This will be old news to most readers, but here are a few graphs and maps concerning life expectancy around the world, with the data coming from the UN World Health Statistics 2008. The map above shows life expectancy. You can see at a glance that it has a lot to do with income. This next chart plots life expectancy versus GDP/capita (in 2008, but expressed in 2005 dollars at PPP from the Penn World Tables).
Generally, life expectancy improves with wealth, but no amount of money, at the present level of technology, can get a country above the low eighties. Japan is the country with the highest life expectancy in the world at 83. The US has unusually low life expectancy for its income level: this is a less desirable aspect of "American exceptionalism", with most developed countries having 1-5 years more life than Americans, on average.
It's pretty clear from the shape of this graph that there's going to be a problem of diminishing returns to additional health care spending.
The global pattern of disease is well summarized by this next graphic, which looks at the total "years lost" due to premature death, per unit of population:
Low income countries have much higher levels of infectious disease deaths, whereas those of us in the developed world mainly die of non-communicable things like heart disease, cancer, strokes, etc.
Finally, this last map was a surprise:
Given the unusually high health care costs in the US, it's interesting that we have a rather low number of doctors for a developed country.
Yes, American's situation is very interesting. Especially, since the current debate over American health care, and the vision of many that it is the best in the world.
ReplyDeleteAmerica is an outliers here. Moreover, it is hard to figure out why they have such poor outcome. It could also be that there are screwed results with regards to race survival in the U.S. -- I seem to remember a study that the life expectancy of urban black men was very low -- like mid-50s.
>Given the unusually high health care costs in the US, it's interesting that we have a rather low number of doctors for a developed country.
ReplyDeleteIsnt this the cause of high prices?
Low/artificially restricted supply, and goosed demand (Medicare/Medicaid/non-taxed health benefits) = higher prices
Rational right?
-- general comments on health --
Having lived in Japan, and seen the relatively healthy old population, with cheap medical care (what the government pays is often less than a US copay), I know that a rational system CAN be made.
US sick care, however, is not, and is likely headed for a major crash; mainly because it's gotten too large as a portion of the economy (nearly 1 out of 5 Dollars) and has been growing nearly non stop for 50 years at much faster than overall GDP growth. Neither augur well for continued growth. Usually behemoths like this fail catastrophically.
Especially when the entity paying for half of the costs is insolvent.
This likely unraveling of the health system will have terrible consequences for Americans, as frankly, Americans are hideously unhealthy. Many have horrible diets, sedentary jobs and a cocktail of drugs and specialists to keep their body's life support system functioning.
In other words, a very low quality of life extended indefinitely by massively expensive and ever more complex interventions.
The worst outcome possible.
Only good for the industry itself.
Which country is the outlier with the $31K income and life expectancy around 53?
ReplyDeleteMichael: Equatorial Guinea. Like most of the outliers, it's an oil exporter.
ReplyDeleteHmm, Argentina is better in life expectancy and number of physicians than both the USA and UK (where I live). With a much lower GDP per capita...
ReplyDeleteOops! Life expectancy in Argentina (75.3 years) is actually less than the USA (78.4 years) or the UK (79.9).
ReplyDelete- John
I'm with Frozen in the North.
ReplyDeleteI think that the US tells the tale of two, different populations with their data mixed together.
Pulling out the lower income, urban population would improve the US' numbers because we have a larger such underclass than most other nations such as Japan and EU countries.
On the other hand, whether it's morally correct to remove the numbers of our disenfranchised populations is another matter entirely.
OT, huge sandstorm halted kuvait oil export, Jeff Masters reports.
ReplyDelete>Pulling out the lower income, urban population would improve the US' numbers because we have a larger such underclass than most other nations such as Japan and EU countries.
ReplyDeleteHere's some data on that:
http://stlouisfed.org/publications/re/articles/?id=2092
"For example, in 2007, the age-adjusted mortality rate (measured in deaths per 100,000 people) among American males between 25 and 64 years was 665.2 for individuals without a high school diploma, 600.9 for individuals who completed high school and 238.9 for individuals with some college or higher.1 In terms of healthy behaviors, the estimated incidence of smoking among American males over the age of 25 with a bachelor's degree or higher was 10.4 percent, while this figure among males with a high school degree or less was about 30 percent.2 Similar differences exist for obesity and for alcohol use.3"
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However, I think this totally ignores the major cost drivers in very old age, such as (Medicaid paid) nursing facility care, and "end-of-life" care.
Also, I wonder if the diseases of the better educated 1. just dont show up until later in life and 2. are less likely to result in death.
I disagree with your analysis that
ReplyDelete"no amount of money, at the present level of technology, can get a country above the low eighties."
Life expectancy is defined as the average age at death, e.g., the average Japanese person dying in 2008 was born in 1925. Because of this, technological innovation acts with a significant lag.
In the absence of technological innovation, the plateau is likely to be permanent if the average impact of the technology of the last 84 years is the same as the impact of today's medical technology, which seems doubtful to me.
>no amount of money, at the present level of technology, can get a country above the low eighties.
ReplyDeleteMaybe technology and money arent the causes of good health; but instead are indicators of physical safety?
Maybe good health will be best served by decidedly low-tech and low-cost methods like walking often and eating from healthy soils?
Maybe the reason the we like to think money and technology buy health is because we're part of a machine/industrial culture that likes to see ALL solutions as human created and human centered, when in reality, we're just another animal on the planet, and should concentrate on that fact; ie, we should build healthy soils and environment to make healthier people. Instead of coming up with elaborate contraptions and mechanisms to adjust for the inevitable problems via money and technology.
Froghopper: Actually, life expectancy is calculated by integrating over recent age-specific mortality rates. So it essentially summarizes the current pattern of mortality, rather than being in part about the distant past.
ReplyDeleteBordoe:
ReplyDeleteI would certainly agree with you that were we to eat a healthier diet and exercise more, our life expectancy would go up. I'm all for it.
That said, most of the improvement in life expectancy from pre-industrial values came about due to the control of infectious diseases, which was a combination of antibiotics, vaccines, and public health measures like sewers and water treatment plants. All technological in nature. Further, it seems likely that statin drugs, bypass surgery, chemotherapy, etc, etc, have got to be adding a bit to the life expectancy, even if they are not nearly as cost-effective as the simpler things.
>That said, most of the improvement in life expectancy from pre-industrial values came about due to the control of infectious diseases, which was a combination of antibiotics, vaccines, and public health measures like sewers and water treatment plants. All technological in nature. Further, it seems likely that statin drugs, bypass surgery, chemotherapy, etc, etc, have got to be adding a bit to the life expectancy, even if they are not nearly as cost-effective as the simpler things.
ReplyDeleteYeah, immediately after I wrote it, water sanitation came in my mind as a health AND safety technology.
I guess the narrow version is, as you suggest, that we're now past the point of "diminishing returns". Clean water, and other basic safety/sanitation measures brings great health benefits; statin drugs, marginal per cost.
Obviously, I'm not suggesting that technology and money are NEVER the solution; merely that they arent the first or only thing worth looking at.
Especially today in the United States.