It's very surprising to see so little mention of race/ethnicity forces in this article, since I understand that to be a large part of the answer to the headline question. There is a gap of a couple years between Americans from Asian, Latino, White, and Black/Native ethnicities (in that descending order). https://nationalequityatlas.org/indicators/Life_expectancy#/...
For Asian- or Latin Americans, life expectancy is comparable or favorable vs respective countries of ethnic background. This remains true for richer countries; Chinese-Americans have a life expectancy of 86.8 vs 85 in Hong Kong and 75 in mainland China.
Meanwhile, Black and Native Americans live several years fewer than other Americans, and (at only 14% of population) account for ~1.6 years of the ~3.4 year life expectancy difference between the US and the G7. White Americans, esp rural, seem significantly worse off than European countries. These differences in racial outcomes seem to persist when controlling for SES: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849870/
(Not that any of my comment is in conflict with the causes pointed to in the article -- smoking, obesity, homicides, etc.)
These articles always tend to focus on small and/or homogenous countries. Comparing the US to many of these countries (Japan, Iceland, Israel, Finland) is comparing apples and oranges.
A better example is Brazil, which is very diverse, like the US, with people from different cultures all over the world, and also large geographically and in terms of population. Like the US, Brazil has high wealth inequality, high homicide rates, low social cohesion, etc.
These kinds of countries have to find new solutions. Sao Paulo or New York is not going to become Tokyo overnight -- they're just fundamentally different.
Why is diversity and size of the country more important to life expectancy than other criteria such as wealth of the country? The US is a much richer country than Brazil, roughly 10th in per capita GDP vs 90th depending on what list you use. That wealth should theoretically allow for better healthcare.
Out of the gate, genetics. Genetically homogeneous cultures would be much easier to provide healthcare to, because you have less diversity of outcomes for treatments.
If there is genetic predispositions to life expectancy, and I'm not saying there is per se, only that it's plausible, the more genetically diverse your country is, the closer to the mean life expectancy you would be, and homogeneous countries would effectively be a form of life expectancy data-mining.
I could further get into discussions of negative outcomes as governance population size increases, but that's a much more speculative discussion. I would say that in smaller countries, where you're much more likely to know someone who is a friend of your representative, you'll have better long run outcomes of governance because you can govern much more pragmatically and less ideologically.
And why would immigrants have lower life-expectancy? Why would the immigration to the US skew the result if we compare for instance with immigrants to Europe (mostly from Africa/Asia). It seems it is a comparable rate.
>And why would immigrants have lower life-expectancy (in reply to comment about immigrants of low socio-economic status)
So lets phrase that taking into context in which the question was asked:
And why would immigrants of low socio-economic status have lower life-expectancy in a nation where those where of low socio-economic status have lower life expectancy?
It isn't at all. At least not without data to back it up.
For instance it could be easy to argue that the opiod crisis which has been depressing life expectancy in the US substantially is primarily affecting existing low socio-economic status citizens of the US rather than immigrants. (some data seems to suggest it might be half the death rate for Hispanics compared to white US population
And doesn't the US have a strong mix of highly skilled immigrants to skew the overall immigrant numbers if indeed low skilled immigrants have shorter lifes?
Another statistical reason why I would think that immigrants have higher life-expectancy is that by definition child mortality won't affect immigrants. If you die before immigrating you are not affecting US statistics. If you are born after immigration you aren't an immigrant.
Life expectancy for an adult is calculated based on your present age, not birth. View any mortality table and your life expectancy changes every year you live.
>If you are born after immigration you aren't an immigrant.
If you are born of an immigrant of low socio-economic status, you are predisposed towards a lower socio-economic status. Therefore the immigrant has influenced this statistic even through non-immigrant births.
>At least not without data to back it up.
You want data to back up that generally in the US and/or within immigrant populations, life expectancy is lower as you go into lower socio-economic groups? Is anyone really trying to refute this?
> A better example is Brazil, which is very diverse, like the US, with people from different cultures all over the world, and also large geographically and in terms of population.
Canada also seems to be another parallel to the US. How's Canada doing compared to the US?
> high wealth inequality, high homicide rates, low social cohesion, etc.
These seem like more important causal factors than race/ethnicity. I understand that these can correlate, but I wouldn't concentrate on the confounding variables.
One glaring omission from that article seems to me to be lack of environmental protection e:g in USA all manner of food additives are allowed that EU for example would ban. Bovine growth hormone is allowed. I'm not sure if it's that, or soft drinks, that makes some Americans so huge. There are many people in other countries that are sedentary , live unhealthy lifestyles, drive everywhere, but the true hugeness of some people seems to me uniquely American. Pesticides like glyphosphate are allowed in USA. Waste water from fracking poured on the road and finds its way into the water system. When I, as a Brit, worked in USA for a while 25 yrs ago, I noticed people constantly complaining about allergies, and also a rather large number of people that had had cancer (albeit the health system seemed to have sorted them out and got them better). This wasn't something I heard so widely discussed back home and I surmised it was due to chemicals. Since then, I think the UK has got worse and more people here complain of allergies now, presumably due to imported food or domestic use of chemicals.
Since the conclusions are at the end of the article, there's no need to guess
Every country should and can do better in this respect, but a particular weakness of the US is a lack of success in preventing poor health. Many of the important factors – smoking, obesity, violence, poverty – are not about providing better healthcare for those that need it, but about preventing poor health outcomes in the first place.
The failure to prevent poor health is a factor that is contributing to both developments shown in the first chart. They worsen the health of the American population and they are expensive for the healthcare system.
How does life expectancy compare between, say, the Pacific Northwest, and the Deep South? I'd like to see that first before I homogenize the entire US and compare to a small country in Europe. E.g. obesity rates vary considerably around the US.
That could be true, though as a suburbanite myself, I have to say that what we seem to do most is walk & run. It's just not forced. After the first few miles of walking per day, I don't think the extra really contributes significantly more health benefits.
That sounds like a good, if informal argument that obesity is a primary factor. Or maybe exercise, which is certainly going to be correlated with obesity. You can be fit and still overweight, for sure, but only to a limited extent.
A few comments opine upon the seeming unfairness of comparing the US to countries considered more “homogeneous”.
OK, let’s compare the US to its similar North American neighbour, Canada, using the info in the article.
The US still lags by a considerable margin. Thems of us north of the border are somewhere between surprised and appalled at how little the US population and leadership seems to care about how much worse off Americans are than their peers in other countries.
Y’all have a lot more wealth, sure, but a lot more poverty, a lot more deathfrom treatable conditions, and a lot more incarcerated, for what it’s worth.
Non-existent? 4% of the population, according to StatsCan, compared with 12% in the US. Not sure that 4% is small enough to not matter, equally unsure that 12% is large enough to skew results as heavily as you would seem to suggest.
If true, one could reasonably conclude that anything that makes money (smoking, guns, opioids) is allowed to continue even if it has bad effects, and anything that costs (pre-natal care) is neglected, even if it has good effects.
Infant mortality is either by far the largest rate difference if you consider the relevant population to be only infants or the smallest rate difference if you consider the relevant population to be the population at large
Shocking how quickly opioids became a major life expectancy difference in a couple decades while every other rate other than suicide is decreasing over time, especially since it's nowhere as prevalent in the other countries
Promising how much smoking rate has dropped in America, obviously some lag so hopefully that brings smoking mortality down a lot in the future
The rich areas of the US do have high life expectancy. New York, New Jersey, Massachusetts, etc. But there are a lot of very poor regions too that drag the average down. For a european equivalent, take western europe and group it with eastern europe and that's basically the United States. But you can absolutely compare Switzerland with New Jersey (Switzerland is twice as big, but the populations are shockingly almost the same).
Comparing the US average life expectancy to the average of other rich countries is tricky because the US population is so much bigger and more diverse than most other countries. If US data were broken down by state, we'd probably see life expectancy in some states more like rich northwestern European countries, and some states more like poor southeastern European countries.
For all that, US healthcare is still uniquely optimized to maximize cost.
> If US data were broken down by state, we'd probably see life expectancy in some states more like rich northwestern European countries,
Here[0]. Hawaii is the highest which is between Finland and Belgium (24/25 respectively)[1]. California is second and comparable to the UK (29).
There definitely is a divide in the rich and poor, but it does appear that there are plenty of poor European countries (as well as some non-European) that are fairing much better. So I don't think we can conclude that this alone accounts for the disparity. There's clearly other important causal factors at play. I'm sure we can guess what a few of them are.
> If US data were broken down by state, we'd probably see life expectancy in some states more like rich northwestern European countries, and some states more like poor southeastern European countries.
This is true.
- New York State life expectancy is 81.4 and the Netherlands life expectancy is 81.41
- Hawaii life expectancy is 82.3 and Spain life expectancy is 82.33
- Mississippi life expectancy is 74.9 and Lithuania life expectancy is 74.93
> Comparing the US average life expectancy to the average of other rich countries is tricky because the US population is so much bigger and more diverse
I read this argument a lot, in various formulations.
The truth is that the the US State with the higher life expectancy is Hawaii [1] at 82.3 years, comparable to New Zealand, that ranks 19th (or 16th depending on the year taken in consideration 2021 [2] or 2022 [3]) in the list of countries by life expectancy.
The 4th State in the list, Minnesota, is already out of the first 30.
That's why on average US score pretty badly, even worse than some undeveloped countries.
I'd say it's mostly a question of lifestyle. You can have all paliative halthcare you want, what matters is regular exercise, good diet and I guess other factors like pollution.
"Many of the important factors – smoking, obesity, violence, poverty – are not about providing better healthcare for those that need it, but about preventing poor health outcomes in the first place."
We all know in the us. Lack of universal affordable health care for all, a social safety network that treats people with illness, loss of income, life challenges, etc. Plenty of people see the lack of these things are great things about America.
Excess... drive by one of your local dialysis centers. I wonder what percentage of diabetics are type 1 in the US? Has to be a tiny percent, just using my eyeballs and looking around.
drugs and the standard American diet - its not rocket science. over 36% of the country is obese, compared to germany at 22%, finland at 22%, belgium at 22% norway at 23%, spain at 24%, poland at 23% etc.
Maybe other reason as well, but improving the american diet would improve health more than anything else. Food companies should be sued like tobacco companies were for the poison they peddle.
I prefer: Let insurance companies offer discounts to those that don't smoke and are not overweight; I get a discount for being a good driver, why shouldn't there be a discount for not living a lifestyle that is likely to use more medical care?
Having gone around Europe a couple weeks ago, I noticed store and restaurant staff would greet some people in English and some in the local language, very rarely seeming to use the wrong language. Sitting on one particularly busy restaurant street, the pattern suddenly became obvious to me: people over a certain weight were always greeted in English. People who were middle aged and not obese were always greeted in the local language.
As an American myself, weights I’ve grown accustomed to as “normal” really are inconceivably big by world standards. It made me realize that even though obesity rates may be high around the world, the amount of weight by which they’re obese are completely different leagues.
I don't buy it. Some areas of the US have obesity rates similar to western Europe (and let's be honest, when your obesity rate is 1 in 4, you don't get to brag about it being low). I suspect there are other indicators that an experienced person could use to identify nationalities without requiring a verbal conversation first.
I really disagree. Walmart is fine and healthy food is cheaper than unhealthy. Walmart sell carrots and potatos too. Way better than my supermarkets at home.
The main problem is people on a poor diet buying expensive premade stuff with alot of fat and sugar in it.
A policy problem I have noticed however is pizza and hamburgers with soda as every day meals in the school cafeteria, as a choice for the pupils. That is just insane from a health perspective.
Don't we think that time is limited though? I have a white collar job and find myself relying of premade food. I can't imagine if I had two jobs or two jobs and kids
I don't know many people that are either super fit, or super fat. A few of each. Perhaps 99% of my friends & family group is just average people. Could stand to lose 10 or 20 pounds, no doubt, but that's not at all unique to America.
What you think of as “average” is actually obese/unhealthy. It is “average” because of most Americans being overweight/obese. Look at photos form the US taken 40 years ago and you will see what healthy non-obese people look like.
This may also be reflective of the demographic of people who are willing to spend money to travel to Europe. We certainly have a lot of fat (and fit) people in the US, but anecdotally most people I know are somewhere in between.
Imagine a country where second grade kids in mid-western states, myself included, would be led by teachers in class to sing songs that go "pizza hut, pizza hut, kentucky fried chicken and a pizza hut..."
No one is forced to eat an unhealthy burger. Advertise the unhealthy burgers as unhealthy, increase demand for healthy burger (or healthier, since there might not really be a healthy burger).
Advertise the sugar and sodium and carb and sat content prominently.
Running on a platform of doing a big study and deciding policy scientifically is like running on a platform of wanting to spend more time with your family: people will like you for it, and vote for someone else.
I love how they completely ignore demographics - show me other "rich countries" that have the influx of immigration - especially to those with immigration skewed towards the lower end of the economic spectrum - that is at epidemic proportions as we are facing in the US now.
"Many of the important factors – smoking, obesity, violence, poverty – are not about providing better healthcare for those that need it, but about preventing poor health outcomes in the first place."
I think we should provide every US legal resident with affordable access to health care, but the lack of it doesn't significantly impact life expectancy at the aggregate population level. Only about 10% lack medical insurance. Other factors like obesity, substance abuse, lack of exercise, and preventable trauma are far bigger factors pushing down national life expectancy.
When looking at statistics like this, it’s somewhat unhelpful to consider the US one country. Because of the low density of the population + essentially no federal government, the US is really a few different regions with vastly different outcomes.
We spend so much on the military exactly so we don't have to send young Americans in to meat grinders.
How many Americans have been killed in the past 20 years during military operations? Approximately 10,000. If that's all the young American deaths we get for trillions of dollars in spending, that is not a great bang for your buck at all. Hell, more than twice that amount died in one day on September 17, 1862.
Oops, I mistook the casualty figure for the total deaths. In any case, even if "only" 3500 people died in 1 day, that is still a rate approximately 4000x higher than the average rate over the past 20 years.
Yes, but their deaths pay for a global hegemony, a friendly trade climate, and access to other countries' natural resources.
Also, you're forgetting all the money that flows directly back into your states, through infrastructure spending, federal services, federal share of funding state services, etc. (Which is a convoluted way of moving money from 'have' states into 'have-not' states.)
Dominated by defense spending and entitlements. Going strictly on budget isn't a great comparison. E.g., many Western European countries spend practically nothing on defense, relatively speaking.
From a policy point of view, US states have more power than the feds.
> it is one country, and no amount of clever word play or stat juking will change that.
That's not relevant to the point. As a geographic feature, the US is disparate and even the urban centers persist under wildly different conditions. Looking at it from a perspective OTHER than how humans classify their societies, might give some insight. Generally scientists are interested in data in aggregate that ignore the arbitrary lines drawn generations ago for human edification.
That's how you could graciously interpret the gp's comment, even if you disagree that it's a useful viewpoint.
Guns, easily transferred beyond state lines, are very different. You can't move health insurance beyond state lines
And just one more example into why its not 1 healthcare country - to be able to pass the ACA, some provisions had to be "opt in" for state legislators to adopt. So if you were born in the wrong state, even when the ACA passed, you still didnt get some of its positives effects
OP said it was unhelpful to consider it one country, not that it was untrue to consider it one country.
I think this is true in the same way that it is unhelpful to talk about the mean net worth of 10 individuals in a room if one of them is Elon Musk.
And, in fact, treating the US as "different countries" is exactly what the author does - by pointing out that it is low-income Americans who actually suffer the burden of lower life expectancy rather than an across the board radical lowering of life expectancy for all Americans compared to other rich nations.
Please go to American Samoa and then Rhode Island and explain how it's not unreasonable to look at things this way. The US is so big and so different in some areas, some people in the USA even get passports that say they're not even US citizens even though they were born in the USA.
One issue is having an open border that allows trafficking of deadly drugs.
"Between 2020 and 2021, nearly 79,000 people between 18 and 45 years old — 37,208 in 2020 and 41,587 in 2021 — died of fentanyl overdoses, the data analysis from opioid awareness organization Families Against Fentanyl shows."
We also push vaccines during a pandemic that was primarily killing the obese in the greatest numbers but no mention of exercise and a reasonable diet.
>One issue is having an open border that allows trafficking of deadly drugs
By this logic the US should have higher life expectancy than the countries it's being compared to.
>We also push vaccines during a pandemic that was primarily killing the obese in the greatest numbers but no mention of exercise and a reasonable diet.
When you're trying to explain differences you should focus on things that are actually... different. Obesity, maybe. Vaccines, not so much.
My point was the messaging from the various "authorities" in the US. They only pushed vaccines, they never said that it's time to focus on your weight and exercise.
Saying "lose weight" doesn't work. Ask some doctors—once their eyes stop rolling, they'll tell you how rarely counseling patients about weight loss has any effect. Further, it certainly won't help much when you're dealing with a timeframe best measured in months.
It's not the accessibility of deadly drugs as much as the unknown variability in the drugs addicts use, causing them to unexpectedly overdose. One could make a compelling argument these drug deaths are actually because the borders aren't freely open to wholesale lab produced narcotics.
The War on Drugs has to be one of the biggest blunders of the 20th century. Attempting to block fentanyl at the borders is a fool's errand and blaming Mexico for supplying US demand is misguided and unjust.
The reason the pandemic is winding down is thanks to the vaccines being pushed. Exercise and a healthy diet was Michelle Obama's pet cause, but that didn't get picked up during the next administration.
It's foolish to compare statistics about all Americans to small homogenous countries like Norway or Japan, as though the difference comes from policy.
The people are completely different.
How do the outcomes of Norwegians compare to those of Norwegian-Americans? How do the outcomes of Japanese compare to those of Japanese-Americans? Here we can start seeing the effects of policy.
If you drop a bunch of Danes, Swiss, or many of these other people in the US their life expectancy in the US would be almost as good. This life expectancy graph should include nations from which US draws much more disproportionately, such as Mexico, Africa (former slaves), Central American nations, etc. For instance, Hispanics have much greater life expectancy in the US vs many of the nations from which they draw. US provides a lot of these opportunities where nations like Switzerland less proportionately provide.
And to the person who pretended like they didn't understand that most slaves came from African regions with low life expectancy, they know they're playing the disingenuous game where they try to pretend the US hasn't greatly risen the life expectancy (presently) of these offspring vs had they been born in their forefather's nation. Including these African nations on the chart would show that, but someone (perhaps racist since they chose not to include Africa) with an agenda left them out.
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>Also what does being descended from someone who worked as a slave have to do with anything
A nice attempt to play dumb and act like these slaves didn't disproportionately come from nations with low life expectancy, in which their descendants quite likely would now live had they not been unjustly removed from their homes. Of course commenter knew this all along, but tried to bait the question.
For Asian- or Latin Americans, life expectancy is comparable or favorable vs respective countries of ethnic background. This remains true for richer countries; Chinese-Americans have a life expectancy of 86.8 vs 85 in Hong Kong and 75 in mainland China.
Meanwhile, Black and Native Americans live several years fewer than other Americans, and (at only 14% of population) account for ~1.6 years of the ~3.4 year life expectancy difference between the US and the G7. White Americans, esp rural, seem significantly worse off than European countries. These differences in racial outcomes seem to persist when controlling for SES: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849870/
(Not that any of my comment is in conflict with the causes pointed to in the article -- smoking, obesity, homicides, etc.)