Whatever Happened to American Longevity?

[flashl]

In the past 20 years, the U.S. has sunk from ranking No. 11 in life expectancy to No. 42. What gives?

Life expectancy is a pretty simple concept: it's an estimation of how long the average person lives. Anyone can understand that. So how is this for a compelling data point: if you look at life expectancy in nations around the globe, you'll find that over the past 20 years, the U.S. has sunk from ranking No. 11 to ranking No. 42. In other words, a baby born in 2004 in any one of 41 other countries can expect to live longer than his or her American counterpart.

This may come as a surprise. Sure, we all know the health care system in the U.S. is broken, but life expectancy isn't just tied to medicine -- it's also related to quality of life in a larger sense. (I can live in a nation with the best health care system in the world, but if it's in the throes of civil war, my life expectancy will be short). As we all know, the American standard of living is the envy of the world. After all, we're the richest country on the globe. So what gives?

While some of us are rich, the average American is not. And while the rich are living longer, the poor are living shorter. Factor in the profit motive that drives U.S. healthcare, and you will begin to understand why American medicine has done little to heal the gap between rich and poor. Over the past twenty-five years, we have poured money into healthcare, but have paid relatively little attention to public health.

...

In sum, the stronger social safety net of the 1960s helped to increase longevity for all Americans; its erosion in the 1980s created a discrepancy between the haves and the have-nots. Indeed, given that socioeconomic status is the strongest predictor of health, it's noteworthy that the lowest quintile of earners in the U.S. saw its income fall by 15 percent between 1979 and 1993, while the highest 20 percent saw their income grow by 18 percent over this same period. The poverty rate in the U.S. was cut nearly in half tin the 1960s; from 1980 to 1989, it inched down by just one percentage point.

AlterNet

[whistle]

1. Fascism

[Warpy]

2. Life isn't the only thing getting shorter

We now average less in height than the people in many western European countries, and that study was based on native born Americans of the same basic ethnic stock.

That shows two things: poorer nutrition and poorer health care. This country has become openly hostile to its people and that is now showing up in easily measured data.

[hvn_nbr_2]

13. "This country has become openly hostile to its people"

Wow. Now there's a statement that ought to be pinned to the top of all DU's major forums. It is the very essence of Gingrich and Raygun. I thought perhaps it should be "this country's government" or "this country's ruling elite," but in fact a great deal of ordinary America that votes Republican is openly hostile to a great part of America.

[Turbineguy]

3. Social engineering by conservatives.

Get rid of those who are not productive to their aganda or have lost their ability to be productive (like wounded veterans for example).

[elocs]

4. I realize it's easy to jump on the evil government and healthcare bandwagon,

but I think that our personal lifestyle choices have a lot to do with our declining longevity and poor comparison with Europeans. Certainly healthcare is lacking, but we are an overweight and largely sedentary society that pays little attention to nutrition or doing the things that would keep us healthy in the first place. We reap what we sow. I've read and heard that only 30% of a person's longevity is based upon genetics and the rest is lifestyle choices and I would agree with that.

[Hannah Bell]

5. Personal lifestyle choices? Not big enough difference to account

for the difference in longevity. e.g. Japanese & french smoke more, live longer.

The more inequality, the lower the life expectancy. It's always the case.

[elocs]

6. "Longevity: It's Your Choice"

from: http://seniorhealth.about.com/library/weekly/aa060301a.htm

Living to a healthy and happy ripe old age, may not be a matter of genetic predisposition or just dumb luck. A study is published in the June 2001 American Journal of Psychiatry, the monthly scientific journal of the American Psychiatric Association that points to personal choice as being the defining factor in determining a person's longevity.

This study tracked the physical and mental health of 724 men over a 60-year period beginning in 1940. It contrasted the mental and physical health status of 268 Harvard sophomores with that of 456 socially disadvantaged inner-city adolescents. Physical exams were conducted every five years, and psychosocial exams were conducted every two years.

The study identified seven factors that appeared to predict successful aging: moderate alcohol use, no smoking, a stable marriage, exercise, appropriate weight, positive coping mechanisms, and no depressive illness. Depression was the only factor that affected the quality of aging which was beyond individual control.

The researchers found that the health of the inner-city men declined more rapidly than did the health of the Harvard men; their health status at age 65 matched that of the Harvard men at age 75. However, the health of 25 inner-city men who obtained a college education declined at the same rate as the Harvard group. The investigators concluded that education - not money and social prestige - made the difference. Education appeared to give these men the resources they needed to make better lifestyle choices and to therefore maintain health and happiness for a much longer time.

You cite just one thing, smoking, that the Japanese and French do more than Americans, yet it has been found that when Japanese come to this country and live the American lifestyle that their health suffers. I, myself, am low income, taking home only $18,000 a year, but since I have a college degree my education will allow me to make better lifestyle choices that will directly impact my longevity. If I stay healthy because of my personal lifestyle choices (healthy diet, maintain proper weight, regular exercise, moderate alcohol consumption and yes, no smoking) I will have far less need to rely on our inadequate healthcare system than if I let it all hang out. We could mitigate the impact of our poor healthcare system if we chose to take better care of ourselves in the first place.

[Hannah Bell]

7. I don't read popular health articles, I read the original research.

I have an MS in Nutrition & am a registered dietitian who quit practicing out of disillusionment with the field. I've also lived in Japan, & the "Japanese lifestyle" is no longer much different from the US lifestyle in terms of food choices: 91 g protein, 85 g fat = average consumption.

I once believed the same line you do; young people typically do, because they're taught to, & there's a superficial plausibility to it, until you look at the bigger picture.

The longevity gains resulting from "individual choice" are miniscule.

Smoking rates, % fat in diet, obesity, etc. - don't explain much about longevity, either in populations or individuals.

[Hannah Bell]

9. another japanese paradox: declining rates of heart disease

post-war despite rising cholesterol & doubling & tripling of meat consumption.

[Hannah Bell]

11. More history: There was a time in the US when the rich smoked more

than the poor, ate more high-fat & refined foods, did less exercise, & were fatter.

The lower classes got more exercise, ate healthy unrefined homemade foods, smoked less, & were thinner.

The rich lived longer then, too.

[Jim__]

8. A couple of thoughts.

Do you know if the 25 inner-city men who obtained a college education continued to live in the inner-city after they completed their education? Do you know if there is any correlation between neighborhood and the "life-style" choices mentioned: moderate alcohol use, no smoking, a stable marriage, exercise, appropriate weight, positive coping mechanisms, and no depressive illness?

My experience with people who live in the inner city is that they tend to drink heavily and to smoke. I wouldn't be at all surprised if they have higher rates of depression and a much lower tendency to treat depression as the article recommends: seeking treatment if it develops and following treatment recommendations is. If you feel blue, with decreased energy or initiative you may be depressed and should seek help from your physician. Not seeking help from "your" physician may not be a lifestyle choice for people living in the inner city.

I also don't believe that getting a college education is a "lifestyle" choice for most inner city residents. In the samples given, 25 of 456 inner-city residents chose to go to college, just a little over 5%. Growing up poor (inner-city) does limit your life-style choices. This snippet is from wikipedia, but I'm sure you can find similar information from other sources:

Children growing up poor tend to have lower IQs. They score between 6 and 13 points lower than other children on various standardized tests (these differences still were present after controlling for maternal age, marital status, education, and ethnicity),<16> children growing up poor have poorer academical outcomes in school than other children, they are less likely to attend college. 88% of children raised in affluence went to attend college, but only 36% of children raised in poverty do so, children raised in poverty are more likely to become a teen parent, more likely to smoke and do illegal drugs and more likely to be unemployed as grownups than other children.<17> But there are some children who are doing remarkably well despite growing up very poor. These children are called resilient. Resilient people adapt successfully even though they experience risk factors that are against good development.<18>

I think getting a college education and living right is a great choice for everyone, and I applaud everyone who makes those choices. However, due to socio-economic circumstances, many people are born into a situation where they are far less likely to make these lifestyle choices than people born into better circumstances. It's really not as simple as "Longevity: It's Your Choice".

I do consider poverty and inner-city conditions to be partially due to government policy.

[Hannah Bell]

10. More food for thought: The Whitehall Studies

"The initial study, the Whitehall I Study, was conducted over a period of ten years, beginning in 1967. A second phase, the Whitehall II Study, examined the health of 10,308 civil servants aged 35 to 55, of whom two thirds were men and one third women. A long-term follow-up of study subjects from the first two phases is ongoing.

The initial Whitehall study found lower grades, and thus status, were clearly associated with greater propensities for significant risk factors, including obesity, smoking, reduced leisure time and physical activity, more baseline illness, higher blood pressure, and shorter height. Controlling for these risk factors accounted for no more than 40% of grade differences in cardiovascular disease mortality. Even after these standard risk factors were controlled for, the lowest grade still had a relative risk of 2.1 for cardiovasular disease mortality compared to the highest grade.

The Whitehall studies have dispelled two myths. The first is that people in high status jobs have higher risks of heart disease. The second is that the gradient of health in industrialised societies is simply a matter of poor health for the disadvantaged and good health for everyone else.

How did the Whitehall studies dispel these misconceptions? The first Whitehall Study compared mortality of people in the highly stratified environment of the British Civil Service. It showed that among British civil servants, none of whom was poor in the absolute sense, there was a social gradient in mortality that ran from the bottom to the top of society. The more senior you were in the employment hierarchy, the longer you might expect to live compared to people in lower employment grades. Twenty years later, the Whitehall II study documented a similar gradient in morbidity in women as well as men. A striking finding from the Whitehall Studies was that the social gradient was observed for a range of different diseases: heart disease, some cancers, chronic lung disease, gastrointestinal disease, depression, suicide, sickness absence, back pain and general feelings of ill-health. A major challenge, and a reason for the importance of these studies, was to understand the causes of this social distribution of so many disorders.

The Whitehall studies have gone some way towards unravelling the mystery of why someone in the middle of the social hierarchy should have worse health than those above them and better health than those below them."

http://en.wikipedia.org/wiki/Whitehall_Study


"The same finding has been replicated in other countries. In Spain, for example, we performed a similar study, looking at life expectancy by social class, and we found that the members of the bourgeoisie (the European term to define the corporate class) live an average of two years longer than the petit bourgeoisie (the term to define the upper middle class), who live two years longer than the middle class, who live two years longer than the skilled working class, who live two years longer than the members of the unskilled working class, who live two years longer than the unskilled working class that has been chronically unemployed. The difference between the two poles—the corporate class and the chronically unemployed—is ten years. This average distance in the European Union is seven years. In the United States, it is 14 years.2

Why these differences in life expectancy? A lot of research has been done in the attempt to answer that question. And we have enough evidence to provide an answer: social distance and how that distance is perceived by people, in addition to the lack of social cohesion that it produces, is at the root of the problem. This situation appears clearly when we compare the life expectancy of a poor person in the United States (who makes $12,000 a year) with the life expectancy of a middle-class person in Ghana. The poor person in the United States is likely to have more material resources than the middle-class person of Ghana (who makes the equivalent of $9,000). The U.S. resident may have a car, a TV set, a larger apartment and other amenities that the middle-class person in Ghana does not. As a matter of fact, if the world were considered a single society, then the poor in the United States would be a member of the worldwide middle class and the middle-class person of Ghana would be part of the worldwide poor—certainly poorer than the poor in the United States. And yet, I repeat, the poor citizen of the United States (although of the worldwide middle class) has a shorter life expectancy than the middle-class person (although of the worldwide poor) in Ghana (two years less, to be precise).

Why? The answer is simple. It is more difficult to be a poor person in the United States than a middle-class person in Ghana."

http://www.monthlyreview.org/0604navarro.htm

[Fire_Medic_Dave]

12. Obesity