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

American health care to the rescue?


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.