Two Cheers for Shorter Lives!

Wednesday, August 15th, 2007

So this Guardian article is almost giddy in pointing out how America is “falling behind” the rest of the world in life expectancy, due apparently to our lack of socialized medicine, our fat asses, and our nasty habit of letting people make their own choices about their lives (well, at least comparatively).

For decades, the United States has been slipping in international rankings of life expectancy, as other countries improve health care, nutrition and lifestyles.

Countries that surpass the U.S. include Japan and most of Europe, as well as Jordan, Guam and the Cayman Islands.

“Something’s wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries,” said Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington.

A baby born in the United States in 2004 will live an average of 77.9 years. That life expectancy ranks 42nd, down from 11th two decades earlier, according to international numbers provided by the Census Bureau and domestic numbers from the National Center for Health Statistics.

The article goes on to cite a number of factors for our drop in the rankings, including high infant mortality, obesity, racial disparities, and our lack of nationalized health care.

There’s so much wrong with this article, it’s tough to know where to begin. So I’ll just run off my objections bullet point-like.

  • As the article itself notes, the U.S. has set life expectancy records in each of the last five years. And though the article quotes public health officials saying we need to do more to fight cancer and heart disease, deaths from both of those ailments have been in dramatic decline for 15 years. Whatever our ranking in comparison to other countries, the picture here is far from bleak. Deaths from cancer have actually declined overall the last two years, despite increases in population. In fact, overall deaths decreased in 2006, and by the largest margin in sixty years.

    Now, you could argue that this is has nothing to do with our vaguely market-oriented health care system, that it’s more the result of healthier living. Or you could argue that we still eat too much McDonalds and sit around on our couches, we’re just lucky because our lives have been prolonged by advances in medicine. Which would be thanks to our health care system.

    But it seems to me that so long as we continue to set average life expectancy records in this country, you can’t really argue both.

  • The discrepancy between the U.S. and Andorra (the world leader in life expectancy) isn’t much. It’s less than six years. That doesn’t seem like anything to get panicky about. Good for Andorrans. All twelve of them.
  • I don’t know how much I’d trust the data coming from some parts of the world. Cuba, for example. Does anyone really think Cuba’s putting out honest numbers about its health care system? Hell, I don’t trust public health data when it comes from the U.S. government.
  • About that infant mortality rate. I regularly hear people cite it when pointing out how inadequate the U.S. health care system is (and don’t get me wrong, I think there are many flaws with the U.S. health care system. I just happen to think socialism will make them worse, not better). But infant mortality is measured pretty differently in different parts of the world. And in the U.S., we’re more likely than most places to count a premature, sickly, or low-weight birth as a life lost if it doesn’t survive:

    The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don’t reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates.

    The other factor here is that thanks to our access to medical technology, we’re more likely to try to save premature deliveries that in other countries would result in stillbirths or miscarriages. So every time an infant dies in the U.S. that would never have been born alive (or counted as born alive) in other countries, it registers as a life that died at the age of “zero.” That’s a pretty significant downward-tug on the national life expectancy.

  • Homicide. Most homicide victims are young, between 16 and 30. And let’s face it, we’re a pretty bloody country. Now I realize this sort of plays into world stereotypes about us, but I’d submit that a big reason we have so much bloodshed in this country is not that we have too much freedom (as the Guardian article suggests), but that we don’t have enough. I’m referring to the particularly militant approach we take to drug prohibition, which as I think this graph makes pretty clear, tends to drive homicides up. There are about 20,000 annual homicides in the U.S. Another 30,000 suicides. The average homicide victim lives less than a third of the annual life expectancy.
  • Nationalized health care? Well in the U.S. the mortality rate for prostate cancer is less than 20 percent. In Canada it’s 25 percent. In the UK, it’s more than 50 percent. Breast cancer? A 20 percent mortality rate in the U.S., 33 percent in France in Germany, and nearly half in the U.K. I find it difficult to believe that the lack of socialized medicine is what’s behind our lagging in life expectancy figures.

    I’d actually like to see where we rank in average life expectancy from, say, the age of 30 or 35 onward. I couldn’t find any such data, but it seems to me that would factor out much of the homicide problem, would negate the problems with how we measure infant mortality, and would probably result in a better showing for the U.S.

    One final note, here. Even if the article is right, and we on average have six fewer years to live due to our excessive freedom to indulge, so the hell what?

    If you want to eschew smoking and fast food, exercise, and otherwise lead the disciplined life that will allow you that extra six years of geriatry, so that you may live as long as the average Andorran, that’s your prerogative. Some of the rest of us may choose to live it up a little, even if that means we spend six fewer months in the nursing home before kicking off. Of course, you could also get struck and killed by the organic food truck in the parking lot of Whole Foods.

    The problem with the public health crowd is that life expectancy, and preventing X number of deaths each year, is really all they value. The freedom to take risks, the freedom to enjoy even the indulgent parts of life, any notion of individual liberty–there are no columns for these things in their spreadsheets. They want government nudging people toward better choices (and by “better” they mean, “choices that will add more days to the end of your life”), even if some of us already understand the risks, and have simply come to the conclusion that 1,000 days of tasting chocolate cake is better than an extra year in a life without cake, or in a life with very little of it.

    I shudder to think what steps the public health crowd would take if we were to take a “mission-to-the-moon”-like challenge to lead the world in life expectancy.

    Reminds me of an old joke: A 60-year-old man goes to the doctor for a check-up. The doc asks…

    “Do you smoke?”



    “Not a drop.”

    “Sleep around?”


    “Smoke pot?”


    “Eat sweets or fats?”


    The doc says, “Well, I have good news and bad news. The good news is, you’ll probably live another 25 years.”

    “That’s great! What’s the bad news?”

    “I don’t know why you’d want to.”

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