Michael Wolraich's picture

    Why Americans Live Shorter Lives

    A new study reveals that US life expectancy is falling even further behind other industrialized countries. As of 2007, the life expectancy of Americans is 75.6 for men and 80.8 for women, which puts us in 37th place internationally. On average, Americans live three years less than citizens in the top ten longest-lived countries, and those countries pull further ahead of us every year.

    Or rather, those countries pull further ahead of some of us every year. The study also reveals huge disparities along racial and geographic lines. Some counties in the U.S. have third-world-level life expectancies as low as 65.6/73.5 while others rival low-mortality nations like Japan with life expectancies as high as 81.1/86.0.

    At first blush, one might be tempted to blame our inequitable health care system for these dramatic disparities. The explanation has intuitive appeal. The health care system is designed to save lives. If people die younger in some places, it must be because they have poorer health care.

    But what if the difference does not lie in any failure to save lives? What if people in some counties are just sicker?

    Let's start at the international level. In what way does the US stand out among other industrialized countries when it comes to physical health? Easy. We are the fattest country on Earth. By far. 30.6 percent of Americans are obese. Among the long-lived Japanese, only 3.2 percent are obese. Among our Canadian neighbors, who outlive us by about three years, 14.3 percent are obese.

    There is a well-established causal relationship between obesity and mortality, so the correlation does seem significant, but the international metrics are crude measures. Can we find a correlation at the county level?

    Here is a representation of life expectancy by county as concluded by the new study:

    Notice the long-lived regions in the Northeast, Midwest, West Coast, South Florida, and Hawaii. Contrast them to the red crab-claw shape that extends across the South from Louisiana to the mid-Atlantic.

    And here is a representation of obesity by county:

    See any similarities?

    While the American health care system is certainly plagued by inequality and other problems, the data suggests that when it comes to mortality, the fault is not in our health insurance but in ourselves.

    The good news is that the drafters of last year's health care reform were aware of the problem. Below the storm over insurance mandates and those mythical "death panels," the act required federal agencies to draft a plan to improve Americans' health outside the hospital.

    In accordance with the requirement, the Obama Administration today released the National Prevention Strategy, which aims to reduce smoking, obesity, alcoholism, and other unhealthy behaviors.

    The bad news is that the most of the strategies consist of unenforceable guidelines and vague recommendations to business and communities like, "Increase access to healthy and affordable foods in communities," and, "Help people recognize and make healthy food and beverage choices." Thanks for the tips, Mr. President.

    The health care law does include $17 billion in local grants to support prevention programs, but don't expect it to make much of a dent in national life expectancies.

    Obesity remains stubborn problem that no amount of recommending or cajoling is likely to solve. Unless governments get serious about limiting access to fatty foods and drinks through taxation and regulation, the US will remain the fattest country in the world with a shamefully high mortality rate.

    Update: Reader Lamont has corrected my international obesity figures, which date back to 2002 and 2003. According to the latest data, Mexico has topped the US as the world's fattest country. Australia, which was nine percentage points behind us in 2002, is only three points behind us now. That contradicts the obesity hypothesis because Australians have significantly higher life expectancies than Americans.

    But as it happens, my old data is actually more relevant. The relationship between obesity and life expectancy is delayed. Obesity today won't significantly impact life expectancy rates for years. So if anything, my data is too recent.



    I hope I have time to finish reading thi ...

    It's a good thing that he had the presence of mind to type those ellipses before he checked out

    ... I'm getting better.

    Thanks, Michael, good read. I'd love to see things like more incentives for walkable communities (better environmentally, too), bike lanes, access to healthy food, etc etc. It's so multifacted, of course. And anyone from overseas comments on our insane meal portions in restaurants. I'm not yet sold on the awesomeness of getting really old, though (sorry, future grandkids). 

    Thanks for stopping, Rachel. I agree, but I think that there needs to be more thought about the effectiveness of various incentives. Publicity campaigns are notoriously useless, but the government keeps pushing them all the same. Bikelanes and sidewalks are great for lots of reasons, but I suspect they tend to affect people who are already fit more than those suffering from obesity. On the other hand, taxes and regulations have been effective--like NYC's tobacco tax and saturated fat regulations--but the WH report does not seem to address those.

    Is that true about all publicity campaigns? Australia had pretty brutal anti-smoking and drunk driving campaigns that I think were quite effective. And here w/ babies, 'back to sleep' is one that is so sweeping now many infants have flattened skulls due to too much time on their backs. In any case, maybe we should just welcome our Japanese overlords already. 

    I think there are a lot of synergies between the anti-obesity goal you're suggesting, and an infrastructure-building program that would create jobs.

    Like, updating the Interstate Highway System for the new era, by laying a new Interstate Treadmill System on top.

    For more ideas, visit my website.

    Or... think some up yourself, then send them to me. 

    Pass the chips.

    Green transportation subsidies

    The obesity issue - especially portion size - has been with us for some time.

    Yabba dabba doo!!!!

    Just a health care cost angle on the obesity issue: obesity is regarded as responsible for 16.5% of total US health care costs. And it is responsible for a huge chunk of the rise in overall health care costs - chronic conditions (like obesity induced diabetes) being responsible for 2/3 of the rise in health care costs. If you want to 'bend the cost curve' dealing with obesity seems like the logical place to start.

    Two words: Fat panels

    Simply Brilliant. 

    In their book The Spirit Level, Richard Wilkinson and Kate Pickett assemble data showing significant positive correlations between life expectancy and degree of societal equality among wealthy countries, and between life expectancy and degree of equality among US states. 

    They reference a famous study called the Whitehall study, conducted in Britain.  Whitehall I, a long-term study of male civil servants, was set up in 1967 to investigate the causes of heart disease.  The researchers expected to find the greatest risk of heart disease among men in the highest status jobs but instead found a strong inverse correlation between position in the civil service hierarchy and death rates: those on the lower rungs died earlier than those on the top rungs.  Whitehall II included women and reached consistent conclusions. 

    The study authors tried to determine if the higher death rates were likely caused by the low status, or by lifestyle differences between civil servants in different grades.  They found those in lower grades were more likely to be obese, to smoke, to have high blood pressure and be less physically active.  But these risk factors explained only one-third of their increased risk of deaths from heart disease.

    (Chapter 6 generally, and Whitehall findings from p. 75, if you're interested.)

    Probably people with money in the USA get the best health care available in the world, while poor people -- and America has a lot of them -- get very little health care, certainly little preventive health care and that is probably what makes the difference. Poor people in America also eat so much junk food, because it is cheap and filling. So it comes to that: rich Americans are the richest, most pampered people in the world and America's poor are as poor as anywhere in the 3rd world. This leads to some pretty strange statistics.

    Summing up: at the bottom most of the problems the USA has come from income inequality, lessening social mobility and the lack of a proper social net.

    Nah...I think it is cable news that is the culprit here.

    That and talk radio.

    There is a map missing showing where all the poor people live. What a coincidence...shorter life expectancy, obesity and poverty all showing up in just about the same spots!

    Fat and sugar are cheap. That's why poor people eat them. Wouldn't taxing fatty foods and sugar drinks just be a new way to punish poor people?  It seems to me nutritional re-education would have a deeper and more lasting effect than taxation. Better yet, how about raising the poor people out of poverty so they could afford some higher quality nutrition.  Frozen fish sticks or Kraft dinner five nights a week will kill anybody.

    Good points, flowerchild.  I dug this up as the simplest from studies some time back about obesity in poor urban areas.  Many neighborhoods, it was discovered, only had quick stop shopping within walking distance, no bus service or inadequate, la la la.

    Now this stuff used to drive Jason Miller around the bend, since he lived in DeeCee and said you could buy fresh veggies on every corner or something, but I doubt that's the case very often, and especially in climates with short growing seasons.

    Keeping soda machines out of schools helps, and some schools are starting it, but fruit juice may not be the best alternative; lots of it's made with corn syrup, too. 

    Tax fatty foods?  How Nanny State punitive can you get? Education on corn syrup's dangers would be lovely; hell, outlaw it.  Oh, no; can't do it: the Democrats just voted against ending the ethanol subsidies.  Corn subsidies = Iowa primary wins?

    And by the way...why do you seem to all want to live longer, anyway?  Live healthier, smarter, more lovingly, more directedly, but longer?

    A nit on this

    the US will remain the fattest country in the world with a shamefully high mortality rate.

    I believe Mexico stole that label last fall, pushing the U.S. down to #2.

    New Zealand, Australia, UK, Canada and Ireland were next on the list, providing evidence that quality of health care system doesn't relate much to the obesity problem.


    Thanks for the correction, Lamont. It turns out that my obesity data is old--from 2002 and 2003. At that point, the US had over six points on Mexico and nine on Australia.

    But actually that's OK because life expectancy would reflect historical obesity trends. My data, if anything, is probably too recent.

    PS I wasn't alleging any link between obesity and quality of care, just obesity and life expectancy.

    Maybe the problem is with...speaking English!

    Move over to French or German or Italian...et voilà!

    Excellent article.

    On the positive side, Portland just changed its city planning guidleines in a manner that assures people can get everything they need to live within a twenty minute walk.  It is a good ingredient to the fight obesity salad.

    On the lighter side (pardon the pun), I live in the least obese state - Colorado.  My wife looks forward to our eventual move to the Delaware Valley.  She believes we'll look thinner by comparison.  By that logic, we can create an economic development slogan for Mississippi or Oklahoma: "Move Here - You'll Look Thinner and Seem Smarter".

    Latest Comments