September 27, 2009
US Life Expectancy Lags Due To Cigarettes

In political debates over health care the fact that the United States lags many other industrialized countries in average life expectancy is sometimes blamed on how health care is funded in the US. But John Tierney of the New York Times reports that once the lifestyles of Americans are adjusted for America's health care system comes out looking pretty good in terms of its effects on longevity.

But a prominent researcher, Samuel H. Preston, has taken a closer look at the growing body of international data, and he finds no evidence that America’s health care system is to blame for the longevity gap between it and other industrialized countries. In fact, he concludes, the American system in many ways provides superior treatment even when uninsured Americans are included in the analysis.

So why does America lag in life expectancy? Past heavy usage of the demon tobacco.

For four decades, until the mid-1980s, per-capita cigarette consumption was higher in the United States (particularly among women) than anywhere else in the developed world. Dr. Preston and other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries.

I see this report as both good news and bad news. First off, Europe is now substantially lagging the United States in turning away from the demon weed. So the good news for Americans is that in future years the US life expectancy should improve faster than in some of the bigger smoking European countries like Greece, Estonia, Slovakia, Germany, and Hungary. The bad news? We do not have a big potential for longer average life expectancy via changes in funding of health care. We need to eat better food, get more exercise, and make other lifestyle changes. If you still smoke you are accelerating your aging process by about 10 years. So stop doing that!

What's going to matter most for life expectancy in the long run: The rate of advance of biomedical science and the rate of development of new drugs and other treatments. What worries me: The current debate about medical care delivery is focused on short term goals and the effects of proposed policies on long term incentives get short shrift. Yet for the vast majority of us our potentially fatal diseases lie years or decades in the future.

Also see Tierney's posts Is U.S. Health Care System Not the Culprit? and Debating the Longevity Gap for more background on this research and the larger debate on this issue.

Share |      Randall Parker, 2009 September 27 11:49 PM  Aging Studies


Comments
odograph said at September 28, 2009 12:09 AM:

"if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries"

Is that a high enough standard? The "top half of the longevity rankings for developed countries?" Shouldn't we shoot for (pardon Men in Black) "The Best of the Best?"

The cigarette thing is interesting but I worry that the "top half" wording implies spin.

Randall Parker said at September 28, 2009 12:43 AM:

odograph,

We also have above average obesity. We aren't going to get to the top without drugs that suppress appetite. Though the European countries are becoming more obese as well.

Brett Bellmore said at September 28, 2009 3:42 AM:

I try telling people that at liberal blogs, when they're debating health care. They just don't care. They want the government to take over health care, and view the awfulness of our health care as a useful talking point. It being not true doesn't make it appreciably less useful.

Maybe they figure once they've taken over health care, they'll make us all diet and abandon any vices, at gun point.

odograph said at September 28, 2009 4:49 AM:

As a solid moderate I'll call BS on Brett's takedown of "the liberals."

It's about the people who don't get health care, period. "The (arch) conservatives" will quickly conjure an image of those people, as the undeserving poor, the people who won't get out and work ... but when you ask "what about their kids?" ... you get a mumble. You get a mumble that is, before they go back to sound-bites.

Sometimes I talk about the guy I know who got his pacemaker when he was 17. Maybe I've mentioned that here. "The (arch) conservatives" will say that his parents should have had insurance. Of course they should, and they did, but it could have gone the other way. Then later, you've got a guy that graduates college and goes to get his first individual insurance with a preexisting condition of a pacemaker. Sucks to be him, right? Again a mumble.

Randall,

The nice thing about body-weight is that you can normalize for it, and then see how you come out wrt "the best of the best." How does a normal BMI person do here versus elsewhere?

BTW, until you get the pill, you could try discouraging driving.

Black Death said at September 28, 2009 5:55 AM:

"But a prominent researcher, Samuel H. Preston, has taken a closer look at the growing body of international data, and he finds no evidence that America’s health care system is to blame for the longevity gap between it and other industrialized countries. In fact, he concludes, the American system in many ways provides superior treatment even when uninsured Americans are included in the analysis."

I think Preston is right. Death rates for prostate and breast cancer have been dropping much faster in the US than in most other developed countries. Factors that impair US longevity include:

* Past heavy tobacco usage (the cardiovascular and oncogenic effects of tobacco persist long after cessation, even though at levels far below those how continue to indulge).
* Obesity is more common in the US than in most other countries (why do we continue to subsidize food production when the principal nutritional problem among the poor is obesity?).
* More NAM's in the US than in, say Europe (NAM's have across-the-board reduced longevity compared to Caucasians and Asians).

Anecdotally, this seems true. Obesity is much less apparent in Europe and almost unknown in the Orient compared to the US. Now I don't mean that you don't encounter chubby people - you certainly do. But the real land whales are almost exclusively an American phenomenon. I remember talking to a German physician about weight reduction surgery, which is increasingly common in the US - he said he'd never heard of such a thing. In the case of smoking, however, the situation is completely reversed. In almost every country you visit outside the US, smoking seems more common. Non-smoking areas are just now appearing in European restaurants, and I've rarely encountered one that's totally non-smoking (except in Ireland). European trains all have smoking cars, while Amtrak is totally non-smoking. Further, non-smoking regulations are routinely ignored in Europe and tend to be strictly enforced in the US.

mike said at September 28, 2009 2:41 PM:

"The (arch) conservatives will quickly conjure an image of those people, as the undeserving poor, the people who won't get out and work ... but when you ask "what about their kids?" ... you get a mumble. You get a mumble that is, before they go back to sound-bites."

Derrr.... Medicaid?

odograph said at September 28, 2009 4:15 PM:

Well Mike, it has always been a puzzle to me that there can be Medicaid, and some millions uninsured. Wikipedia's answer is:

Poverty alone does not necessarily qualify an individual for Medicaid.[2] It is estimated that approximately 60 percent of poor Americans are not covered by Medicaid.[3]

To tell another tale of how our system "works:" I have Kaiser. I pay my insurance. The thing is, the California courts have ruled that Kaiser must treat indigents when they show up at emergency rooms, regardless of whether public funding can be found. So my "insurance" becomes someone else's "health care." If Medicaid worked, that wouldn't happen either.

John Moore said at September 28, 2009 10:40 PM:
Well Mike, it has always been a puzzle to me that there can be Medicaid, and some millions uninsured.

Can you say "pre-existing conditions?" It's part of the problem. Get the wrong problem and you can not buy insurance at any price in many states, and only really lousy insurance in others.

Billy Oblivion said at September 29, 2009 6:52 AM:

@Odograph:

It's not "indigents", it's *anyone* who shows up w/out insurance. This means that you could be solidly in the middle class and not have insurance because you "don't get sick" and then get hit by an illegal immigrant driving without a license (and without insurance). Medicaid was never designed for this sort of thing.

If you ARE indigent most hospitals will work to get you signed up on Medicaid as most indigent people are eligble.

@John Moore:

The vast majority of those millions do NOT have "pre-existing" conditions sufficient to prevent them from getting health insurance. There are many pre-existing conditions (hypothyroid as an example) which does not prevent one from getting health insurance.

The biggest single chunk of those "millions" are people in their twenties who just feel the don't need insurance because they won't get sick. Many on the left want to require *everyone* to get some sort of insurance in order to take money from those kids and give it (in the form of health care or health insurance subsidies) to Baby Boomers and "Greatest Generation" types. This is the same sort of fraud as that Ponzi scheme known as "Social Secuity" in that it assumes that you will always have a sufficient pool of healthy young to support the old folks. Of course it's the old folks *right* to completely screw the young out of their future by taking 12% of their income in Social Secuity withholdings plus medicaid, plus the additional tax of paying for far more insurance than they need you GUARANTEE that they will not be able to save sufficiently for THEIR retirement.

And of course you're going to need to keep pushing that retirement age up higher and higher as time goes on further screwing the young today because you're making them pay for people who get to live on the largess of others for longer than those kids will.

I have some sympathy for those who have serious pre-existing conditions, and you CAN build a regulatory and insurance regime that can deal with those issues, but you have to approach it from the perspective of building a more-or-less open market answer, not from the perspective, as the current crop of progressives on both sides of the aisle, that the Government should control everything it cannot outright own.

The Government does very, very little well. The current medicare system, the current DoD, the current FDA, the current whatever is RIFE with fraud, waste, and abuse, and as long as no one looks to hard our dear leaders just keep "whistling past the graveyard".

eleccig said at September 29, 2009 2:58 PM:

I recomend people to swhich from tobacoo smoking into Vaping electronic cigarettes, no need to create any sort of combustion which it ultimately creates smoke and is very harmful with over 4000 chemical compounds created by burning a cigarette with various toxins and carcinagins that is cancer causing. compared to an electronic cigarette which has no tobacco that has 0 carginagines or harmful toxins, it’s 99% water and 1-3 persent nicotin which can be addicting but not harmful. please make the right choice for yourself and for others be safe! www.greensmoke.com/smokeout.

Jeff said at September 29, 2009 5:55 PM:

Smoking as the culprit is illogical.

I don't know where I heard it, but I was told once that the US life expectancy is lower because of how we calculate births.

I can't remember the details, but it was something like we count a premature baby as viable whereas socialized medicine countries do not.

This was supposed to be based on our optimistic sense that we can save them, where they know there is little hope.

Can anyone confirm this difference in methodology?

Changes in live births will change the life expectancy far more dramatically than a few months difference at death: a 0.1 year old child that dies brings down the life expectancy by 70-80 years for that data point. A premature death at age 75 only 5-10 years. Bad, but less depressing.

Generally I have the impression that our data is more aggressive at describing the full picture where theirs is more artificial by focusing on hiding its failings.

Comments?

Jeff said at September 29, 2009 6:19 PM:

This (http://mathworld.wolfram.com/LifeExpectancy.html) would suggest that an important factor in calculating life expectancy is the starting point. What is l(x)? This is the number that starts the series.

If your country started l(x) with births at full term that would adjust the results.

This webpage (http://www.who.int/whosis/indicators/2007HALE0/en) points out that the WHO relies on mortality data reported from countries.

May be the theory I mentioned has merit?

CJS said at September 29, 2009 10:44 PM:

This article has some good and relevant info, too.

http://www.nytimes.com/2009/09/22/science/22tier.html?_r=1&hpw

CJS said at September 29, 2009 10:51 PM:

Um, all I can offer for the reason I re-linked the original article is that I'm really tired.

However, it makes a lot of sense that lifestyle differences and differences in the calculations on infant mortality rates affect the overall longevity rates.

Jeff said at September 30, 2009 11:05 AM:

My next question is based on personal observation. When I lived in France as a youth, there was less commuting and more walking and better diet.

In the US, we forty-somethings get a gut then decide to lose weight and start behaving. Being in a car to commute and not walk does not immediately lead to weight gain. Family obligations and poor time management lead to weight gain as the natural metabolism slows but eating habits remain unchanged.

In my household we are starting to eat better and weight loss is following for my wife and me. We are not unusual.

We don't smoke.

I think this assessment is way off.

More exercise from natural commuting in denser cities and better diet tend to reflect in lower heart attack rates. If you look at Parisians in town versus suburban Parisians (not the poor immigrant communities, but similar socio-economic groups in different metro planning styles) I would believe the suburbanites have more in common with Americans than those in town.

marcdunord said at October 10, 2009 2:46 AM:

some basic considerations about stats (averages) will help here:

there are more smokers in europe.

but their health stats seem to be similar to those of european non-smokers, since

crass differences between europe and the usa –in europe’s favor– disappear when you remove smokers from the comparison.

this means that usa smokers fare horribly compared to european smokers (or, much less likely, that european smokers have much better health stats than european non-smokers).

it’s almost sure that usa smokers fare much much worse than european ones, simply because smoking is a lower-class thing in the usa.

so among usa smokers there must also be many more diabetics, drug addicts, alcoholics, reckless drivers, wife beaters, hypertension acrobats, overweighters, etc, i.e., people who do all those things that make "life worth living"TM.

in other words, the usa’s "melting pot"TM not only segregates by race and class, but also by morbidity, three things that because of "manifest destiny"TM tend to coincide!

the country indeed gives the poor and the lower middle class the "freedoom to choose"TM to be diabetics, drug addicts, alcoholics, reckless drivers, wife beaters, hypertension acrobats, or overweighters, etc, a very diverse "plethora of opportunities"TM to choose from, opportunities that these less deserving classes like to take as a combo more often than not.

obviously europeans are not enjoying these basic freedoms as freely –oh freedom! as aretha would put it– (although europeans have been catching up thanks to the recent efforts for "labor flexibility", "private pensions", by some of their most illuminated –if venal– leaders and intellectuals).

so the innocuous exclusion of smokers "for comparison fairness" by the authors removed many of the most self-destructive poor and under-insured people from the usa data and left more affluent, better educated, more health-conscious upper-class usa people to be compared with a more random segment of the european population. not exactly fair, one would say.

one has to wonder though if the authors did not know about this in advance and, if they did not, why on earth they chose not to dissect the above superior health of european smokers that the effect of the smokers' exclusion made evident.

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