Tweet
The performance of the United States health care system and society in terms of life expectancy is very poor, far below the average of other high income countries. It is poor in terms of level of life expectancy in years of life. It is poor in terms of average annual growth rate in life-expectancy. So, it is poor in terms of both achievement and progress. It is certainly not the best in the world.
The performance is poor for both sexes. It is poor at birth, at age 40 and at age 65. It is poor compared to the average performance of other high income countries and the performance of other specific countries that could be models for US health care (IMHO: Australia, New Zealand, and Switzerland). It is poor compared to other systems that could be adapted into good systems for the US, but may be politically infeasible here (Canada and France).
Table 1 shows recent ten year average growth rates of life expectancy for other high income countries, for the US, the rank of the US average growth rate among high income countries, and the rank of US life expectancy, in that order.
Table 2 shows the same statistics for recent five year average growth rates. Tables 1 and 2 show that the average growth rate in life expectancy in the US has been below the average of 22 high income countries for both the ten and five year periods, with exactly one exception.
The sole exception, shown in Table 2, is that the average five year growth rate (to 2006) in life expectancy for women at age 65 in the US rose to slightly above average of other high income countries, though the rank of the US was still only mediocre: 8 out of 22 countries. Seven countries had higher growth rates: Denmark, Finland, Greece, Ireland, Norway, Portugal and Spain. So, even the best recent performance of the US is not nearly the ‘best in the world’.
Note that for men at birth and age 40, and women at age 40, the growth rates in life expectancy are stagnating or slowing down. Contrast that poor performance with other countries.
It is difficult to see what factors unrelated to the health care system could explain such a poor performance. The violent life-style of the US has been used as an excuse: the US has a higher rate of death due to violence and accidence than most (but not all) other high income countries. But violence and accidents cannot explain the poor performance for people age 40 and 65.
The poor growth rates of the US cannot be due to maxing out potential for growth in life expectancy because of a high level of attainment. The US ranks low in the level of life-expectancy in years, as well as growth rates. Other countries have higher growth rates with higher levels of life expectancy in years. This seems remarkably inefficient for the best healthcare system in the world. One could understand having a low growth rate in life expectancy over time, if the life expectancy itself was very high compared to other countries: further growth might be restrained against some kind of limit of medical technology or healthcare practice. But to be bad in both the level of life expectancy, and in the growth rate, and to be much worse than average over extended periods of time seems like some kind of FAIL to me.
Table 4 shows the level of life expectancies by age group and sex for five other countries that have what the GOP and their minions call ‘government run health care’. The US has the lowest life expectancy of them all, at all ages and for both sexes.
It is interesting to note that for those age 65 is where the US performs best (though not the near the best among other high income countries). The average growth rates in life expectancy for all age groups in other high income countries seems to be accelerating, while it is stagnating for younger groups in the US, except for young women. However, both elderly men and women have accelerating growth rates in life expectancy, though, again, the growth rate is not among the best.
This relatively better performance among the elderly gives evidence in favor of healthcare reform. Two of the three groups with accelerating life expectancies in the US are the elderly, who have near universal coverage. The high levels of life expectancy and the accelerating growth rates give evidence that more regulated government financed universal health care system does not mean poorer care for the elderly.
Remember that other high income countries provide universal care for all ages, and perform better at all ages and for both sexes, and at lower cost.
If people are going to sling disgusting charges of euthanasia and eldercide around, then I propose the following response, backed up by data. The current US system has gone one step better than eldercide and has adopted a policy of saving money by killing off people before the get elderly. The current system shows more variety and sparkle than a glum gray socialist dystopia that would kill all of the elderly. The US system was killing off old women for twenty years, until around 2000. Since then it has switched modes into killing off old men, who seem to have had it too good for a long while, and perhaps were getting swelled heads.
Table 1.–Ten year growth rates in life expectancy and rank of US.
……………………………..Growth Rates (% per year)…….US Ranking, out of 22
Category………………other high income………..US…….growth rate…life expectancy
Women at birth………………0.27…………………0.20…………18……………..21
Men at birth…………………..0.41…………………0.32………….19……………..21
Women at 40…………………0.39…………………0.24………….17……………..20
Men at 40………………………0.61…………………0.52…………12……………..15
Women at 65…………………0.81………………….0.67…………15……………..16
Men at 65……………………. 1.27………………….1.03…………18……………..11
Table 2.–Five year growth rates in life expectancy and rank of US
……………………………..Growth Rates (% per year)……US Ranking, out of 22
Category……………..other high income………..US…….growth rate…life expectancy
Women at birth………………0.30……………….0.22………….17……………….21
Men at birth…………………..0 42………………..0.27………….21………………21
Women at 40…………………0.38………………..0.24………….17………………20
Men at 40…………………….. 0.67……………….0.49………….16………………15
Women at 65…………………0.88………………..0.91…………..8……………….16
Men at 65……………………. 1.30………………..1.19………….15……………….11
Table 3.–Life expectancy in years, 2004-2006
Category…………………..AU……….CA………FR………NZ……..CH……..US
Women at birth…………83.3………82.8…….83.9…….82.0…….84.0…….80.5
Men at birth……………..78.4………78.1…….76.9…….77.7…….78.8…….75.3
Women at 40……………43.7………43.3…….44.0…….42.6…….44.0…….41.4
Men at 40………………..39.4………38.9…….37.6…….38.8…….39.3…….37.1
Women at 65……………21.3………21.2…….22.1…….20.5…….21.8…….20.1
Men at 65………………..18.1………17.9…….17.8…….17.7…….18.3…….17.2
AU: Australia, CA: Canada, FR: France, NZ: New Zealand, CH: Switzerland, US: United States
(sorry about the ragged tables, only way I could figure out how to do it on short notice)
Details
Countries included in the analysis are Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, United Kingdom, and United States.
Ten and five year average growth rates calculated to 2005/6 for life expectancy at birth and at age 65; and calculated to 2002/3 for life-expectancy at 40. Level of life-expectancy in years is average of last three years of data. Data for UK is lagged on year due to lack of data for most recent year.
Source: OECD Health Statistics 2007 and 2009.
http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html
12 Comments
I have read (don’t recall where) that the increase in obesity has been a contributing factor. Not sure whether the other industrialized nations have the same problem, but I would venture not to the same extent.
This is not to contest your thesis, merely to bring up another factor. I understand that obesity is actually increasing as the economy worsens since cheap (fast) food is also high-fat.
Obesity and the availability of health care are not unrelated factors. While it may be too much to say that the universal availability of preventive medical care would get rid of the obesity problem; it might have reduced the rate of increase in Obesity
Obesity is a sign of poverty and poor diet as the American “affordable” diet is high in starches and fat. It is a form of malnutrition. so IMO it is tied in with our health issues but, until we support low income people’s diets and provide more affordable healthy food, we will see the obesity rate increase as our low income population grows as it is.
It might be interesting to note here that:
The highest obesity rate is: Mississippi (also the highest poverty rate)
The lowest obesity rate is: New Hampshire (also the state with the highest population of high income families).
See what I mean?
My wife cooks low fat food very cheaply.
We don’t eat red meat, virtually vegetarians.
We buy and cook at home which is far cheaper
People are obese because fat food taste better.
The reason for our lower life expectancy is poor
diet, lack of exercise, poor choices
Maybe we need government run grocers and fast food restaurants
to control behavior
Your opinion may be true. But my opinion is that if we stick with measureable factors, it is difficult to make the case that the US has a uniquely awful history of poor health habits compared to other countries. I invite people to download the free spreadsheets from OECD and one can graph and look at the history of obesity, overweight, smoking prevalence, cigarette consumption, alcohol consumption in Australia, Canada, New Zealand, Switzerland, etc. A person can do it in ten minutes with excel.
Source: OECD Health Statistics 2007 and 2009.
http://www.oecd.org/document/1….._1,00.html
To repeat myself, right now, the US may be uniquely bad in terms of obesity starting 35 years ago, but Australia and New Zealand have look like they are on our path to widespread obesity with a lag of ten years. If you want to attribute the flatlining of US life expectancies starting in the 1980s to the rise of obesity in the US, you have to answer why other countries with similar rises ten years later did not also experience an immediate hit.
I admit that there may things that are difficult to measure, or have been poorly measured so far that might have an influence. My understanding from docs I talk with is that we really cannot say it is overweight and obesity themselves that are deadly, but rather obesity mixed with bad diet and low excercise. But many countries have worse smoking histories than the US, and smoking is deadly all by iteself.
So, I do tend to be skeptical of attributing ALL of the poor performance of the US to poor health habits.
And, if you do want to attribute all of it, then that is another argument for reform, since that blows up the argument that prevention by itself can save no money and improve no health measures.
There is controversy about the role of health risks in determining life expectancy, and I have had some arguments with people elsewhere and here at FDL on how to deal with that issue.
My opinion is that by ‘health risks’ we should look at behaviors such as smoking, alcohol consumption, obesity, nutrition. Things like blood pressure, cholesterol, are outputs as well as inputs to the health care system. (that is, they are determined to some extent by both the behavior and medical treatment).
If you look at the issue that way, I do not think that the US has uniquely unhealthy habits. The Swiss smoke more and eat more fat. Australians and New Zealanders have health risk profiles that are similar to those of the US, both now and over time.
For example, obesity rates in the US started increasing about 35 years ago. They started increasing at about the same rate in Australia and New Zealand about 25 years ago. If the intitial increase in US obesity itself was the cause of the stagnation in US life expectancies than began in the early 1980s, then you should see a similar stagnation in Australian and New Zealander life expectancies beginning in the 1990s, but you don’t. They sailed right through that decade with very good performances compared to the US.
Aussies and New Zealanders, and Canadaians also like to drink and smoke like the US.
Some health risks, like detailed nutrition info (what kind of fat, for instance), physicial activity are diffiult to measure, so that could be part of it.
The two main points of this post were supposed to be:
1) by the reform opponents’ logic, if the US has the best health care in the world, then it is killing off both young and old, because it could have the best life expectancies in the world, but it doesn’t,
2) there is no data at all supporting the idea that having universal care and cost containment will harm the welfare of the elderly.
We don’t need to go into country specific health risk behaviors to establish that second point.
Great piece, and one of the biggest myths out there that the US doesn’t ration care.
Nice post wesgpc. I look forward to your posts. They’re a great source well-summarized facts.
thanks .. rags and all … a very informative post …
fascinating and thanks.
Blessings,
Oops, noted a mistake in my comments. The rise in obesity in the US started 35 years ago, not 25 years ago, as stated in my first comment. The first increases started in the mid 1970s.
Oops, another typo. Table 4 mentioned in text should be table 3.