings are smoke-free, which makes it less and
less convenient for people to maintain a smoking habit.

[0] The cost of having an illegal market isn't always monetary. For example,
Eric Garner was killed after an encounter in which police approached him
because they claimed he was selling untaxed cigarettes:
[https://en.wikipedia.org/wiki/Death_of_Eric_Garner](https://en.wikipedia.org/wiki/Death_of_Eric_Garner)

~~~
seanp2k2
21 in CA as well as of March 2016 [http://www.npr.org/sections/health-
shots/2016/05/05/47687267...](http://www.npr.org/sections/health-
shots/2016/05/05/476872674/california-raises-age-of-tobacco-purchase-
to-21-and-tightens-vaping-rules)

I didn't notice until very recently when I saw a sign on a cash register (I
don't smoke). Good for us. It's also very hard to smoke here, many places have
lots of rules about where you can do it (not indoors, really far from doors,
etc). I'm kind of surprised that people still bother.

That said, when riding a bike around, it's very apparent that many people
smoke weed in their cars now. You can smell it for about a block or two behind
their vehicle.

~~~
abalashov
No kidding! I was just thinking about this last night on my 34 mi bike ride in
the rural bits surrounding Athens, Georgia. It seems like every third car that
passes me emits the scent of weed in some way.

------
CoolGuySteve
This map seems correlated with socieconomic status and all the health
implications that go along with that. And it looks similar again to Republican
voting districts. It's Sarah Palin's "Real America", so to speak.

One thing the Democrats would do well to focus on is the fact that there's a
large portion of the country that is sick, where the statistics look more like
an underdeveloped country. Those of us who live in the major cities would do
well to empathize with this other part of the country and their malaise, even
if for our own sake of having a more sane and less partisan government.

~~~
lotsofpulp
Democrat or not, those in the "other part of the country" are the ones voting
against themselves, i.e. for politicians who oppose subsidized healthcare, who
oppose workplace benefits such as paternity, maternity, and sick leave, those
who oppose healthy food for public school students (and public schools in
general...)

Those living in major cities have empathized with those in areas that
consistently vote for "smaller" government, by not voting for the same
policies and politicians that are causing them harm.

~~~
Glyptodon
The belief in smaller government and general distrust of it in some such areas
(but not all) is, IMO, often because paternalistic urban policies don't
effectively meet rural needs. Which is taken as proof that government can't
solve their problems.

The politics of benefits in such areas are also frequently driven by a
perception of affordability -- it's all very nice to have paternity,
maternity, sick leave, etc., but when the perception in the community is that
there are few jobs, and what jobs there are can barely afford to pay people's
wages to begin with, of course it's going to be accompanied by a belief that
forcing the provision of benefits is just going to destroy jobs and not help
anybody.

I think it's important to take some sort of needs hierarchy into perspective -
when daily living is tenuous and stressful, I think many of the benefits the
"too stupid to know what's good for them other parters" don't seem to be moved
by are addressing the wrong steps of their needs hierarchy, or fail to take
into account the financial and environmental realities of their day-to-day
lives.

Just as housing has turned out to be an important first step in combating
homelessness (as opposed to medication, employment, etc.), I would not be
surprised if there were different first steps needed to support people in
poorer, more rural, areas than what are perceived within them as very white-
collar benefits.

~~~
nitwit005
If the rural areas are doing poorly, it's always tempting to blame the cities,
or the "urban elite", or whatever. Yet the rural areas quite often dominate
state politics. If their own representatives are acting paternal, it's hard to
see how it's the cities fault.

Providing help to rural areas remains quite popular across the board. There is
a long history subsidizing rural agriculture, infrastructure and utilities.
It's proven difficult to eliminate the poverty despite that.

~~~
Glyptodon
State politics are often little more than a reaction to national politics
crossed with support for moneyed interests like car dealerships and some
grandstanding/boot-licking race-to the bottom job policies. National politics
really sets the tone, context, and priorities people are aware of, especially
so in an era when most reporting and commentary is national in scope and local
information is often via word of mouth and social media.

I do think it's true that in many rural-dominant states you can't blame a
state-level urban elite, and that's not really what I intended to suggest in
my comment (though I do think in "blue" states there very much is such a
dynamic, witness Jefferson, rural sheriffs flatly stating they won't enforce
various state laws, etc.). Frankly, I don't think blaming an urban elite at a
national level makes sense either, as I don't believe what I referred to is at
all intentional.

That said, I think the examples you list of things subsidized may also be
examples of things that are likewise slightly misplaced priorities in terms of
the larger picture. For example, I'd imagine (though I don't specifically know
that) agriculture subsidies mostly go to large enterprise farming operations
and have little trickle-down effect to many every-day rural people. Likewise,
subsidizing rural infrastructure seems like it may be necessary regardless of
any significant benefit, though it's once again highly speculative on my part
(for example, I'd guess fire-fighting services require significant external
subsidies in some areas, but also don't have tremendous effect on the day-to-
day life experiences of average "locals").

My previous statement is also why I think the election of Trump may be an
important milestone in solving some of their problems: namely I think (hope)
he may be a gateway to the realization in certain quarters that what were
presumed to be their problems and solutions actually aren't, leading to a
significantly reformulated and broadly unified national consensus. (Yeah,
probably a pipe dream...)

------
nolemurs
I couldn't help but notice that the top three counties (Summit, Pitkin, and
Eagle counties in CO) are largely empty space with some of the country's best
ski resorts. I suspect that the life expectancy there may largely be driven by
fit retirees who move there.

~~~
rsync
Not merely ski resorts, but specifically Aspen (in Pitkin County) and Vail (in
Eagle County). These are not merely fit retirees, but the richest retirees in
the world.

Further, there is a bit of selection bias here in that the town of Aspen is at
8000 feet of elevation. You need to have a decent baseline of physical
fortitude just to step off the plane there as an older person...

Finally, for what it is worth, day to day life in Aspen (even outside of the
ski season) is extremely active and everything about the town promotes that
activity.

I personally don't think there is anything actionable or interesting[1] about
Aspen and Vail having high life expectancies - they are completely non-
representative of any piece of the real world.

[1] Well, other than fitness and activity increasing your lifespan, but we all
know that already.

------
JohnGB
I really wish that journalists would learn some 3rd grade maths before writing
anything with numbers in it. How does the life expectancy vary by "more than
20 years" when the difference between the counties with the highest (85) and
lowest (67) life expectancies is 18 years?

~~~
mikeyouse
You should be more diligent if you're going to be so snarky... 85 wasn't the
highest life expectancy. WaPo noted three adjacent counties with very high
life expectancy and captioned the graphic, "Summit, Pitkin, and Eagle
Counties, each at more than 85 years."

Their actual values were 86.83 years, 86.52 and 85.94 years. Oglala Lakota
County had a life expectancy of 66.81. Lo and behold, 86.83 - 66.81 is more
than 20 years.

From the source article:

> _Counties were combined as needed to create stable units of analysis over
> the period 1980 to 2014, reducing the number of areas analyzed from 3142 to
> 3110. In 2014, life expectancy at birth for both sexes combined was 79.1
> (95% uncertainty interval [UI], 79.0-79.1) years overall, but differed by
> 20.1 (95% UI, 19.1-21.3) years between the counties with the lowest and
> highest life expectancy._

Pretty cool data viz here:
[https://vizhub.healthdata.org/subnational/usa](https://vizhub.healthdata.org/subnational/usa)

------
legitster
Is there any reason this isn't just selection bias? Young, healthy, people
with good careers travel to big cities. The rest stay behind. Do we have data
to compare those who stuck around vs those who grew up there but moved away?

~~~
pdubbs90
The map shows life expectancy at birth, so healthy people moving from rural
areas to cities shouldn't effect it.

------
brooklyntribe
Rural upstate NY. Always checking out the obits. There were some weeks there
when no one broke 62. Seems to stabilized, but more rural than Appalachia. The
winters are brutal, MDs are hard to find.

~~~
rm_-rf_slash
Truth. Here in Ithaca the health care is pretty good, but quality falls
quickly after 15 minutes drive in any direction.

Not to mention that, aside from college towns and the canal cities, most of
upstate NY hasn't been economically prosperous for generations. It takes a
toll on folks.

------
dkarapetyan
Heck I bet within a 5 mile radius it varies. Just go to east palo alto and
then go to "not east" palo alto. The reasons I think are pretty obvious and
almost certainly correlated with how affluent your neighbors are. Money
basically solves all problems when it comes to wealth related problems like
access to good schools and healthcare. Even though in theory healthcare and
education should not be so strongly coupled to money.

------
dainichi
The "life expectancy of a county" is not a trivial thing to define if you ask
me. Is it how long children born now in a county can expect to live, no matter
where they live or die, does it only depend on people who die in the county,
or is it somehow weighted by the time people live in the county? Maybe there's
a standard definition, but my guess is that most people don't know.

~~~
finolex1
Conventional life expectancy measures are calculated based on the death rates
at each age of the residents in that place. Therefore the death rates of
people at 80+ or 90+ years may be affected by their lifestyles 30-50 years
ago, so it's not always an accurate measure of how long you would expect a
child just born to survive in that place.

AFAIK it's not weighted by the time people live in that place. Perhaps areas
with lots of affluent retirees will have distorted life expectancy rates that
may not be reflective of people who are born and spend their lives in that
area.

~~~
dainichi
Thanks for that explanation. So if a county has, say, a lot of hospices (and
people change their residency when they go there, not sure how that works in
the US), that will affect the expectancy negatively, saying nothing about how
living in that county affects longevity.

------
Zyst
There's a phrase that stood out to me:

>“We are falling behind our competitors in health. That is going to impact our
productivity; that’s going to take away our competitive edge when it comes to
the economy,” Mokdad said. “What we’re doing right now is not working. We have
to regroup.”

What's the logic behind this? Out of curiosity. It's a morbid thing I hesitate
to say, but from a purely utilitarian view isn't it better for a country— from
a macro perspective— if people die as close as possible as they finish their
working life and retire?

I might be completely off base there, and this is mostly a request for more
information, not saying people should die early. As far as I'm concerned I
hope we all live to 200.

~~~
csa
Death can often be a very slow process.

Sometimes it will cause a worker (and the worker's company) to be less
efficient due to health-related issues. Not to mention that caregivers (e.g.,
family) may also be less efficient by taking time off from work or quitting
work all together.

Sometimes people will be put on disability for health reasons before they
should need to retire. This is a drag on the welfare system and (often) the
economy if they had been a productive member of the workforce.

There is also a potential quality of life issue (both present and expected),
but that's not as easy to measure as the previous points. It also has some
potentially complex implications that are beyond the scope of this post.

~~~
Zyst
What would be a better scenario, though. Do we not die slowly even if we are
older, which also requires more caretaking?

What's the difference between having it happen early and late?

I do agree with the Quality of life issue, though. If I'm a highly skilled
worker (And thus have prospects to migrate) And some people in say, a country
in Europe, live to see 150 years of age, while in my country on average people
live to 70 I'm moving out as soon as humanly possible.

Realistically the gap doesn't grow that large, but I'm using hyperbole to make
a point. I might be too dumb to articulate it though.

~~~
csa
The issue in the quote is (premature?) death as it relates to economic
competitiveness. That is why early -- that is, in working years -- matters
more than late.

Late and slow death has its own indirect impact on economic competitiveness,
but that is not the focus of the quote, imho.

------
protomyth
Oglala Lakota County which is completely contained inside the Pine Ridge
Indian Reservation is served by Indian Health Service with 94%+ of the
population being eligible for free, government provided medical care. I
notice, other than pointing it out on the map, they didn't discuss it in the
article.

[http://www.richheape.com/american-indian-
healthcare.htm](http://www.richheape.com/american-indian-healthcare.htm)

------
notadoc
Of course life expectancy is going to vary by county, because the variables
that contribute to life expectancy; income, lifestyles, dietary habits,
quality of health care, and access to health care are vastly different.

I assume you'd need a broad cultural shift in attitudes about food
consumption, obesity, physical activity, and vast health care networks that
ignore income to change it.

------
MR4D
Some random information in this article....

For instance, they cite almost no lung cancer deaths in Summit county
Colorado, while the highest rate is found in Florida.

Well, duh - why the heck would a lung cancer patient want to try and breathe
thin air at 9,000 ft??? Sea-level would be much more comfortable.

Not picking on the statistics, but they could have pointed out that some of
the variation is purely logical.

~~~
efm
The three mountain counties in Colorado with the lowest death rates in the US
don't have major hospitals. Without hospitals, fewer deaths.

------
pnathan
Not surprised. Visited the Midwest a few years ago, and obesity was
ridiculously off the charts compared to the Intermountain West or WA/CA. The
are significant social factors playing out on a wide and complex scale.

My advice, if you're stuck in one an area with unhealthy habits, is to move to
an area with healthy habits.

------
worldsayshi
> "We are falling behind our competitors in health. That is going to impact
> our productivity; that’s going to take away our competitive edge when it
> comes to the economy"

Interesting how it seems like health itself isn't seen as the target metric.
Nope, economy is what's important.

------
irrational
What about from country to country. I'm from the US and, at least where I
live, it is rare to see someone smoking. Second hand smoke has basically
become a thing of the past. But this past week we went up to Vancouver BC and
we were shocked at how many people were smoking. It seemed like you couldn't
go 10 feet without walking through another cloud of second-hand smoke.
Apparently the anti-smoking campaigns of the US never made it up North ;-) Or
maybe their socialized medicine makes it so that they don't have to worry
about health consequences as much. I don't know. I just wonder if the life
expectancy is lower in Canada (or at least Vancouver) since smoking seems to
still be A-OK.

~~~
jandrewrogers
Smoking is more prevalent in the Pacific Northwest region than it is in, say,
Silicon Valley. It is still less common than some other parts of the US. This
was very noticeable to me when I moved to Seattle from the Bay Area. In the
Bay Area (and many other parts of California), smoking is approaching
extinction.

It is a regional culture thing. Most smokers in the Pacific Northwest are
strongly biased toward the lower economic strata. By comparison, in many parts
of New England (for example) there are quite a few smokers in the upper half
of the economic strata.

~~~
switchbak
I've lived in and around Vancouver for years, and I find there is very little
smoking there. Not sure where the GP's data is coming from, but he/she is
drawing very broad conclusions from a very limited dataset.

If anything, (many) Vancouverites have the stereotype of being super-healthy,
yoga-practicing, organic eating folks who actively shun unhealthy things like
smoking. Unless it's weed :)

edit: I was talking about the GP's comment, not your's specifically.

------
cylinder
Not everything is the government's fault. Go observe the lifestyle choices and
dietary choices some of these people make, and then add in the drinking and
smoking.

------
tn135
And why is that a surprise ? The public schooling in USA has widely distorted
the housing market creating ghettos where similar people will get clubbed
together.

~~~
wil421
How is this a US problem? Everywhere I've ever visited, and I've been to as
many countries as I have States, has quote on quote:

"Widely distorted the housing market creating ghettos where similar people
will get clubbed together."

I think they call them neighborhoods. Rich people live in nicer houses than
other people. Pretty sure it's been like this since one caveman had a bigger
cave with bigger rocks to throw.

Sacasim aside I really think we need a national school system. In Georgia it
varies by counties. Some counties compete on a national level others are dead
last in the nation, if we aren't counting Mississippi.

~~~
tn135
> How is this a US problem?

One word: Mobility.

I lived in a slum in India and went to a private school that catered to poor
kids. Got scholarship and worked my way up to start living into a high-rise.
The private school had a big role to play in it.

That is not possible for low income neighbourhoods for USA anymore. The
mindless regulations make private schools expensive. It is not possible for a
retired school teacher to run a class-room in a garage at night and call it a
school. That teacher will end up in jail and sex offenders registry. The poor
hispanic neighbourhoods of south San Jose will have to rely on the pathetic
public schools and those schools will ensure their students flip burgers.
Those kids will find it hard to move to Palo Alto.

Public schools not only distort the housing markets but they feed into that
evil spiral of poverty. I would love to see department of education dismantled
completely and money given to kids to chose their schools of choice and let
entrepreneurs make money by catering to the needs of all kids.

~~~
wil421
India is/was a socialist state and I would expect social services to be spread
more evenly than non-socialist countries. I also believe mobility is easier in
developing nations and was better to some extent right after the Industrial
Revolution and workers rights movements.

I am confused by your arguments. You're saying abolish public schools. Great
idea then we could create pillar schools where only the elites attend like
Yale and Harvard. Then the poor people will have to take out loans from the
elite to attend good High Schools. Oh wait.

I'm a product of mobility. My father grew up in rural government housing in
Georgia. Thankfully he went to GaTech and stayed in an environment with good
public schools.

~~~
chimeracoder
> India is/was a socialist state and I would expect social services to be
> spread more evenly than non-socialist countries. I also believe mobility is
> easier in developing nations and was better to some extent right after the
> Industrial Revolution and workers rights movements.

Saying "India is a socialist state" is, well, technically correct (it's in the
Constitution) but a pretty misleading way to characterize the sort of social
mobility in India that GP was talking about.

India is home to the longest-running continuously-serving democratically
elected Communist government in the _entire world_. It's also home to what
could be considered borderline anarcho-capitalist metropolises that are larger
than many European countries.

As it turns out, the sort of mobility that GP is talking about is very rare in
the states led by Communist and socialist parties, which have generally
struggled economically[0]. It's most prevalent in the states (and cities)
where the leftist governments never took hold, or where they were elected, but
carried out very little of their vision in practice.

In any case, the scale of mobility and economic growth experienced in the
economic hotspots of India (Delhi, Mumbai, Bangalore) has been made possible
by the end of imperial colonialism, and the concurrent rise of a global
economy. No developed country like the US will ever be able to experience that
same level of rapid growth.

[0] There is one exception, though in that state, 33% of the state's GDP comes
from foreign remittances (mostly from expatriates living in the Gulf), which
is incredibly high, and higher than any other state. There is definitely an
object-lesson in mobility to be learned there, but it's not the sort of
mobility GP was referring to.

~~~
wil421
Compare you're localized (hotspot) mobility to what the West experienced at
the end of the 1800s. China is a much better example and I dislike China.

You're saying I am technically correct about India being socialist.

The reason India has mobility is the same reason black markets or black
economies exist in Communist countries. Where there is a lack of government or
public services, black markets will form to fill the gap, capitalism. See
USSR, Yugoslavia, and North Korea. Difference is India seems to allow it.
There is another comment below about staring schools in a garage for poor
people. From what I've seen India has these shadow schools.

~~~
chimeracoder
> Let me remind you the California has a higher GDP than your entire county.
> My state Georgia has a 1/4 of your GDP with only ~10 million people.

No, my country had a GDP of $18.5 trillion in 2016. You must be thinking of
India, which had a nominal GDP of $2.5 trillion.

Though of course, this entire digression has next to nothing to do with my
previous comment, so I'm not sure why any of those numbers are relevant.

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wil421
I thought you were the other poster.

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throwawaysf9
I create a throw away account and say this almost every time a post hints at
something like this: It is commonly taught at the school of public health at
Cal that "your zip code is a stronger indication of your life expectancy (and
quality) than the color of your skin". This has been known for years now.

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RichardHeart
If there was no difference in behavior at all between all of the people of the
USA, I think you'd still see pockets of more and less progress, just due to
the natural distribution of dying. I'm curious what the expected variance by
zip code would be if everyone's behavior was identical.

As the article states, some countries are making more progress than the USA on
modifiable risks, such as smoking. Australia is one such country. If
advertising health were as profitable as advertising vices, we'd be in better
shape.

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ska
It's not just lack of progress, in some areas it is regression.

You state this obvious factor as if it were immutable. The article addresses
it, unsurprisingly, and provides examples that at least suggest progress can
be made to limit it.

