Why we stink at longevity

Ben Southwood writes,

In fact in the US case it’s not even obesity, or indeed their greater pre-existing disease burden, that is doing most of the work in dragging their life expectancy down; it’s accidental and violent deaths. It is tragic that the US is so dangerous, but it’s not the fault of the healthcare system; indeed, it’s an extra burden that US healthcare spending must bear. Just simply normalising for violent and accidental death puts the USA right to the top of the life expectancy rankings.

Pointer from Tyler Cowen. That is what I have in mind when I claim that one of our cultural problems is that we spend too much on health care and not enough on public health. I would rather put money to work on efforts to reduce violent and accidental death than on futile care in the last year of life.

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12 Responses to Why we stink at longevity

  1. andrewknorr says:

    Wouldn’t violent death actually reduce lifetime health care costs? Anything that increases longevity would probably increase health care spending, and vice versa.

    • adam says:

      The author is saying that violent deaths are responsible for “dragging [US] life expectancy down.” There’s no claim about healthcare costs.

  2. Moo cow says:

    That would mean looking at the role of guns in all this. Not possible.

  3. Michael says:

    First, a lot of violent deaths are suicides, heavily facilitated by alcohol and guns, since most suicides are impulsive.

    Second, big gains in public health tend to happen early and inexpensively: clean water, vaccination, decent baseline education, safe food, policing, a dynamic economy, and so on. Wealthy countries are mostly past that. After that, you start getting into the long tail of many different behavioral and environmental margins, drowning in various pet theories and unproven ideas: green spaces, food deserts, mindfulness for toddlers, bike lanes, organic food. Good luck with those.

    We underestimate all the trade-offs that come with those fundamentals. If you said that the poorest Americans had, over the last few decades, seen their daily calorie intake increase you might say it was good. But obesity skews heavily towards the poor, whose general health behaviors are not good. A study in NBER last year found that 15% of the increase in obesity was attributed to smoking cessation, a largely middle-class behavior. On and on. I am not saying nothing can be done, and generally with Arnold, but there are few big ideas and big changes left, which makes making them happen a lot harder.

    Personally, I would say “stigmatize alcohol, pot, video games, and guns”. That has worked for the upper half of the income distribution, less so for the lower half.

  4. Lord says:

    A stronger full employment economy would help a lot. A stronger safety net or basic income would help some. Gun control is hopeless. Self driving cars will help in time.

  5. Handle says:

    Hmm. Some of the numbers from that table seem odd to me.

    Denmark comes in under the US in both actual and standardized means, and also gets a hefty boost of a full year (vs the US +1.6) from standardization. Meanwhile Australia loses 0.8 years. I don’t know whether I should be a little skeptical about the data until I see more, or whether I need to update my priors about national stereotypes, but I would have thought Denmark to be a less violence-and-accidents prone country, and more into preventative measures, than Australia. Too many Mad Max movies maybe.

    Turkey is a lot more dangerous (+7.6) than Mexico (+1.9), and so is Czechia (+2.9) and Hungary (+4.6)? Meanwhile Greece (-2.7) is one of the safest places?

    Longevity probably isn’t really a good proxy for what we actually care about and are trying to measure.

  6. djf says:

    “I would rather put money to work on efforts to reduce violent and accidental death than on futile care in the last year of life.”

    This sounds odd coming from a self-described libertarian. Any exciting new ideas about how to reduce violent and accidental (largely drug and alcohol-related) death? This has been a subject of public debate for only that last 50 years or so.

    Oh, wait, here’s an idea – midnight basketball!

    As we’ve seen in recent years, allowing the police doing their jobs to deal with these problems, and incarcerating criminals – which just might have had something to do with the reduction in the crime rate in 90s and 00s – has recently been branded “racist.” Probably counterproductive, but that’s just a guess.

    It might also help not to import immigrants from notably violent societies, but opposing such immigration has also been branded “racist.” What a dilemma.

  7. JK Brown says:

    Except that with out suffering the risks that violent/accidental death are often a consequence of, we become fragile. Overt violence should be reduced, at least down to the rare event, but getting ride of accidental death means not taking risks, not having episodic stressors.

    “Humans tend to do better with acute than with chronic stressors, particularly when the former are followed by ample time for recovery, which allows the stressors to do their jobs as messengers.”

    Taleb, Nassim Nicholas (2012-11-27). Antifragile: Things That Gain from Disorder (Incerto) (Kindle Locations 1186-1187).

    • sort_of_knowledgeable says:

      My understanding is that most accidental deaths are not from physical activities like rock climbing or big wave surfing that could be expected enhance physical fitness but from accidents resulting from drunk driving or other activities not particularly fitness enhancing.

      • drycreekboy says:

        The anecdotal response to your point is that risk-taking behaviors are confounded.

        A good example of what I’m talking about is Tom Wolfe’s description of 1950s test-pilot culture in The Right Stuff: Driving and Flying, Drinking & Driving, Drinking & Flying – all with as high-performance versions of the vehicles involved as could be had. Pilots, allegedly, would sometimes find themselves taxiing a high-performance aircraft hungover, or “in some cases” still drunk – relying on their oxygen masks to help revive them.

        What you can establish empirically in this regard, one way or the other, is a question beyond my ken.

  8. Raymond Ward says:

    My understanding is that much of the difference relates not just to accidental deaths, but specifically overdose deaths. And really, not just to overdose deaths, but more specifically to narcotic overdose deaths. In the United States we have a much high rate of prescribing narcotics than other countries with longer lifespans, and this results in a much higher rate of individuals addicted to narcotics. And at high doses, there is just very little room between the effect the patient (or user) is trying to achieve and the dose that stops them from breathing. I think the only solution is for prescribers to return to the much lower prescribing habits that they had up till the early 2000’s.

  9. B. Reynolds says:

    “It is tragic that the US is so dangerous”

    Anytime you see something about “the US is X”, then you’re just wasting your brain cells. You especially know it when a statistic is rolled out comparing a thing in the US to a European country with a population of South Carolina.

    The US is a large country. In most cases, the US is not anything in particular. Chicago may be X, small towns in Appalachia may be Y, San Francisco may be Z.

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