My armchair hypothesis is that the quality and availability of medical care trumps most other factors. Singapore is known to have a great medical system, even for those not well off.
This is probably also the reason USA is doing so badly. If you're in the bottom quintile, the quality and availability of medical care is awful. If we ever instituted medicare-for-all, I expect average lifespan would shoot up by a couple years at least.
Check out the documentary forks instead of knives to see more examples like this.
It was great for opening the topic and provoking discussion though, which is much needed.
You're spot on with respect to diet. I believe Singapore has the highest rate of diabetes in the developed world.
With respect to supposed excellent medical care, some problems in Singapore that I noticed:
- There is little access to preventative medical care. If you do get preventative medical care it tends to be very expensive (scan all the things!). In my home country, I would get a yearly test for glaucoma as my grandmother was affected and it's genetic, but in Singapore this is quite unheard of (I tried once and was subjected to a battery of tests that cost hundreds of dollars). In my home country most people get yearly dental care, but there's no such thing in Singapore.
- People change doctors a lot, which I think is problematic. However, you're kind of forced to change doctors every time you change companies or if your company switches to a different health insurance provider.
- Strong drugs are available over the counter, no questions asked. GPs also happily give out way too many drugs for minor issues.
- People in Singapore can end up losing all their money if they get a serious illness.
- Strong promotion of pseudo-medicine, such as TCM. It is legitimized even by otherwise respect universities, which may have TCM research centers. After a GP visit, it's also common that you get some pseudo-scientific medicine from the secretary handling your payment (e.g. 'don't eat chicken').
I'm not so much arguing against your hypothesis. However, I worry that optimizing for life span might not mean that people are healthier.
In fact, in some countries, death is sometimes chosen over necessarily prolonging life:
- Getting very expensive, painful/dulling medical procedures that end up prolonging your life is discouraged by doctors in some countries
I think that is quite a bold criticism that is 10 years ahead of its time.
The examples of euthanasia and expensive procedures being discouraged are statistically insignificant at this point in time.
So why is your contempt reserved for "CAM"?
> Unproven treatments that may make problems worse, while also encouraging patients to stay away from tested treatments
I keep hearing this but I've only witnessed the opposite.
I've utilised "CAM" for conditions that mainstream medicine couldn't help with (after years of trying to get help from different mainstream practitioners).
Only a combination of treatments from "CAM" modalities (naturopathy, osteopathy, myotherapy, yoga/pilates, limited chiropractic & TCM) has enabled me to get properly well.
Every "CAM" practitioner I saw encouraged me to keep checking in with mainstream doctors, which I did and have continued to do.
My mainstream doctors now look at my test results and just say "whatever you've been doing, keep doing it".
I get that there are horror stories, as there are in many facets of life. But like much of what makes up mainstream news reporting, the very thing that makes them noteworthy is that they are exceptions to the norm.
As someone who has gone about as deep into researching health/medicine as one can without actually undertaking a medical degree, I'm comfortable that the hysterical reactions over "CAM" are overblown.
So, it would seem, are government regulators around the world who are actually looking at the data, otherwise there would be even more stringent controls imposed on practitioners than are already in place.
 "Complementary and Alternative Medicine"
I know it’s hard to believe and to generalise beyond your own experience but you are one data point. You might have gotten better without any of the things that you mentioned. Most likely it was a placebo effect, strengthened by your own research and belief in the practices.
I’m not sure the lack of government regulation is a valid point. In my experience, and as you’d see if you read Goldacre’s book, government administrators don’t understand statistics. Even if they did, they don’t neccesarily legislate to maximise welfare.
> Because CAM doesn’t even attempt to be correct.
Practitioners don't stay in business if they don't provide benefits. So unless you're asserting that most "CAM" clients like spending money for zero benefit, this claim doesn't hold up.
> I know it’s hard to believe and to generalise beyond your own experience
If you were committed to intellectually honest discussion, you'd have at least made further enquiries of me before making this assertion.
I have many acquaintances pursuing similar paths through their own health challenges, and have done for many years. I've examined many case reports and research studies, in order to understand the medical basis for what I've observed and experienced. So, yes, I'm one data point, but I've observed and researched many others.
> You might have gotten better without any of the things that you mentioned.
There's no basis for this. My health consistently declined for many years - for reasons that are now easily explained. And it started to turn around only after I started undertaking particular healing practices from the "CAM" sphere - but for reasons that are easily explained using scientifically sound medical knowledge.
> Most likely it was a placebo effect, strengthened by your own research and belief in the practices.
Serious question: do you suggest that my healing was imaginary, or that it was real but caused by beliefs/emotions rather than material factors?
People who invoke the placebo effect in this context often aren't conscious of importance of the distinction, but it matters a lot.
If it's the former, then I guess there's no more to discuss without knowing the details of my case - which you're welcome to enquire about.
If it's the latter, well then I agree with you that my healing has been influenced - indeed mostly driven - by changes in beliefs/emotions, as is the case with the version of the placebo effect that I subscribe to.
I've extensively researched the placebo effect and what is known about it, and how it may be relevant in my case, and I'm happy to discuss it further if it's a topic you're genuinely curious about.
> I’m not sure the lack of government regulation is a valid point. In my experience, and as you’d see if you read Goldacre’s book, government administrators don’t understand statistics. Even if they did, they don’t necessarily legislate to maximise welfare.
My point is not that there is a lack of regulation. There's a lot of regulation in most jurisdictions; professional bodies, health authorities, consumer protection authorities, criminal justice systems.
Governments may not legislate to maximise welfare but they are highly motivated to avoid horror stories on the front pages of newspapers, and the infrequency of such occurrences indicates that the level of harm caused by "CAM" is low.
Sure it would be great if it were lower, as is the case with all aspects of society where any harm occurs.
But striving for a world that only allows the practice of therapies that have been approved in advance by the mainstream medical establishment is not going to lead us to a better world than what we already have.
Chinese people have been practicing it for thousands years and we are doing just fine in terms of life expectancy, actually better than US.
Surgery or modern medicine (injection, pills) focuses on one particular manifestation of illness and targets a particular illness.
On the other hand, TCM is not targeting a particular illness, but rather, it sees illness as the symptom of something deeper going off track in the body. Hence it tries to regulate and balance the body so that it can correct itself, without too much intervention.
It's not something that you can quantitatively study easily and get concrete results, as it is more long-term and therapeutic rather than short-term result driven.
I mean, I'm not claiming to be an expert here or anything, it's just that last time I read up on that sort of thing it sounded like there was no evidence that chiropractic medicine or acupuncture was more than just placebo. Do you have citations?
>After eight weeks 60 per cent of patients receiving acupuncture, including with toothpicks, reported feeling better. Clinical improvements were reported by just 39 per cent of those who had conventional treatments.
but it didn't make much difference if they stuck in needles or just prodded them with toothpicks. (quote from https://www.mirror.co.uk/news/uk-news/toothpick-acupuncture-... dicussed by NHS here https://www.nhs.uk/news/medical-practice/acupuncture-relieve...)
And even if it's kind of placebo, if the patient feels better that's something, without the risk of an opioid epidemic.
But some examples of where practices from TCM and CAM are achieving recognition are:
- The Nobel Prize awarded to Tu Youyou for finding artemisinin effective for treating malaria 
- A recent NIH review finding acupuncture, yoga and other non-drug therapies effective for common pain conditions 
- A study of a chiropractic technique to reduce the physiological effects of emotional stress/trauma 
But aside from these studies, surely the market is at least somewhat of an indicator of some level of benefit. Economists generally regard consumers of being capable of making rational decisions about how to spend their money in ways that most benefit them.
Of course it's not a water-tight rule, but nor is it completely false. Yet many people dismiss the entire CAM industry as being fuelled by nothing but stupidity, and dismiss the possibility that at least some of the industry's customers are capable of making rational spending decisions when it comes to their health.
All the meridians and whatnot don't lend more credibility over...soil, say. Until they're tested properly. After which Nobel prizes can be won.
The vast majority of people using/practicing "CAM" are not claiming "CAM" to be "better" than modern medicine; they take a horses-for-courses approach.
Modern medicine is fine for acute illness where you need a medication or surgery to address an infection, break, blockage, etc.
"CAM" seems to be valuable for chronic non-life-threatening conditions like fatigue, pain, mild hormonal issues, mild auto-immunity, etc. It's also chosen by people who are quite healthy and want to keep it that way by optimising their nutrition, emotions, muscular-skeletal strength/alignment, etc.
So it's not a matter of what is better or worse than the other, it's a question of finding the right tool for the job. Every conventional doctor I've consulted in the past few years has endorsed that approach.
"Traditional" simply means TCM hasn't changed much over the years.
This is what is meant by the "traditional medicine that works is called medicine" soundbite. The soundbite on its own condenses the argument very imperfectly, and people should be wary of using it.
Edit: It's also worth noting that in Chinese, TCM is simply 中医, which literally means Chinese medicine. I'm not sure who decided to add the "traditional" in front, but it's not actually how it's called in China.
> Traditional medicine is distinct from modern medicine only by virtue of the parts that don't work.
If you say it this way, then maybe we should stop using the term TCM and just call it its original name "Chinese medicine" so we can both be happy.
Low crime rate. Less crime, less death and injuries.
High percentage of old people working. Working means more money to sustain life and pay medical bills.
CPF. You and your employer pay a percentage of your salary to government as CPF. This will be used for medical insurance and pension.
Good air quality and cleanliness in general. Helps in certain diseases.
Also means old people carry on getting exercise and feeling like they are a useful part of society.
Medical care will only take care of your biology, but that's only half of the battle.
Isn't Japan notorious for doing the opposite? At least it made the news....
"Several reasons for the increase in kodokushi have been proposed. One proposed reason is increased social isolation. A decreasing proportion of elderly Japanese people are living in multi-generational housing and are instead living alone. Elderly people who live alone are more likely to lack social contacts with family and neighbors, and are therefore more likely to die alone and remain undiscovered."
It's not because it makes the news that it's quantitatively important. Murders make the news in Japan the whole time yet Japan is one of the safest countries around.
I've read several times that medical outcomes across the board are worse in the US than in European countries with national health systems - i.e. even for the richest, privatised healthcare doesn't work (on average).
The framing of "privatized" vs. government health care is, IMNSHO a holdover from the cold war when everything needed to be as ideologically distinct from USSR as possible. Now, it's just corrosive. This isn't a dichotomy; it's not even really a gradual scale - it's typically a whole host of choices of how to set up those regulations. Presuming in advance that privatization is a good (or bad) thing simply leads to worse outcomes.
Singapore has forced savings accounts for basic care (out of pocket spending drives costs down), less barriers to entry into the medical profession (thus more doctors at lower wages than the US), less regulation that results in non-competitive hospital and medical practice like in the US.
It's far more effective at delivering high quality at low cost due to more market forces. They spend 3% GDP for excellent results vs 16-20 in the US which is a regulatory death by a thousand cuts.
Catastrophic care is covered by the government but this is far more efficient than universal systems elsewhere.
If you think US Healthcare is a problem of a lack of regulation you don't understand US Healthcare…
Which is why it's a shame when we get hung up on "privatized" vs. not - on that kind of topic people have often already made up their mind, and you're just not going to get anywhere anymore.
If you consider that Medicaid tends to be quite focused on outcomes (spending money where it's effective) and covers ~1/4 of the country, this isn't surprising.
Better diets and less drug use should both be rather cheap to impact at a policy level. I think much of the problem is that it's popular in the US to oppose the government having policies that would improve the quality of life of poor people.
I'm curious about this. Can you point me to any resources to learn more about that? Or could you elaborate on why it is so, especially the "insecure" part?
The fact that there's minimal social safety net, certainly doesn't help either.
I recall reading some studies that came to the same conclusions as above, but I don't have them handy at the moment.
Does that lead to a lot of homelessness and crime?
Regarding crime, Singapore is one of the safest in the world. A lot of that comes down to effective policing and extremely strict sentencing that puts criminals behind bars for a very long time.
Family ties are a lot stronger, so a lot of people falling on hard times do get substantial help from their family members. But there's minimal governmental safety net of the type you find in Western Europe.
Americans are very obese due to having a terrible diet and our heart disease kills more proportionally than our peer countries.
If you look at life expectancy of various ethnicities they are comparable to their countries of origin. If you look at life expectancy after 40 (where people are using medical care) the gap between the US and europe closes (but not completely).
I don't understand what medicare for all seeks to accomplish that isn't already available with medicaid.
Medicaid is only available for the extremely poor; Many states have expanded this after the ACA passed, but my understanding is that there's still a pretty good gap between where you qualify for medicaid and where health insurance is affordable in much of the country.
Medicaid only help the poorest. You need to be at a certain income to get it. I am a graduate student that is currently on it.
Medicare-for-all helps everybody regardless of income. Everybody is entitle to it regardless if you're poor.
A big part of that is getting the basics right. Diabetics don't need to start gofundmes to afford insulin, they don't get into medical emergencies if they run low on funds, then get swamped with medical debt from having to be hospitalized (further digging their insulin fund hole). they can live healthy and productive lives.
Are there numbers for this? As an American I have enjoyed great health care on-demand all my life at very little or no expense and I pay very little for insurance.
Some of that is explained by efficient outcomes not really being a systematic goal, but we also have a dumb regulatory framework where a bunch of things are highly regulated and prices aren't touched.
Healthcare is massively overrated.
Working in the medical field as an internal medicine physician, I'd say that focused and good-quality healthcare is vital to prolongation of life, and poorly derived, financially-motivated 'medicine as profit' is massively overrated.
IQ is only a bit more genetic than environmental (about 55-45, from most of what I've seen on the issue), so even if IQ was extremely strongly associated with lifespan, that would be a weak basis for characterizing the latter as being overwhelmingly inborn.
> Americans would clearly live a lot longer than they do if they spent less on healthcare.
That's far from clear; there's reason to suspect American food cut healthcare costs and do as well or better, but there is certainly no guarantee that blindly cutting spending would do that. If
Correlation is not causation, and many other factors correlate to both lifespan and IQ, neither of which are entirely a result of genetics.
Another would be noncellular things like quality of sleep.
Lifespan statistics are heavily influenced by early deaths. Drugs and violence take many more lives in the Western Hemisphere than in Singapore. This is enough to explain a large portion of it. Especially during this opioid epidemic.
I'd argue that diet is significantly worse throughout the Western Hemisphere as well, but nutrition is a difficult science.
On HN the idea is: if you have a substantive point to make, make it thoughtfully; if you don't, please don't comment until you do.
It says very little about quality of life.
Also, SG's are very thin. A big contrast to Americans.
Another point: SG seems to have crazy-lax food service regulation compared to USA. Hawker centers are everywhere. Many make a living serving delicious, inexpensive foods this way. I would propose there is little to nothing to show for some of the US's hyper-aggressive food regulations leading to governments pouring bleach on food, or private charities holding secret events to help homeless people in America.
I haven't personally owned restaurants in both SG and USA, but what I understand is it is way easier in SG in terms of red tape, capital, insurance etc. I think that's a very valid criticism.
The food in America is diabolical. The amount of processed food with too much salt, sugar and fat makes you ill after a while.
For the difference in health outcomes I’d start to look here. Especially as poor people have very little healthy options in the states.