Recently a report – U.S. Health in International Perspective: Shorter Lives, Poorer Health — looked at factors that contribute to poor health and lower life expectancy in the United States as compared to similar industrialized nations. I already mentioned the role that violence plays in reducing American males’ life expectancy, but an even bigger culprit may be American culture.
The Associated Press quoted Dr. Steven H. Woolf, who chaired the panel that produced the report as saying,
We have a culture in our country that, among many Americans, cherishes personal autonomy and wants to limit intrusion of government and other entities on our personal lives and also wants to encourage free enterprise and the success of business and industry. Some of those forces may act against the ability to achieve optimal health outcomes.
It is interesting to look at how, for example, the United States and Great Britain have each chosen to deal with a specific method of suicide — overdosing on acetaminophen. According to a study in the British Medical Journal,
In the United States paracetamol [acetaminophen] is associated with more than 100,000 calls a year to poison control centres, as well as 56,000 visits to emergency departments, 26,000 hospitalisations, and 450 deaths.
The United Kingdom has a similar problem with acetaminophen overdoses and deaths, so in 1998 it passed restrictions on the sale of acetaminophen. In the Uk,acetaminophen can only be purchased in packages of 32 tablets in pharmacies and is limited to just 16-tablet packages when sold elsewhere. Moreover, the tablets must be individually blister packed to increase the time and effort required to gain access to a large number of pills.
Meanwhile, here in the United States I can walk down to the neighborhood Walgreens and for $12 pick up a 500 count bottle of 500mg acetaminophen.
Not only is the idea of restricting access to acetaminophen not even on the table in the United States, but even the suggestion of such restrictions would likely be met with derision as limiting personal autonomy unnecessarily.
We know that those of us living in the United States have shorter life expectancy than those living in similar industrialized countries, such as in Europe. We also know that Americans are far more likely to be the victims of homicide than those who live in countries like ours, but how much does that increased risk of homicide impact life expectancy? How much longer would we be likely to live if we didn’t live in such a violent country?
The Associated Press looked at this question in its coverage of a recent report about health discrepancies between the United States and other industrialized nations. The report, U.S. Health in International Perspective: Shorter Lives, Poorer Health is available to read for free online.
First, lets look at just how big those life expectancy discrepancies are. The report looks at life expectancy of men and women in 17 similar countries in 2007. For women, the U.S. life expectancy rate in 2007 was 80.78 years. Japan led the world in life expectancy for women that year at 85.98 years. So U.S. women had a life expectancy 5.2 years lower than Japan.
For men, the U.S. life expectancy rate in 2007 was 75.64 years. Switzerland led the world in life expectancy for men in 2007 with an average of 79.33 years. So American men born in 2007 could expect to die 3.69 years sooner on average than men born in the same year in Switzerland.
The report estimates that homicide and suicide together account for up 25 percent of that disparity for U.S. men. So, compared to Switzerland, American men born in 2007 will on average die a little over 11 months earlier because of the combination of an extremely high homicide rate and relatively high suicide rate.
An interesting study was published in Health Affairs last year finding a fairly stark difference in life expectancy based on years of education (emphasis added).
In this article we update estimates of the impact of race and education on past and present life expectancy, examine trends in disparities from 1990 through 2008, and place observed disparities in the context of a rapidly aging society that is emerging at a time of optimism about the next revolution in longevity. We found that in 2008 US adult men and women with fewer than twelve years of education had life expectancies not much better than those of all adults in the 1950s and 1960s. When race and education are combined, the disparity is even more striking. In 2008 white US men and women with 16 years or more of schooling had life expectancies far greater than black Americans with fewer than 12 years of education—14.2 years more for white men than black men, and 10.3 years more for white women than black women. These gaps have widened over time and have led to at least two “Americas,” if not multiple others, in terms of life expectancy, demarcated by level of education and racial-group membership.
The actual study is behind a stupid paywall, but there doesn’t seem to be any consensus as to what is causing such a large gap. Part of it appears to be down to things like increased smoking rates among people with less education (especially white women) as well as more obvious things like higher levels of education begin correlated with better access to health care.
In February the United Nations Population Division released the 2004 revisions to its World Population Prospects publication, projecting how much further world population is likely to grow.
Under the UN’s medium variant scenario, world population will reach 9.1 billion in 2050. This represents a slight upward revision from more recent estimates that had world population reaching just 8.9 billion in 2050.
Almost all of that growth will occur in the developing world. Ninety-five percent of all population growth today is occurring in the developing world compared to just 5 percent in the developed world according to the UN Population Division. Of that estimated 9.1 billion, only slightly over 1.2 billion will live in countries that are currently designated as developed — about what the population of the developed world is today.
The medium variant assumes that the total fertility for women worldwide is going to drop from its current level of 2.6 to just slightly over 2 by 2050. If the worldwide TFR average were to only decline slightly to just over 2.5 — the high variant scenario — world population would reach 10.6 billion by 2050. If it were to decline faster, however, and fall to about 1.5 — the low variant — world population would reach just 7.6 billion in 2050.
Global life expectancy continues to rise. The Population Division reports that global life expectancy rose from an estimated 47 years in 1950-1955 to 65 years in 2000-2005. By 2045-50, global life expectancy is expected to rise to 75 years. In developed countries, where life expectancy averages 76 years today, it is expected to reach 82 years by 2045-50.
Those life expectancy projections assume that the developing world will be able to implement effective programs and policies to halt excess mortality due to HIV/AIDS. Whether or not this happens remains to be seen. As the Population Division reports, HIV/AIDS has taken a serious toll on life expectancy in some parts of Africa. In Southern Africa, for example, life expectancy fell from 62 years in 1990-1995 to just 48 years in 2000-2005, and is expected to drop even further to just 43 years over the next decade. The Population Division projects that 43 will represent a bottoming out of the crisis and that life expectancy in Southern Africa will then slowly begin to rise again.
One of the main effects of the worldwide decline in total fertility rates will be an aging of the population that is unprecedented in human history. According to the Population Division, the number of people over the age of 60 is expected to triple from an estimated 672 million in 2005 to a whopping 1.9 billion by 2050. There will also be a 4.5-fold increase in the number of people over the age of 80, from an estimated 86 million today to 394 million in 2050.
World Population Prospects: The 2004 Revision. (PDF) United Nations Population Division, February 2005.
The Centers for Disease Control reported this month that life expectancy in the United States reached a new high of 77.2 years.
For men, average life expectance is now at 74.4 years, and for women at 79.8 years. Broken down by race, the average life expectancy for whites is 77.7 years and for blacks 72.2 years.
Statistician Elizabeth Arias who was the lead author of the CDC’s study of life expectancy told the Atlanta Journal-Constitution that changes in behavior played a major role in increasing life expectancies,
For instance, the decline in smoking — from 50 percent of the population in the 1950s to about 25 percent now — has a lot to do with decreases in heart disease and cancer.
Life expectancy climbs to record high in America. M.A.J. McKenna, The Atlanta Journal-Constitution, March 15, 2003.
The basic debate over population is not one over facts but rather interpretation of facts. Nowhere is this more obvious than when the United Nations hold a conference on aging.
According to UN statistics, by 2050, there will be more than two billion people over the age of 60. For the first time in human history, there will be more people over 60 than there are under 15. That will represent an enormous social and cultural shift.
In 1950, the average life expectancy for the world was a mere 44 years. By 2050 it is expected to be 77 years.
But few people, especially in government, seem to take the time to stop and marvel at what an amazing feat increasing average life expectancy by almost more than 40 percent in a hundred years is.
Instead, of course, the stories in the BBC and elsewhere focus on what a problem this is going to be. Health care costs are rising, people in developing countries who suffer from diseases early in life have a much lower quality of life after they reach 60, etc.
Some days I suspect medical researchers could announce the discovery of a wonder drug that cures all disease and triples life expectancy and the United Nations would rush out a report within a month on the horrible challenges such an advance would impose on the nations of the world.
So let me say it for them — there are today more people alive who are living longer at a higher standard of living than at any time in human history. It is a great time to be alive.
Ageing ‘is an international problem’. The BBC, April 8,