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New Jersey fact of the day
Life expectancy for an Asian female living in Bergen County, New Jersey: 91 years.
Here is the source, via Jason Kottke. Yes, lifestyle and attitude matter. This is one indication that the American health care system isn't as bad as it is sometimes made out to be.
Addendum: From a different direction, here is Levitt and Dubner on paying doctors to wash their hands.
Posted by Tyler Cowen on September 24, 2006 at 06:30 AM in Medicine | Permalink
Comments
"matter. This is one indication that the American health care system isn't as bad as it is sometimes made out to be."
but it does clearly show (especially taken a difference of 20 years in life expectancy some groups) that is very unequal and it also does bring up the ethics of a markets based healthcare system that seems to tend towards inequality, as the paper concludes:
"Disparities in mortality across the eight Americas, each consisting of millions or tens of millions of Americans, are enormous by all international standards. The observed disparities in life expectancy cannot be explained by race, income, or basic health-care access and utilization alone. Because policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the US, health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries."
Posted by: andrew jones at Sep 24, 2006 9:37:17 AM
Even the loudest critics of the American health care system agree that it gives good care to the well off.
Bergen County, by the way, is among the top 25 counties in the US in median per capita income. (See Wikipedia.)
Posted by: Alex R at Sep 24, 2006 9:54:02 AM
Do note, from the paper, that income is not the main driver of the longevity results...
Posted by: Tyler Cowen at Sep 24, 2006 9:57:45 AM
life-expectancy (CIA-Factbook):
Sweden:
total population: 80.51 years
Swiss:
total population: 80.51 years
Canada:
total population: 80.22 years
Germany:
total population: 78.8 years
USA:
total population: 77.85 years
So, what can we conclude from that? If we take Germany and USA as relatively liberal health-care systems (which both allow private health-care)and Sweden and Canada as nationalized health-care command by the state itself. One would use an axiom saying that age would first show a healthy life (or can there be an unhealthy life WHILE being a long life at the same time?) and a good health-care system.
In this case, nationalized Health-care would be optimal over any market-based health-care system (as long as we take into account that "collective health care" doesn't say anything about individual miserys in those systems).
But, how does Swiss fit into this, with their alos relatively free health-care system and private health-care?
So, what I want to ask you, is whether you say that the health-care system should be more like Sweden or even freer (although there is no good example for that). Or is it the life-style which makes the difference (Sweden and Canada are more icy and they enjoy walking more than I have experienced it in the US?)?
Although I'd be glad about a pointer to what kind of criticism you refer to.
Posted by: Max at Sep 24, 2006 11:18:56 AM
There was a post here a while back, I can't find it, claiming genetics don't matter much in determing the length of life. When I look at this paper it is hard not to see a large genetic or cultural component. Another study found the UK residents had better health in middle age than American of European ancestry. There is also the consistent finding that the richer you are the longer you live. I think this is true even if there is national health care. The big impovment in life span came with vaccinations and antibiotics. Life expectancy increased 20 years from 1900 to 1950 and only 7 years since then. Half of the 7 years is estimated to be due to life style changes not improved medical care. Once the basic care is avalible the key to a long life is not superior medical care but not to get sick. When I look at this scatter of facts it occured to me that the one thing that would make them fit, that stress is an important factor. The poor are more stressed that the rich, men more that women, urban more than rural, blacks more than whites.
Posted by: joan at Sep 24, 2006 1:11:40 PM
I wonder how the results would stack up fatness was a variable. Americans are much fatter than people in the rest of the world. America also has much more violent crime than other first world countries I think these would go a long way to explaining the differences in life expectancy.
Posted by: Michael F at Sep 24, 2006 3:00:24 PM
We looked at the determinants of life expectancy by us county several years ago and here is what came in statistically significant at 5% level. All variables are in percentage (as in percentage of population of the county) terms except where obvious:
Males:
Positive effect:
Urban
Rural Farm
Married
High School Education
Some College
Language other than English Spoken at home
Foreigh Born
Czech ancestry
Dutch Ancestry
English Ancestry
German Ancestry
Norwegian Ancestry
Swedish Ancestry
West Indian Ancestry
Baptist
Brethren
Mennonite
Presbyterian
Catholic
Log of Elevation
Negative Effect:
Household Size
Income (although it is seems to be convex as the quadratic term has a positive coefficient)
Poverty
Violent Crime
Population Density
Hospital Beds
Black
American Indian/Eskimo/Aleut
Chinese
Cuban
% of Native Americans living on Reservation
Pentecostal
Jewish
Temperature in July
Females:
Positive Effect:
Rural Farm
Married
Some College Education
Language other than English spoken at home
Foreign Born
Czech
German
Norwegian
Swiss
West Indian
Baptist
Brethren
Other Christian
Catholic
Log of Elevation
Negative Effect:
Household Size
Income (same convex relationship as with males)
Poverty
Violent Crime
Population Density
Irish
Black
American Indian/Eskimo/Aleut
Asian Indian
Cuban
Pentecostal
Episcopalian
Jewish
This is what we found. We included variables measureing pollution, insolation, state fixed effects, and anything else we thought might influence longevity.
Posted by: ryan at Sep 24, 2006 3:43:58 PM
ryan: A large fraction of people in rural areas die in hospitals in big cities, not in the counties where they live. Also people, especially in cold climates, will go live near childern if their health fails or after retirement. Can/Did you correct for this.
Posted by: joan at Sep 24, 2006 6:33:19 PM
Joan,
The data we used included life expectancy at birth which was estimated using place of residence, not place of death.
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Posted by: levitra at Sep 25, 2006 5:57:58 AM
"So, what I want to ask you, is whether you say that the health-care system should be more like Sweden or even freer (although there is no good example for that). Or is it the life-style which makes the difference (Sweden and Canada are more icy and they enjoy walking more than I have experienced it in the US?)?"
one possibility is that national or socialized healthcare creates instant monopolies that can push the price of drugs down and hence provide better care for less while spreading the best ideas for treatment. I'm not sure on how consolidated the U.S. healthcare system is, but taken the fragmented nature of private clinics and hospitals it's possible that American healthcare has fallen because it's stratified i.e. if there was a Walmart of healthcare we might be better off and that is essentially what a the a natioanl system is to begin with. Also several studies have shown that American healthcare is also ineffecient when it comes to spreading good ideas, it can take over 15 years from clinical trials for a drug to finally be used by even a majority of physicians not to mention that drug reps slug across the land pitching their wares shows that obviously getting people to buy new drugs is a hard business and probably ineffecient too. The later study BTW comes from Gartner's healthcare section, but I can't find it in the midst of their site.
Posted by: andrew jones at Sep 25, 2006 10:38:14 AM
"This is one indication that the American health care system isn't as bad as it is sometimes made out to be."
Yes, but this is an indication of poorer quality of life! If it iss preferences/life-style choices that explain the discrepancy in populations then people in the United States must be more willing to trade years at the end of their life for improvements in present-quality-of-life than are our European counterparts.
Why do Americans choose, by lifestyle, to live shorter lives? It must be because we are no as happy and this is either because we are more demanding or is because we are poorer in non-goods markets like status and identity which resist easy commodification.
Posted by: Drew at Sep 26, 2006 12:44:42 AM
"This is one indication that the American health care system isn't as bad as it is sometimes made out to be."
Yes, but this is an indication of poorer quality of life! If it is preferences and life-style choices that explain the discrepancy in life expectancy between populations then we must ask what is so valuable that American's are willing to shorten their live for it.
Why do Americans choose to die earlier?
(1) American's can buy more for years at the end than people in other populations can.
(2) American's are more demanding. They face the same choice sets, but will choose to gimme more NOW.
(1) notwithstanding that the US subsidizes things that are bad for us like Corn/Corn-Syrup is implausible in goods markets and markets for most services since these markets are fairly global; it is probably not a terrible assumption to presume that American's and European's face similar choice sets for conventional, store-bought, goods. For non-commodifiable goods American's may be able to purchase more of these goods than their European counterparts -- status is a more widely available good in the US than it is in Europe and Americnas may be willing to pay for it in years at the end of their life.
(2) is more belivable to me than (1). American's find they have a higher "neccessary-utility" than people in Europe (compare the capacity of American's to suffer to the infamous eastern-european), American's must expend more resources to maintain their utility at their do-not-go-below-this-line level of utility.
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