Wednesday, May 13, 2009

U.S. life expectancy

In the health care debate you can expect to hear plenty about how the U.S. spends more money on health care than any other country and achieves worse outcomes, defined as lower life expectancies.

As I've noted before, however, this is thoroughly unsurprising given that Americans have different -- and often less healthy -- behavioral patterns than other countries. We have one of the highest homicide rates among developed countries (although admittedly the impact on life expectancy is tiny, but nonetheless illustrates some disturbing societal behaviors). We are notoriously obese, with an obesity rate at over 30 percent that is twice that of Canada, three times that of the Netherlands and ten times that of Japan. Coincidentally all three of those countries have longer life expectancies.

But even other factors such as geographic layout can influence life expectancy. For example a trip to the grocery store in many places in the U.S. requires a car while in much of Europe you only need a quick walk. You are of course more likely to be killed driving than walking.

Indeed, statistics bear this out. In 1994 40,676 Americans were killed in auto accidents. Based on a population of 265 million at the time this works out to 1 fatality per 6,514 people.

In contrast Denmark had 495 fatalities in 1997 for a rate of 1 per 10,656 based on a population of 5,275,121. Finland had 430 for a rate of 1 per 11,627 based on a population of 5,000,000. Sweden had 540 for a rate of 1 per 16,416 based on a population of 8,865,051. Norway had 300 for a rate of 1 per 14,928 based on a population of 4,478,500.

Plainly demographics and cultural factors play a significant role. We also see this playing out within the U.S. Consider this data from Harvard researchers that found very different health outcomes for different demographics. Reasons for the discrepancies?
The differences were attributed to a combination of injuries and such preventable risk factors as smoking, alcohol, obesity, high blood pressure, elevated cholesterol, diet and physical inactivity -- particularly among people from 15 years to 59 years of age. They were not due to income, insurance, infant mortality, AIDS or violence, said the study's lead investigator, Christopher J.L. Murray, director of the Harvard Initiative for Global Health.

Most public health initiatives target children and the elderly, he noted.

The study looked at life expectancy by geographical areas as well. Hawaii led the 50 states and Washington, DC, with an average life span of 80 years, while DC trailed at 72 years.

Personal choices could be more important than access to medical care in improving life expectancy, Dr. Murray noted. Half of the people who have high-blood pressure fail to get it controlled, two-thirds of those with high cholesterol do not get medication to lower it, and two-thirds of diabetics fail to manage the disease, in spite of the fact that 85 percent of the population overall has health insurance.
The best way to improve health outcomes is to improve behavior. But that not only undermines the life expectancy argument, but also demonstrates the need for personal responsibility rather than collectivist action.

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