Sunday, December 1, 2019

Death at an early age

There are many ways to gauge the health of a population, whether a nation or some specific portion of it, but the commonest and broadest measure is the average life expectancy: the number of years a child born will live on average. Life expectancy in developed countries has increased for most of the past century, as antibiotics decreased deaths from infectious diseases and better sanitation became universal. US life expectancy began to lag that of most other developed countries in the late 1980s and by 1998 had fallen to a level below the average among OECD (the Organization for Economic Cooperation and Development) countries. Average life expectancy in those countries has continued to increase every year but stopped increasing in the US in 2010 and since 2014 has fallen, even though we pay almost twice as much per capita as do those countries on health care. Why is this?

Death rates among those 65-84, while obviously high (the biggest risk factor for most diseases is old age!), have fallen substantially between 1999 and 2017, while the death rates for those 25-64 reached a low in 2009 and have risen since. The death rates have risen significantly among those 25-44, as deaths from suicide (usually by gun), opioid overdose and alcohol-related liver disease – diseases of despair - have all jumped. Infant mortality rates have fallen slightly in the US over the past 20 years but remain well above those in other developed countries and are improving at a slower rate than theirs.

Differences in life expectancy are clearly related to factors other than health care expenditure. Researchers have shown dramatic differences in life expectancy among people living in zip codes less than 10 miles apart, sharing access to the same hospitals but having very different household incomes. Increased stress, including economic, has been linked to higher heart attack rates. Rising unemployment or under-employment probably explains the much higher suicide and opioid-related death rates in the industrial heartland, Appalachia and northern New England. Maternal death rates are 5-fold higher among African-American women than whites.

The solution to our discouraging health statistics is not more health care spending. Rather it lies in reining in our excessive and wasteful spending and re-directing this money to such areas as vocational education, improving social support, providing better access to healthy foods and increasing minimum wages. A living wage is the best medicine available for most conditions.

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