The US is falling behind other advanced countries in longevity gains. This is the essential content of stories that appeared this week in almost every major newspaper. The stories are based on a carefully-crafted study released by the National Academy of Sciences. I first comment on where the US stands compared to other countries in terms of a few key health statistics. Then I go on to summarize key findings of the new report. Finally, largely in an editorial mode I comment on some of the deep-seated cultural factors that are involved, factors that may contribute to the US falling even further behind other leading countries when it comes to health and longevity.
Health statistics –where does the US stand?
Many US citizens like to think of our country as “having the most advanced medical system in the world.” In terms of health statistics, however, we are very far from a leader. We are in the middle of the pack and in some cases worse off than developing countries. Here are a few example statistics:
– Infant mortality: According to the CIA World Factbook (2009 statistics) the US ranks 46th, just below Cuba and Guam. We have 6.26 deaths per thousand births, nearly three times as many as the first ranking nation Singapore with 2.31 deaths per thousand births. Other countries doing better than us include Slovenia, the Czech Republic and Iceland.
– Maternal mortality: 41 countries do better than the US in terms of deaths of mothers upon giving birth according to World Health Organization statistics. Among the countries with fewer deaths per 100,000 births are Belarus, Bulgaria, Croatia, the Czech Republic, Estonia, Hungary, Kuwait and Iceland.
– Percent of rural population having access to improved drinking water: 57 countries rank better than the US including the Ukraine, Tuvalu, Turkey, Tonga, Slovinia, Slovakia, Egypt, Malasia, Macedonia, Thailand, Serbia, Qatar, Greece, Guyana and Montenegro, and the Democratic People’s Republic of Korea according to WHO statistics.
– People living with HIV or AIDS. According to the CIA World Factbook we have the world’s 8th largest population of these people, 1.2 million. Russia, China and India rank way below us.
Changes in life expectancy
A few days ago the National academy of Sciences issued a report “Explaining Divergent Levels of Longevity in High-Income Countries.” The findings should be disturbing to US citizens. We are trailing other advanced countries in both longevity and rate of increase of longevity.
According to the introduction to the report “Over the last 25 years, life expectancy at age 50 in the U.S. has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the U.S. spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes. — According to Explaining Divergent Levels of Longevity in High-Income Countries, the nation’s history of heavy smoking is a major reason why lifespans in the U.S. fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages — cancer and cardiovascular disease — available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable.”
The report was covered widely in the popular press with headlines like Why is America’s life expectancy lagging? “Despite spending more on health care than any other country in the world, the U.S. is lagging in life expectancy. American men and women do not live as long as people in France, Japan, and other wealthy nations, and the gap is widening. Now, the National Research Council has attempted to find out why that is. Here, a quick guide to their findings: — How much does our life expectancy lag? We rank 36th in the world, behind even South Korea and Cuba, with an average life expectancy of 78.3 years. Japan, whose citizens can expect to live to the ripe old age of 83, ranks first. But what is especially worrying is how we’re failing to keep up with other developed nations. Between 1980 and 2006, the life expectancy for men born in the U.S. rose by only 5.5 years — a lower rate than in 21 other developed countries. Women didn’t fare much better, gaining six years in life expectancy since the 1950s, while women from nine other high-income countries gained eight years. — What did the National Research Council say was behind the gap? Smoking, primarily. Even though only about 21 percent of U.S. adults smoke these days, reports Katherine Hobson in The Wall Street Journal, that number was closer to 37 percent back in 1980. “Smoking-related illnesses such as lung cancer can take decades to have an impact on mortality rates.” Men will likely see their average longevity increase in the next few years, as their “smoking habits are well past the peak,” says NPR. Women, however, “took longer to cut back, and the toll of smoking will be around longer.” — Are there other factors? Obesity also plays some part, but just how much is a “controversial” question, says The Boston Globe. The NRC estimates that obesity could “account for up to a third of the shortfall compared with other rich nations.” Lack of exercise is also a factor. Americans are “among the most sedentary people” in the developed world, says Nathan Seppa at Science News, “vying with Poland for the dubious status of topping that category.”
The picture is that we are falling behind other advanced countries in both health and longevity. These statistics are not static. A few years back the US was at or near the top of the list in most categories of health as well as longevity. I do not think we in the US are getting worse off; in fact we have been improving. However, much of the rest of the world is moving a lot faster. We are falling further and further behind the leaders. Even some countries we have thought of as “third world” are catching up with and surpassing us when it comes to health and longevity. I note that the same trends apply to a number of other specific public health measures as well as levels and effectiveness of education, investment in public infrastructure and general quality of life.
The report described above and most of the press articles blame our relatively poor longevity performance on smoking, a sedentary lifestyle, a non-universal medical system and poor nutrition. I agree these are the important proximate causes. However, I believe understanding what is really going on requires looking deeper. Our society is subject to underlying operating conditions having to do with the cultural situation in the US, conditions rooted deeply in our mindsets and systems that will not go away easily. I comment editorially on some of these conditions here.
Though the US cultural picture is complex and multi-faceted, it contains strong remnants of a frontier culture, valuing individual initiatives and private solutions over public ones. While many cultural traditions such as in Europe and Japan value community initiatives to address shared problems, we have tended to value individualistic initiatives. Distrust of government-based public solutions runs deep in many of us. And initiatives of giant corporations, even ones bigger than many governments, are seen by many to be preferable to government initiatives. This value system can be seen very clearly as prevalent in a large sector of our political system. It also shows up in many dimensions that affect the public health and longevity pictures:
– Compared to European countries we have fewer and smaller public spaces and a transportation system which is automobile-based with much poorer public transportation options. This translates into many fewer opportunities or requirements for walking, less exercise, and poorer health in many dimensions(ref)(ref)(ref)(ref). There is less opportunity for exercise-related stress that lead to cardiovascular and other exercise-related health benefits and hormesis-derived longevity-enhancing effects.
– Powerful lobbying groups representing private economic interests keep our health care system fragmented, non-universal, and far less cost-effective than single-payer health care systems. So, many people who cannot afford expensive insurance or private health care do not get their basic health needs taken care of and die early. We are virtually the only advanced country that does not have universal health care.
– There is a general reluctance to invest in infrastructure, be that in education, public spaces, clean water systems or sanitary landfills. There is a preference for privatized solutions wherever possible – or no solutions at all.
– The media system, particularly TV, being commercial puts great emphasis on expensive proprietary drugs for treating diseases and relatively little emphasis on general health, good diet, lifestyle elements and dietary supplements.
– We do not know how effective dietary supplements are as compared to expensive drugs because nobody is willing to underwrite the expensive clinical trials required to find out. – There is a premium on as little regulation as possible and substantial delays in public health regulations when those regulations affect important industries and economic interests having important political lobbying power:
o High-taxation of tobacco products and effective regulation of tobacco use were delayed many decades after the public health issue and life-shortening effect of tobacco use were first identified. The article Tobacco Smoking and Longevity was published in 1938. And smoking is still largely condoned and second-hand smoke in the homes of tobacco smokers is still an issue.
o The coal industry and electric utilities that burn dirty high-sulphur coal have effectively lobbied for decades against clean air regulations. The result is a relatively high incidence of a variety of sometimes-fatal lung diseases, including lung cancer.
o Only in recent years has there been limited control of toxic pollution, and many rivers and lakes and tracks of land remain with high concentrations of toxic substances. Thousands of toxic waste sites remain not cleaned up threatening water supplies. Airborn mercury from burning coal and mercury in fish remain largely-unaddressed issues. The life-shortening effects of toxins are well documented.
o Even the practice of medicine has clearly unhealthy elements such as a drastic increase in CATscan diagnostic X-rays despite the known life-shortening effects of radiation. See my article Protection Against Radiation – The Second Line of Defense.
o Regulation of clearly-unhealthy foods, certain processed foods and junk foods, is now only getting started and may take decades before it is completely implemented. Again, poor diets translate into higher prevalence of diseases like diabetes and cardiovascular failure and the consequence is shorter average lifespans. See the previous blog entry Public health longevity developments – focus on foods.
Our political system is now deeply divided between those who seek greater government participation for the common good and those who seek less. At stake is whether we look to government for improving public spaces and our public transportation system, for improving our educational system, for deeper research in the life sciences, for implementing further health-promoting regulations and for a host of related matters. The alternative is to reduce government involvements in public health issues, continue to allow industries to regulate themselves and to look to private industries for our solutions. In my opinion, following this second course is likely to cause us to fall further and further behind the rest of the world with regard to the health and wellbeing of our citizens – eventually into third-world status.