It's not a homer prejudice. It's an analytical criticism of distorted data. It is at least arguable that the US belongs right up there.
The WHO cites various causes for why the United States ranks relatively low among wealthy nations. These reasons include:
* In the United States, some groups, such as Native Americans, rural African Americans and the inner city poor, have extremely poor health, more characteristic of a poor developing country rather than a rich industrialized one.
* The HIV epidemic causes a higher proportion of death and disability to U.S. young and middle-aged than in most other advanced countries. HIV-AIDS cut three months from the healthy life expectancy of male American babies born in 1999, and one month from female lives;
* The U.S. is one of the leading countries for cancers relating to tobacco, especially lung cancer Tobacco use also causes chronic lung disease.
* A high coronary heart disease rate, which has dropped in recent years but remains high;
* Fairly high levels of violence, especially of homicides, when compared to other industrial countries.
who.int
Does the U.S. Lead in Life Expectancy?
By Carl Bialik
Life expectancy has become a popular measure for comparing different countries’ health-care systems. Keeping people alive is, of course, an important goal of medicine — and the fact that the U.S. ranks below dozens of countries has served as fodder for politicians angling to revamp the U.S. system.
health care
However, two economists have argued in a recent book that life expectancy is a lousy way to compare two countries. Murders, suicides and accidents can have a big effect on life-expectancy stats because their victims die younger, on average, than victims of disease. And, they argue, the health-care system can’t do much to prevent those kinds of deaths. After adjusting for those kinds of deaths, the U.S. ranks at or near the top of developed nations in life expectancy, health economists Robert Ohsfeldt (of the Texas A&M Health Science Center) and John Schneider (of Health Economics Consulting Group LLC) write in “The Business of Health,” a 2006 book published by the conservative American Enterprise Institute think tank.
The notion is politically significant. The U.S.’s poor ranking in life expectancy is a key tenet in filmmaker Michael Moore’s excoriation of American health care in “Sicko,” and in calls by reformers for broader access to medical care — calls being heeded by the leading Democratic presidential candidates. Yet the U.S. has an unusually high rate of deaths from accidents and homicides, compared with other developed countries. (For instance, transport-accident deaths are three times higher in the U.S. than in the U.K., according to the World Health Organization, while the murder rate is 10 to 12 times greater.) Subtract out these deaths and suicide — where the U.S. is at or below average — and the American health-care system doesn’t look so bad. Hence, the adjusted life-expectancy rankings have been mentioned in several conservative publications critical of health-care reform, including National Review and City Journal.
But there are several shortcomings to this analysis. First, death rates from accidents, homicides and suicide are dependent not only on how many people suffer injuries from such events but also on how effective the health-care system is at averting death in borderline cases (a point I made in a column earlier this year). Various factors influence that success rate; one of them is the distance emergency services must travel to reach victims, in which population density comes into play and the relatively spread-out U.S. is at a disadvantage.
Also, the authors didn’t directly adjust for these deaths. Instead, Dr. Ohsfeldt and Dr. Schneider performed a statistical calculation, called a regression, to estimate how much mortality rates from homicide, suicide and accident influenced mortality, on average, from 1980-1999 in 29 of the 30 developed countries in the Organisation for Economic Co-operation and Development (they skipped tiny Luxembourg). Then they adjusted life-expectancy stats to get a rough handle on what life expectancy would have been like had the rates of these deaths been the same in all 29 countries. Their result: The U.S. would have ranked first, at 76.9 years of life expectancy — an increase of 1.6 years. Meanwhile, Japan fell from 78.7 years to 76 years, indicating it had been benefiting inordinately from low rates of accidental deaths and homicides. (You can see a partial list at this blog.)
Carl Haub, a demographer at the Population Reference Bureau in Washington, D.C., said the method was incomplete. A more-precise analysis would have removed those who died from these causes from overall mortality stats, and then recalculated life expectancy. (For more on how life expectancy is calculated, see this earlier blog post.) “Just because another method is a lot of work, does not mean regression will yield a correct result,” Mr. Haub told me.
Prof. Ohsfeldt acknowledges that regression was chosen for its relative simplicity for what he called his “little book project.” And he agrees that some deaths that his book attempted to remove from the life-expectancy tables might be dependent on health-care systems. “We’re not trying to say that these are the precisely correct life-expectancy estimates,” he told me. “We’re just trying to show that there are other factors that affect life-expectancy-at-birth estimates that people quote all the time.” These factors (which could also include rates obesity and smoking, also arguably the result of lifestyle choices rather than health care) call into question the value of country rankings, especially where the difference between the leading countries is often less than a year. Prof. Ohsfeldt compared the situation to college rankings where two schools with minute differences are ranked, somewhat arbitrarily.
What do you think? Should certain deaths be excluded from life expectancy? Is it a solid basis for comparing health systems? Please let me know in the comments.
blogs.wsj.com |
