Accidents, Murders, Preemies, Fat, and U.S. Life Expectancy

American health care to the rescue?

Ronald Bailey | June 17, 2008

Last week, the National Center for Health Statistics announced that the average life expectancy for Americans has risen to an all-time high of 78 years. In addition, record high life expectancy was recorded for both white males and black males (76 years and 70 years, respectively) as well as for white females and black females (81 years and 76.9 years). This is obviously good news. But a question nags—why are people in other countries living longer on average than Americans? After all, we are the country that spends the most money per capita on health care.

For example, according to the World Health Organization, average life expectancy in Japan is 83 years; Australia, 82; Switzerland, 82; Canada, 81; Sweden, 81; Spain, 81; Italy, 81; France, 81; Germany, 80; and the United Kingdom, 79. In all, there are 29 countries whose citizens have longer life expectancies than Americans.

So why do Americans die younger than people living in most other developed democracies? Well, there is the Michael Moore answer delivered in his "documentary" Sicko—it's because we lack a benevolent government funded health care system. But life expectancy is not dependent on just medical care. For example, Texas A&M health economist Robert Ohsfeldt and health economics consultant John Schneider point out that deaths from accidents and homicides in America are much higher than in any other of the developed countries. Taking accidental deaths and homicides between 1980 and 1999 into account, they calculate that instead of being at near the bottom of the list of developed countries, U.S. life expectancy would actually rank at the top.

However as Carl Bialik, the invaluable Wall Street Journal "Numbers Guy" columnist, notes Ohsfeldt and Schneider's analysis does not account for the fact a better health care system would have saved more accident victims and thus would have boosted life expectancy. In fact, in 2002, Harvard researchers argued that the U.S. murder rate is much lower than it would otherwise have been because so many assault victims are being saved by improved medical care. Nevertheless, Ohsfeldt and Schneider are likely right that U.S. life expectancy is being depressed by our higher accident and homicide rates.

America's relatively high infant mortality rate also lowers our life expectancy ranking. A 2007 study done by Baruch College economists June and David O"Neill sheds some light on why U.S. infant mortality rates are higher—more low weight births. In their study, U.S. infant mortality was 6.8 per 1,000 live births, and Canada's was 5.3. Low birth weight significantly increases an infant's chance of dying. Teen mothers are much more likely to bear low birth weight babies and teen motherhood is almost three times higher in the U.S. than it is in Canada. The authors calculate that if Canada had the same the distribution of low-weight births as the U.S., its infant mortality rate would rise above the U.S. rate of 6.8 per 1,000 live births to 7.06. On the other hand, if the U.S. had Canada's distribution of low-weight births, its infant mortality rate would fall to 5.4. In other words, the American health care system is much better than Canada's at saving low birth weight babies —we just have more babies who are likely to die before their first birthdays.

Life expectancy rates also depend on personal habits such as smoking, diet, and physical activity. Interestingly, U.S. smoking rates are lower (17 percent of adults) than for many developed countries with higher life expectancies. For instance, 30 percent of Japanese adults smoke daily. In France, 23 percent of adults smoke; Germany, 25 percent; Switzerland, 25 percent; Spain, 28 percent, and the U.K., 25 percent.

The fact that Americans tend to be a lot fatter than the citizens of other rich developed countries increases their risks of heart disease and diabetes. A recent international survey reported that 31 percent of Americans are obese (body mass index over 30), whereas only 23 percent of Britons, 21 percent of Australians and New Zealanders, 14 percent of Canadians, 13 percent of Germans, 9 percent of the French, and 3 percent of Japanese have body mass index measurements over 30.

Taking all these unhealthy proclivities into consideration, the American health care system is most likely not to blame for our lower life expectancies. Instead, American health care is rescuing enough of us from the consequences of our bad health habits to keep our ranking from being even lower.

Ronald Bailey is reason's science correspondent. His book Liberation Biology: The Scientific and Moral Case for the Biotech Revolution is now available from Prometheus Books.

Comments

Nigel Watt|6.17.08 @ 5:07PM|#

But Ron, the government is supposed to prevent people from being fat in order to stop them from needing that care!

|6.17.08 @ 5:19PM|#

In other words, the American health care system is much better than Canada's at saving low birth weight babies -we just have more babies who are likely to die before their first birthdays.

What would be interesting would be to see why we have so many more low birth weight babies compared to other countries.

This kind of ties in to this article I saw this morning in the Chicago Sun-Times. The articles was talking about how here in the US, the number of premature babies being born is on the rise significantly:

One in eight babies -- well over half a million a year -- are born premature, a toll that's risen steadily for two decades with no sign of stopping. Of the 4 million babies born annually in the United States, almost 13 percent are premature, said Dr. Jonathan Muraskas, co-medical director of the neonatal intensive care unit at Loyola University Hospital.

The government this week begins an unprecedented push to figure out why, with special aim at a category of preterm births that may be lowered: so-called late preemies, those born weeks, not months, early.

So far though I haven't seen any good answers as to why this trend is occurring.

|6.17.08 @ 5:25PM|#

From what I read, the trend is based at least partially on 2 things:
1) The U.S. attempting to save (and thus count ast live births) babies born VERY prematurely. 22-25 weeks or so gestation. Apparently in many countries those aren't counted.

2) Our deliver model is based on OBGYN/hospital births which often include early (38-40 week) inductions and scheduled C-sections (which happen before the due date). In other countries there is more of a midwifery model of care -->less interventions.

Lifestyle choices and teen pregnancy probably result in a lot of issues as well.

|6.17.08 @ 5:25PM|#

The fact that Americans tend to be a lot fatter than the citizens of other rich developed countries increases their risks of heart disease and diabetes. A recent international survey reported that 31 percent of Americans are obese (body mass index over 30), whereas only 23 percent of Britons, 21 percent of Australians and New Zealanders, 14 percent of Canadians, 13 percent of Germans, 9 percent of the French, and 3 percent of Japanese have body mass index measurements over 30.

Ding! Ding! Ding! No offense to Ron Bailey (I happen to be a fan), but this whole article could have centered on this one issue and that would have been enough to explain the shorter life-span in the US.

|6.17.08 @ 5:25PM|#

DELIVERY...I swear I can read and spell.

|6.17.08 @ 5:28PM|#

So far though I haven't seen any good answers as to why this trend is occurring.

Easy.

Over the last three decades, women have been waiting longer to become moms. In 1970, the average age for a first-time mother was about 21. In 2005, the average age of first-time moms was 25.2 years.

Sam Grove|6.17.08 @ 5:38PM|#

I wonder if Vitamin D insufficiency plays a role?

http://www.mercurynews.com/ci_9537876?IADID=Search-www.mercurynews.com-www.mercurynews.com

http://www.uvadvantage.org/portals/0/pres/
(presentation doesn't play properly in Firefox)

Sam Grove|6.17.08 @ 5:40PM|#

Link 1

link 2

|6.17.08 @ 5:46PM|#

How about iatrogenic deaths?

Brian Defferding|6.17.08 @ 5:47PM|#

Here in Wisconsin, we'll never give up our prominent beer guts, statistics be damned!

economist|6.17.08 @ 5:48PM|#

Yeah, bitches, htis jsut proovs thar American health care = greatest health care in the world and anyone who quesrions it is afucking dipshit.
I'm going to go jack off now.

|6.17.08 @ 6:27PM|#

So once that DARPA urban challenge pans out and the tech enters the marketplace we're all good then. I want my self-driving car now! Then we could do away with all those ugly road signs, stop lights, etc. No more speed traps. No more traffic light cameras with illegally short yellows. And now on top of all that, the longest life expectancies in the world. Mmmm... Utopian.

Jim Hacker|6.17.08 @ 6:36PM|#

ChicagoTom,

I can think of three reasons. None are well researched, so don't quote me, but I think some of these may be at least partially valid.

First, babies that die within 48 hours (sometimes up to a couple of weeks) are often not counted as 'viable' in some countries (not sure about the US). But the US often goes to much greater lengths to support premature babies. We may have some issues of classification, then, where we classify some births as premature that would have been classified as miscarriages or stillbirths in other circumstanes. Indeed, this may actually mean that we have some extra survivals that wouldn't have happened elsewhere.

2 - As mentioned above, we have more teen pregnancies than elsewhere. Teens are likely to give premature birth or have other complications.

3 - Women waiting until their 30s to have children. Someone mentioned above that American women are having children much later than we used to. This also leads to birth complications.

bonus 4th possible factor - fertility treatments. In vitro fertilization and other fertility treatments produce high numbers of twins, triplets or more babies. The more cohabitation in the womb, the greater the chance of premature birth. Each of those cases of octuplets from a couple years back added 8 premature births to the record.

lunchstealer|6.17.08 @ 6:37PM|#

God damn it, I've got to stop doing those 'funny Yes Minister' posts, because I keep forgetting to uncheck 'remember me' and start peppering the forum with random posts from Sir Humphrey, Bernard Wooley, and Jim Hacker.

Chad|6.17.08 @ 6:56PM|#

Jim Hacker | June 17, 2008, 6:36pm | #

ChicagoTom,

I can think of three reasons. None are well researched, so don't quote me, but I think some of these may be at least partially valid.

I did see some research data once concerning your first issue: the differing definitions of "viable" between different nations. Indeed, it could account for a large fraction of the difference between infant mortality rates. I wish I could find it. I remember in particular how it showed that France had a MUCH lower death rate during the first day of life...and then essentially the same death rate from days 2 to 365.


Long story short: There are far too many uncontrolled variables that affect lifespan to even begin to expect to see a correlation between it and the quality of your health care. Exercise, smoking, and eating habits easily dwarf the health-care affect, once the basics are provided.

|6.17.08 @ 7:32PM|#

Chad-

What about the correlation between iatrogenic death and life span? Have you ever read Death by Medicine?

e|6.17.08 @ 7:57PM|#

Ronald Bailey is right. Tens of millions of Americans are uninsured and thus have no contact with our health care system in the first place, other than at the emergency room. Thus, our lower life expectancy can hardly have anything to do with our health care system.

|6.17.08 @ 8:12PM|#

No, Bailey can't be right if he fails to account for the correlation between iatrogenic death and life span. In fact. how can one argue that homicides skewer life expectancy and not account for death by medicine?

Bottom line: Our health care system is another one of those myths of american exceptionalism. Let's face it, it sucks if one is appraising the thing from an absolute standpoint and if one expects, as a smart consumer should, a committment to excellence from those who provide any service.

What the sicko crowd has wrong is that the primary reason why our health care system stinks is because it is already socialist, not becasue it is not.

economist|6.17.08 @ 8:52PM|#

Okay, who made a fake post under my name? This is really starting to piss me off.

Chad|6.17.08 @ 10:02PM|#

liberty mike | June 17, 2008, 7:32pm | #

What about the correlation between iatrogenic death and life span? Have you ever read Death by Medicine?

I find the hubbub about iatrogenic issues quite overblown. Going to the hospital, like any endeavor, is full of ups and downs...ten steps forward, one step back. The bizarre expectation that everything should or could be perfect every time puzzles me. It isn't that way in any aspect of our lives.

Should we study where mistakes are being made and find ways to reduce them? Sure. But should we be surprised that they are there, or think that they aren't just as common everywhere else. Nope.

|6.17.08 @ 11:08PM|#

What about the correlation between iatrogenic death and life span?

Its potentially a factor, but it would only drive American life expectancy down if American healthcare were worse than other countries.

Most iatrogenic deaths, if I recall, happen in hospitals. I find it very difficult to believe you are more likely to catch a serious medical error or infection in an American hospital than a hospital anywhere else.

miche|6.18.08 @ 12:04AM|#

When claiming teen pregnancy as a factor for low birth weight, one should mention that it's teen mothers under the age of 15 most affected.

I only mention it because I was a teen mother with larger than average size female babies. My daughter (20) is also considered a teen mother (children are 15 months and 6 weeks) and her babies were born larger than average even though both deliveries were planned pre due date c-sections.

I know that my experience isn't hard evidence, but I'm one of those people who think that women should have children when our bodies are young and best prepared for it. It's my opinion that time is before 25 years of age and given that every girlfriend I have is doing it with the help of a doc and petri dish, my opinion seems right to me.

|6.18.08 @ 9:15AM|#

I'm one of those late mammas, having had my first child just 18 days before my 30th birthday. My second will be born in the middle of my 32nd year. About half of my friends started in their early 20s, the other half are only now beginning to try, or aren't even in a relationship yet.

Those of us with careers and the independent streak are the ones who waited.

I've seen no preponderance of troubles in either category, although I will say that it's been shockingly easy for me to get pregnant :)

I think Kimberly was on the right track with her 5:25pm comment. Planned, elective c-sections and generally medical births are the norm here, but nowhere else. If such medical births were limited to pregnancies of greater-than-normal risk, and if normal pregnancies were handled by midwives, we'd have far fewer issues of premature infants.

And yes, I think the prevalence of fertility treatments are also contributing.

|6.18.08 @ 9:17AM|#

and miche, I didn't mean that 'career... independent streak' comment to characterize anyone but the girls I grew up with

just so we're clear

I realized after reading that comment that it sounded kind of... bitchy O_o

|6.18.08 @ 9:21AM|#

The authors calculate that if Canada had the same the distribution of low-weight births as the U.S., its infant mortality rate would rise above the U.S. rate of 6.8 per 1,000 live births to 7.06.

Just to play devil's advocate, since I don't have any evidence either way, what about the argument that Canada and elsewhere have fewer low-weight births because their health care system leads to better pre-natal care, thereby catching problems earlier and keeping small things from becomming big ones? There are, after all, a lot of conditions that are small when caught early but life-threatening if left untreated too long.

miche|6.18.08 @ 9:47AM|#

Bronwyn,
Thanks for the second comment but I found nothing bitchy about the first. I think it's pretty independent to leave your parents' home early to swim upstream on your own dime. I also think it's independent to get out there, build a career and roar a little before marriage and motherhood. In the end though, most of us end up with a burning desire to parent and end up in pretty similar places- you know, depending on husbands to cover the bills while Mom stays home to parent and schedule playdates. (One day I'll tell you about all the Stanford, NYU and Yale trained docs I know that had babies and never stepped foot into a medical setting again.)

miche|6.18.08 @ 9:52AM|#

Shit it's my turn to clarify to a mostly male board that I don't mean to imply Dads don't parent too. I just mean that it's not uncommon for the most very career driven women to want to stay home with their children for a length of time.

|6.18.08 @ 10:54AM|#

I caught a show on Alabama public tv a few weeks ago about low birth weight/ preemies born to black women. Their conclusion was that stress in the mother was the largest contributor. This would fit perfectly with Miche's comments. There is a ton of presure on women now to have the educated career and also pop out some young ones and raise them well.

|6.18.08 @ 3:18PM|#

Add to that, brotherben, that we "professional" women are expected to work right up to the moment our water breaks and get right back to work 6 weeks later.

There's the dual pressure, no matter what. If you stay at home, then you're seen as lacking in intellectual capacity, you're not driven, you're not contributing to society, blah blah blah. If you work, you're denying your femininity, abandoning your children to the hands of strangers, you're putting your own needs above those of your children...

Crap, a gal just can't win :-/

|6.19.08 @ 2:40PM|#

1. More multiple births occur in the USA due to racial make up and fertility treatments. Since multiple births are less health this is a factor.

Interestingly multiple births are more common among people of African descent and Americans of African descent have much higher infant mortality than Caucasian Americans . Hispanics on the other hand despite being much poorer have lower infant mortality than Caucasian Americans.

2. If you look at Rand health Insurance experiment and the work of Robin Hanson and Shannon Brownlee it becomes apparent that Americans long life span is not due to medical care.

According a recent study done by the Center for Disease Control although very obese people die younger than average, people who are merely fat live longer that thin people or average weight people. This might be why Americans live longer then other people once you remove accidents and homicides and adjust for infant mortality factors.

|6.19.08 @ 2:49PM|#

I think that liberty mike is on to something. The eight Americas showed that poor rural northern whites had a longer life span than average whites. Poor rural northern whites have less access to healthcare. There are many other statistics that point that way.

Brian|6.23.08 @ 2:00PM|#

One point not mentioned. If the United States had a lower population of people of African decent (who consistently rank lowest in life expectancy rates) the average life expectancy would likely rise and be on par if not higher than the rest of the developed world.