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2011-07-11 11:38:47
By Tom Geoghegan BBC News, Washington DC
Blood pressure test
New life expectancy figures show Americans some way behind countries like
Canada, the UK and Australia. Why?
Living in the world's richest country comes at a price, and it's measured in
life years.
Graph
Men in the US are on average aged 75 when they die. That is 1.5 years younger
than men in the UK and 3.5 years younger than men in Australia, says a new
study.
American women live on average to just under 81 - about three years younger
than the average Australian woman.
While life expectancy in the US continues to improve, says the report by
researchers at University of Washington in Seattle and Imperial College,
London, it is not increasing as quickly as in other Western countries, so the
gap is widening.
"The researchers suggest that the relatively low life expectancies in the US
cannot be explained by the size of the nation, racial diversity, or economics,"
says the document, which ranks the US 38th in the world for life expectancy
overall.
"Instead, the authors point to high rates of obesity, tobacco use and other
preventable risk factors for an early death as the leading drivers of the gap
between the US and other nations."
Risk factors
smoking
obesity
high blood pressure
high low-density lipoprotein cholesterol
high dietary trans fatty acids
high salt intake
low dietary omega 3 fatty acids
high blood glucose
low intake of fruits and vegetables
alcohol abuse
physical inactivity
Source: University of Washington
"We weren't surprised that we had lower life expectancies than other countries,
but we were surprised by the fact that we were falling further behind," says Dr
Ali Mokdad, professor of global health at the Institute for Health Metrics and
Evaluation at the University of Washington.
Take a country like Australia, he says. "It also has a nation of immigrants. It
also is a relatively young country. It has similar socioeconomic
characteristics.
"It has an obesity problem, and yet it has continued to improve in life
expectancy and remains one of the healthiest nations in the world."
So how should the US address these risk factors?
Smoking alone is responsible for one out of every five deaths in the US, the
professor says, yet the US has not been as tough as Australia in restricting
tobacco advertising and public smoking.
Australia also has a greater focus on primary care - which helps with health
education, and early treatment of any problems - and it has done a good job
reducing the number of road traffic accidents, he adds.
The US could also save 100,000 lives a year by reducing salt in people's diets,
since high blood pressure kills one in six people, Dr Mokdad says.
Snapshot from Mississippi
Trailer in Mississippi
"We have high rates of poverty and high rates of uninsured or people lacking
access to care. We have fewer primary care providers and fewer physicians per
person than most states. And high rates of low education.
"We have the highest rate of obesity in the country and therefore one of the
highest rates of diabetes. A relatively high rate of tobacco use and high rates
of cardiovascular disease, stroke and cancer.
"It's going to take a long time to make progress, but we have 40 communities
that have banned indoor smoking in public buildings, and the percentage of high
school smokers is falling. In other ways, we are making being healthy an easier
choice."
Dr Mary Currier, Mississippi health officer
Then there's the big issue - about one in three adults is classified as obese.
That's about 10 times as many as in long-living countries like Japan, according
to OECD figures.
But the US is a big country, and while parts of Mississippi have a male life
expectancy of 67, behind nations like the Philippines, women in areas of
Florida live as long, on average, as the Japanese, who top the longevity
rankings.
It is precisely this kind of inequality that goes some way to explain why the
US - and the UK to a lesser degree - lag behind other countries, according to
Danny Dorling, a professor of human geography at the University of Sheffield in
the UK.
He believes a more even distribution of wealth, even if the average were lower,
could mean longer lives for everyone.
"I think stress is a part of it - this is the key thesis of Michael Marmot and
his book on the status syndrome. People get worn out faster with greater
inequality.
"However there is much more. If you have most health spending just going on a
few people who have the best health to begin with - [as in] the US system -
that is hardly efficient.
"In a more unequal rich country more doctors are working on things like plastic
surgery. More dentists whiten teeth than fix bad teeth and so on."
Infant deaths
While it is not surprising that poor Americans lose out from inequality, Prof
Dorling argues that the rich may suffer too.
Yukichi Chuganji, former world's oldest man Several of the world's oldest
people have been from Japan
"Top income groups are badly affected because their doctors are not necessarily
mainly interested in their health but work for organisations that have to make
an income," he says.
"I am not suggesting it is deliberate but you make more money out of a patient
who spends more on many drugs and investigatory operations than one who lives
longer with less intervention.
"In a more equal system the rich who are well get less intervention - and they
live longer in the UK than the US."
Growing income inequality in the UK, since the 1970s, has has helped to push it
down the European life expectancy rankings, says Mr Dorling.
However, life expectancy is not just about forecasts made for newborn babies.
When you look at life expectancy at 65, the US does perform well, says Svetlana
Ukraintseva, research scientist at the Center for Population Health and Aging
(CPHA) at Duke University in North Carolina.
Elderly Americans have a higher chance of surviving heart disease and many
cancers than their counterparts in other rich countries, she says. Where the US
lags behind is what happens at a much younger age. Infant mortality rates are
high, she points out.
"So it's not the medical system itself that is the problem but access to it,"
she says.
"Medical insurance for all might help."
This is one goal of the healthcare reform signed into law in March 2010, which
will oblige American adults to have health insurance when it comes into force
in 2014.
However, this remains a controversial idea in the US and the legislation could
yet come unstuck.
Challenges to the constitutionality of the law are working their way through
the courts, and fierce opponents in the Republican Party make no secret of
their desire to repeal the legislation if the opportunity arises.