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« California Pension Death Star Approaching | Main | How Americans Stack Up In Dying From Violence, War, Suicide, And Accidents »

Deaths From All Causes: The Short (But Not Necessarily Happy) Life Of Americans

Americans under fifty are paying the price. We don’t know exactly why. Even the panel of experts that authored the massive report, U.S. Health in International Perspective: Shorter Lives, Poorer Health, admits that it can’t entirely pinpoint the reasons. But we do know how Americans under fifty, particularly males, are paying the price: with their lives.

The US health disadvantage, as the report calls it, is more prevalent among “socioeconomically disadvantaged groups.” But even if you’re “white, insured, college-educated, or in upper-income groups” and live a healthy lifestyle, you’re less likely to make it to 50 than your counterparts in the other 16 wealthy “peer” countries of the study—Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, the UK, and the US. And if you do make it to 50, you’re going to get there in worse shape.

The report, based on mortality studies for the years through 2008, carves out three categories, “Deaths from Noncommunicable Diseases,” “Deaths from Communicable, Maternal, Perinatal, Nutritional Conditions,” and “Deaths from Injuries.” The latter, which I discussed in yesterday’s post, distinguished between deaths from “intentional injuries” and “unintentional injuries.” Grisly statistics. [Read.... How Americans Stack Up In Dying From Violence, War, Suicide, And Accidents].

“Deaths from Communicable, Maternal, Perinatal, Nutritional Conditions” is divided into dozens of categories and subcategories, and every country has its own nightmare. In Portugal for example, 7.4 people per 100,000 die of HIV/AIDS, more than double the rate of the country next in line, the US (3.4), and 246 times the rate of Japan (0.03).

Do the Japanese cover up their deaths from that scourge by declaring a different cause of death, such as pneumonia? Or is their reliance on condoms for birth control responsible for that immense success, at least in the hetero community? For example, in love hotels, and they’re everywhere, there is always a condom near the bed. One. If you need more, bring your own. One of thousands of tidbits I discovered in Japan—that all became the backdrop to an awesome story. And then a book. It started in France with a Japanese girl. Check it out on Amazon.... BIG LIKE: CASCADE INTO AN ODYSSEY.

Yet in Japan, 29.7 people per 100,000 die of respiratory infections, three times the rate in the US (9.7) and almost eight times the rate of Finland (3.9). On the other hand, in Japan, with its socialized healthcare system, the infant mortality rate is only 1.3 per 100,000. In the US, it’s 7.1. Over five times the Japanese rate. By far the worst in the group. But is it an endorsement of socialized healthcare? The second and third worst countries in infant mortality, Canada (5.9) and the UK (5.2), also have socialized healthcare. No easy answers.

Another conundrum: in deaths due to nutritional deficiencies, France is in the hot seat with 2.0 deaths per 100,000, twice the US rate (1.0), and way ahead of third place, Finland (0.14).

Overall, Finland has the lowest rate of “Deaths from Communicable, Maternal, Perinatal, Nutritional Conditions,” with 11.1 deaths per 100,000 people. On the other end of the spectrum: the US (33.7), the UK (36.1), Japan (40), and Portugal (45.5). So the chance of dying from these diseases in the US is three times higher than in Finland; but in Portugal, it’s four times higher.

Non-communicable diseases are the biggest killers. And easy answers remain elusive. For example, melanoma and other skin cancers kill 5.8 Australian per 100,000, the worst in the group. So we speculate about the ozone hole, the brutal sun, and people spending time on the beach. In Japan, the death rate is 0.47, by far the lowest in the group. So we speculate about people wearing gloves, hats, and protective garments every time they step outside. But then Norway has the second highest rate of deaths (4.7), followed by other northern countries, Sweden, Denmark, and the Netherlands. The US (2.8) is in the middle of the pack. And sunny Italy (2.0) and Spain (1.8) are outdone only by Japan.

Wedged between “Deaths from Neuropsychiatric Conditions,” such as unipolar depressive disorders, bipolar disorder, schizophrenia, and epilepsy are deaths from “Alcohol Use Disorders.” Danes succumb to it at a rate of 9.9 per 100,000—not including accidents. Next the French (4.0), the Germans (3.9), and the Austrians (3.9). For the latter two, the culprit may be per-capita beer consumption [Beer, A Reflection Of The World Economy?]. The US (1.6) is in the middle of the pack. At the bottom: Spain (0.38), Italy (0.25), and Japan (0.16).

In another conundrum, Alzheimer and other dementias kill Finns at the highest rate (34.9) followed by Americans (24.8)—both countries with relatively low life expectancies. At the bottom, Germans (5.9), Austrians (4.4), and the people who live longer than just about anyone else, the Japanese (2.5).

Cardiovascular diseases are a scourge in all wealthy countries, led by Germany (174.9), Finland (163.6), and the US (155.7). Least affected: Mediterranean countries Spain (115.7) and France (99.2), and finally Japan (97.3).

But there are some areas where Americans are lucky. Stomach cancer, for example, kills 2.76 Americans per 100,000, but six times more Japanese (16.8); and liver cancer kills 3.9 Americans per 100,000, as compared to 11.1 Japanese, almost three times more. Overall, non-communicable diseases kill Danes at a rate of 440 per 100,000, Americans at a rate of 418, and Japanese, the healthiest in that respect, at a rate of 272.

So, life expectancy for Americans is ugly:

“Something fundamental is going wrong,” lamented Dr. Steven Woolf, who chaired the panel. “This is not the product of a particular administration or political party. Something at the core is causing the U.S. to slip behind these other high-income countries. And it’s getting worse.”

The panel tried to nail down the culprits: a health-care system that leaves millions of people uninsured, the highest rate of poverty, education, eating habits, socioeconomic and behavioral differences, cities built for cars not pedestrians.... But it determined that these reasons cannot adequately explain the differences—because even wealthy, educated, insured whites with healthy lifestyles are getting the short end of the stick. 

And worse: high infant mortality, traffic accidents, violence, HIV and AIDS, and alcohol-related mortality hit younger age groups the hardest—leaving them with a lower probability of surviving to age 50 than their peers in wealthy countries. And the lucky ones who do reach 50 get there “in poorer health than their counterparts.”

All this despite the costliest of all healthcare systems that eats up 18% of GDP. But now anecdotal evidence is coagulating into numbers that weigh down corporate earnings calls. It appears the wily consumer is having second thoughts about prescription drugs. And is fighting back. A paradigm shift that is causing “unprecedented concerns” in the industry. Read.... The Consumer Revolts Against Prescription Drugs.

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Reader Comments (7)

Perhaps the drugged up lifestyle of Americans is the main reason?
4% of the worlds population using 40% of the world's prescription drugs?
$70+ billion in 'recreational' drugs used annually in the Us, not counting alcohol and tobacco?
The 'bar on every corner and beer at the games' mentality?
The fact that there are almost as many cars as people?
That Americans over-eat and have terrible diets? ( I worked with a young late 20s man a few years ago who was diagnosed with cancer of the stomach and intestines. He used to eat sausage sandwiches at break every day, fast food and other greasy foods all the time, hated veggies and fruits. Died a few years later after many thousands of dollars in treatments and operations.)
That they don't exercise?
That most live in stress all the time?
That most live in big city smog and pollution?
The list of why's is endless in the Us and getting worse. Now they drug school kids to 'calm' them. What next?
January 11, 2013 | Unregistered CommenterMakati1
Some other points:
1. The stats often suck and can often not really be compared. If you really want to compare things you need to have a good look at that.
2. Imho you should divide it into 2. Chance of getting it and success with curing it after you got it.
3. Re the first are simply in general mainly unhealthy lifestyle choices. Eliminate those (the unhealthy lifestyle choices you will end up with other factors: other climate; other race (genetic-stuff). Depending on the illness one time the former will be the most important one time the latter and often it is a mix. But still overall imho mainly unhealthy lifestyle choices.
Which would not really be a problem if people would acept the consequences of their choices. With healthcare however they do generally not. Uninsured but not able to pay for it as the new carloan has to be repaid but when something happens effectively demanding that someone else picks up the bill for treatment. In a way it is more socialised than in Europe this way. When young not wanting to pay high premiums (to pay for the elderly) but when old not able to pay premiums and demand it comes from the general purse.
For the US in general you donot have to be a rocketscientist too see that the general lifestyle is not very healthy compared to most other countries. I donot have problems with that as long as people accept the consequences of their lifestyle-choices. And it is unlikely genetics when I was young and that is not that long ago obesity was not even helf of it from what it is now and genetic material doesnot change that quickly. Compare children with their parents at the same age say 30 year ago.
People in the US however donot accept most of their lifestylechoices. In setting up a system you simply have to take that into consideration other wise it will not work.
4. Curing. A lot can be learned from 'best practices' and isnot done yet. And countries with a for Westeners difficult language like Japan, Korea, S'Pore are often completely ignored, while they will be often the most interesting. Also costwise btw, the US in general has more expensive cures than a lot of other countries (while the cures are not more successful).
5. The way in the US healthcare is organised (or may be better disorganised in this respect), makes a national healthpolicies very difficult.
Problems largely occur at the bottompart of society. That part is simply larger in the US and probably more bottom and these people often ruin the stats.
6. The problem with the high healthcare costs is imho mainly that a large part of it has to come from the public purse. If people want to pay themselves 18% of their income it is not so much of a problem. It starts to get a problem when paying is done partly via taxes (as it is difficult to make the link between the two and often not everybody pays the same). And get even worse further up. Massive numbers hardly contributing anything, the poor using dollarwise more healthcare than the richer (and considerably); uneven contributions; ot the richer paying de facto massive amounts (and using a parallel network for which they have to pay again). This causes al sorts of social and as a consequence thereof economic friction. Basically the more you socialise the bigger the friction will get. especially as the US is now in a stage that simply middle incomes have to be taxed heavily as that is the only way to generate enough revenue to pay for all the stuff. There are not enough really rich and anyway these have their advisors and are not location fixed, like we see everywhere in the world. real high taxes for the rich or for companies and there is a massive exodus.
January 12, 2013 | Unregistered CommenterRik
Once again, this is an issue boils down to money and class. The haves and have-nots.
This is why I oppose raising the Social Security eligibility age from 65 to 67 or to 70.
Yes, overall life expectancy has risen and overall we should live longer because of advances in medicine and tougher pollution laws. But when you break it down by class, race, socio-economic conditions, those on the lower end of the scale aren't living any longer. They are more prone to having to work longer hours and live with pollution, a poor diet, untreated depression, etc. Sure there are exceptions. Some people do pull themselves out of poverty and make it to an upper class, with a lot of breaks along the way. But those odds are long for most of us.
The wealthier end of the spectrum gets to live in the healthiest places, avoid physically hard work and is able to afford the best health care possible. Consequently, they live longer and pull up the life expectancy rate for everybody.
If we must tamper with the S.S. retirement age, do it progressively -- like the income tax. Start by averaging a person's salary between ages 50 and 57, or from 55 to 62.
Then raise the retirement eligibility age from 65 for those who average between $100,000 and $250,000 to 72 years old. And raise it to 75 for those over $250,000. For those earning $50,000 to $100,000, keep it at 65. For those from $25,000 to $50,000, lower it to 62. Anyone under $25,000 is probably at poverty level, so lower the SS age to 57.
And finally, raise the cap at which SS is withdrawn from pay, from something like $106,000 to $250,000.
It's not punishing the wealthy. It's protecting everyone else from getting unfairly punished again and again.
The life of a person who has lost everything and is lying in the street is worth no less than someone who has everything, including a giant-sized ego of self-worth.
Better yet, leave SS alone and start putting the financial terrorists and complicit politicians in jail.
January 12, 2013 | Unregistered Commenterkimsarah
Comparing statistics of one country to another is a risky proposition. Cultural and linguistic differences can make comparisons meaningless. Some examples:
1.) Japan counts all newborns who die within 72 hours of birth as being stillborn. This does wonders for their infant mortality figures and greatly increases their average lifespan since all the near zero lifespan infants are just vanished into the stillborn category.
2.) In reference to stomach cancer, in the US Doctors differentiate between cancers of the stomach, esophagus and the duodenum. In some countries all these organs are considered to be part of the stomach. Thus China for instance has much higher rates of stomach cancer and zero rates for the other organs.
3.) Autopsies are rarely performed in many European countries. Since such diseases as coronary artery disease are often only apparent post mortem this means that the rates for those diseases are much higher than the reported numbers.
4.) The cultural bias against reporting some causes of death can be overwhelming. This is particularly true of suicide and alcoholism. The rate of alcohol related diseases is probably much higher in Italy than the reported rates, Doctors are subjected to enormous pressure to not report such diseases especially on death certificates. In Denmark it is considered almost unthinkable to even mention the WORD for cancer. Again Doctors are pressured to list some other cause of death. Many suicide are characterized as firearm accidents or "falls" just to spare the feeling of the survivors in any country.
January 12, 2013 | Unregistered CommenterKen
If you look at America's life expectancy over time you will see a slow and steady increase, so it's not as though we have suddenly started declining. The "decline" is only relative to other nations. American life expectancy is better than it has ever been.
January 13, 2013 | Unregistered CommenterBoJenry
Rick and Ken - I agree: most stats suck, more or less. Including the unemployment rate - and comparisons from country to country are silly. But we do it anyway because stats are the only thing we got. Outcomes are always dubious and leave more questions than they provide answers. Nevertheless, we're stuck with stats. And so there is the hope that we can glean something useful from them.
January 13, 2013 | Registered CommenterWolf Richter
"Do the Japanese cover up their deaths from that scourge by declaring a different cause of death, such as pneumonia?"

Yes, they do. As a result of the socail stigma attached to AIDS, doctors put a different cause of death down. (The same goes for a heart attack rather than "fukujoshi")

When I taught in Japan and had a doctor for a student we talked about this and he informed me it was a common occurance.
January 14, 2013 | Unregistered CommenterLee

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