Measuring health care's effectiveness

This is a quick response to my diary about Healthcare.  Obviously this community is in favor of Universal Health Care.  I'm not.  

Some people brought up the issue of life expectancy and incorrectly believed the US ranks poorly in terms of life expectancy.  

I think we all should agree that life expectancy is probably our best metric for health care efficacy.  If you have a better metric feel free to suggest it, but I can't think of one.

But, if you think life expectancy is a useful metric than you have two problems.

1. The US has the highest natural life expectancy of any 1st world country.  It's true we don't have the highest "average life expectancy" but that's because average numbers include homicides and car accidents. If just look at people who die natural deaths than Americans live the longest.

2. All 1st world countries have similar life expectancies.  Even though we're the best we're not much different from any other country. This suggests we're fighting a pointless battle.  Spending more money on health care does not raise life expectancy by much.

I don't like writing long diaries so I just want to address one misconception for now.  Maybe in the future I will address more.

•  Yawn...

  by Intercaust on Sun Sep 16, 2007 at 09:32:00 PM PDT

  •  as if the homicide rate and accident rate are not

    connected to the iniquities of the American system!

    Yeah I suppose if you excluded minorities from crime statistics about 1 million African American Prisoners would go up in a puff of smoke.

    See.

    Exclude the poor and underpriveledged from the stats and guess what--America has the best Eucation, Healthcare, Homicide, Suicide, Obesity rates in the world!

    by Salo on Sun Sep 16, 2007 at 11:01:18 PM PDT

•  There are many metrics

  and the US usually ranks low in all of them. Infant mortality is a good one. Preventable deaths is another. Access is a really useful one. More than 50 people die every day because they do not have access to health care.

  All the metrics need to be considered when looking at this subject. And it would be useful to consider the 'germ theory of disease', the fact that diseases are caused by infectious agents that spread from person to person.

  This one metric approach is really silly.

  by DaleA on Sun Sep 16, 2007 at 09:37:01 PM PDT

  •  lowest in all of them?

    But we have the highest natural life expectancy.  The purpose of health care is to prolong life.    We live longer than any other country.

    But I took the time to show you my statistics.  Can you show me yours?

    by consta on Sun Sep 16, 2007 at 09:51:23 PM PDT

    •  If we can do better

      (more equity in healthcare delivery, lower morbidity, better medical outcomes, higher quality of life) why should we settle to be the best in life expectancy? America has often improved on its own record even as it has led the world. "We're not as bad as the other guys" isn't a very convincing reason to do business as usual.

      by RudiB on Sun Sep 16, 2007 at 10:45:25 PM PDT

      •  no but..

        We got this far without the government.  And when the government intervenes it usually harms more than it helps.

        Another common misconception in this debate is that if the government doesn't get involved there won't be additional improvements.  That's just not true.

        We will continue to make advances and we will do so faster if the government is not managing health care.

        If the govt. wants to subsidize health care through vouchers or tax reductions that's another issue.

        by consta on Sun Sep 16, 2007 at 10:51:12 PM PDT

        •  Seems there is a fundamental flip-flopping

          in this discussion. Government management of healthcare is NOT the same as government paying claims for basic healthcare service. I'm in favor of the latter (i.e., single-payer, or Medicare for all as some call it) but against the former. I want to choose my own healthcare providers and manage my own care, thanks very much. Moreover, even when the government handles the payment for basic healthcare services, the rich can always "buy up." It has always been so.

          by RudiB on Sun Sep 16, 2007 at 11:05:27 PM PDT

          •  also who says that accidental death...

            ...should be separated out by a statistician?  If a crash victim is uninsured are they going to get very good treatment? An umisured stab victim?

            Also medical bills account for 50% of personal bankruptcy bills in the US...that can't be considered a good outcome.

            by Salo on Sun Sep 16, 2007 at 11:21:46 PM PDT

        •  Debunked:

          

          See for yourself what happens when you anti-tax extremists take over and cut back on everything. The blood of the people who lost their lives is on your hands. I have a close friend out there who could have been killed. Go to hell with your anti-tax extremism.

          by Eternal Hope on Mon Sep 17, 2007 at 06:42:07 AM PDT

    •  oh yes if one excludes

      endemic violence, death from neglect, then sure the US does well. If you exclude the F I got one semester I got a 4.0.

      by Salo on Sun Sep 16, 2007 at 11:02:59 PM PDT

    •  Highest Life Expectancy

      The United States ranks 38 in the world for life expectancy.
      http://en.wikipedia.org/...

      by TheMomCat on Mon Sep 17, 2007 at 12:03:39 AM PDT

    •  No,

      the purpose of health care should be to increase quality of life.

      Being 80 and bed-bound with no family around after suffering a few strokes, unable to communicate is no life. That is how my Grandfather spent his last few years.

      I spent time in a lot of nursing homes--he wasn't the only one breathing but able to do little else. Depression, loneliness, amazing numbers of drugs were common. Dementias, crippling arthritis, oxygen tanks, wheelchairs everywhere.

      Dale is right--the US ranks low in almost every other measure. We can do better.

      If you just look at length of life you are missing out on what is important. Living.

      by SeattleLiberal on Mon Sep 17, 2007 at 12:19:54 AM PDT

    •  Measuring medicine

      Life expectancy is a lousy metric for measuring quality of a nation's health care. There are too many factors other than medical care that contribute to longer and shorter lives. How about using something that is an almost direct measurement of medical care? How about researching how the US compares to other First World nations in terms of the survival rate for cancer patients? Do American cancer patients on average outlive British cancer patients?

      by StainlessSteelUrsus on Wed Sep 26, 2007 at 03:51:32 AM PDT

  •  nvm..

    I found one statistic is true.  We have a high infant mortality rate.  But...

    "the infant mortality rate has continued to steadily decline over the past several decades, from 26.0 per 1,000 live births in 1960 to 6.9 per 1,000 live births in 2000. "

    And what pushes this number up?  No, its not lack of UHS.  It's lifestyle choices.

    Babies don't die in the US because of bad health care.  They die because their parents don't life a healthy life style while they're pregnant.  They smoke, drink, eat poorly, etc.

    In developing countries babies are dying because of bad health care.  This just isn't true in the US.

    http://www.cdc.gov/...

    by consta on Sun Sep 16, 2007 at 09:59:14 PM PDT

    •  not just babies:

      They die because their parents don't life a healthy life style while they're pregnant.  They smoke, drink, eat poorly, etc.

      very true!!

      BUT, it is not my choice to breathe polluted air, drink polluted water, and eat foods that were grown in polluted soil, etc.

      pollution is hurting our health

      Pollution has been linked to about 200 different diseases, ranging from cerebral palsy to testicular atrophy, as well as more than 37 kinds of cancer, startling US research shows.  ...

      in 2005, WaPo had this article:

      When the Environmental Protection Agency unveiled a rule last week to limit mercury emissions from U.S. power plants, officials emphasized that the controls could not be more aggressive because the cost to industry already far exceeded the public health payoff.

      What they did not reveal is that a Harvard University study paid for by the EPA, co-authored by an EPA scientist and peer-reviewed by two other EPA scientists had reached the opposite conclusion.  ...The Harvard study concluded that mercury controls similar to those the EPA proposed could save nearly $5 billion a year through reduced neurological and cardiac harm. Last Tuesday, however, officials said the health benefits were worth no more than $50 million a year while the cost to industry would be $750 million a year. ...
      Health advocates say mercury is so harmful to fetuses and pregnant women that steps are needed to sharply control emissions; industry groups and the Bush administration have warned that overly aggressive measures would impose heavy costs.  ...

      things that affect the health and safety of the people need regulating, imo, because it is all about the bottom line with business.  the healthier our environment, the healthier our people and the lower our healthcare costs will be.

      by sc kitty on Sun Sep 16, 2007 at 11:46:34 PM PDT

      •  yes

        but these things have nothing to do with UHC. Thus infant mortality is not linked to lack of UHC.

        by consta on Mon Sep 17, 2007 at 09:12:53 AM PDT

        •  i was responding to your comment

          It's lifestyle choices.

          lifestyle choices do affect to cost of healthcare, for sure.  ideally, the better the lifestyle the less you go to the doctor for care.  

          my point was that there are things that we have no control over (as ordinary citizens) that affect us, no matter how perfect our lifestyle choices are.

          by sc kitty on Mon Sep 17, 2007 at 11:21:42 AM PDT

•  Interesting point...

  that I had not heard before.  Just imagine what I life expectancy would be if we had better health care.  Actually, it may not improve that much.

  Another myth that is promoted by some of our candidates is preventive care.  They argue that promoting good health and doing early intervention would be cheaper and save lives.

  Early intervention and more diagnostic testing actually does not save money, and often doesn't increase health. Examples abound, such as PSA for men, and questions about the efficacy of Mamography for women beyond a limited age period.

  Panaceas are usually wrong.  The New York Times has a major article in the magazine about some of the reasons for our false impressions.  It's long, complex, but well worth reading.

  It explains why the reports of what makes us healthy are so often wrong.

  by arodb on Sun Sep 16, 2007 at 09:56:59 PM PDT

  •  thanks.

    I'll probably read it tomorrow when I'm bored at work. ;)

    by consta on Sun Sep 16, 2007 at 10:20:46 PM PDT

•  This is a good place to start

  The World Health Organization keeps statistics on health related issues. The list they have on this page shows some of the metrics that need to be considered.

  And the study you reference is really questionable. It is not done in accordance with standard health statistics customs and conventions. Nor does it use standard health criteria. Instead it invents something new, gives it a name and lets it float. Nor does it take into account that there can be a health or disease factor in murders and accidents.

  BTW, the purpose of health care is not just to prolong life. It is to increase the quality of life. To prevent premature death. To alieviate pain. Many goals of health care are achievable only with Universal Access.

  by DaleA on Sun Sep 16, 2007 at 10:11:49 PM PDT

  •  I agree when you say

    "The purpose of health care is not just to prolong life. It is to increase the quality of life"

    That's true and I was misguided to think our only goal is to prolong life.

    But to say:

    "Many goals of health care are achievable only with Universal Access."

    Is a bit of a stretch.  Health care has been improving the quality of life for decades without being managed by the government.

    Health care, like all markets, will continue to improve regardless of government intervention.  And government intervention thus far has done more harm than good.

    by consta on Sun Sep 16, 2007 at 10:19:59 PM PDT

    •  I should clarify

      When you say "Universal Access" its not clear you mean government management.  Most people equate Universal Coverage with government management so I did the same.

      But if my assumption was wrong I apologize.  

      I agree we should be concerned with giving everyone access to good health care.  I just don't think we need govt. management to do it.

      by consta on Sun Sep 16, 2007 at 10:22:42 PM PDT

      •  On Natural Life

        'Natural Life' appears to be a legal term, not a medical one.

        Specifying a cause of death is required by law in all states. Death certification provides public health statistics and prevents cover-ups of murder. Certification requires determination of a cause of death which is a disease or injury directly related to death (heart attack, stroke, AIDS) or the circumstances of death (gunshot wound to chest, death by hanging). The manner of death must also be stated (natural, accidental, suicide, homicide, unknown, pending). In your specific case, "Natural Causes" means that the death was natural but a specific cause was not apparent from the clincal history or circumstances surrounding death. In order to find a cause an autopsy would have been neccessary. In older people autopsies usually aren't done if the circumstances are natural

        Could you quote a medical study that shows the same result in medical terms?

        by DaleA on Sun Sep 16, 2007 at 10:26:14 PM PDT

    •  Public Health

      Consta says: 'Health care has been improving the quality of life for decades without being managed by the government.'

      Absolutely untrue. The government by and large furnishes Public Health: water, sewerage treatment, insect control, food and drug inspection, epdemic control, species border control, public health education and many other programs. All of these are governmentally provided, universal and mandatory. And have been in place for over a century. Governments have a long history of successful health care provision. And a long history of running them successfully and economically. Your statement is demonstrably false.

      Do you really think we should take the government out of health care by making everyone responsible for treating their own sewerage? One person can have flush toilets and a septic tank; his neighbor an open pit in the back yard. Hey no problem or OMG?

      How about treating people with drug resistant TB? Without Universal Access, some people will not be able to seek care. And the disease will spread. Governments are actually fairly successful in treating TB.

      Diseases are infectious. They spread from person to person. Infection begins the 'etiology' which leads to progressive levels of disease. All people have a rational self interest in seeing that those infected can get prompt treatment so the disease does not spread to them. Only Universal Access provides this self protection.

      Interestingly it can now be shown that heart disease, cancer, asthma and obesity have an infectious component in their etiology. Check out Louis Pasteur. He showed how this works over a century ago.  

      by DaleA on Sun Sep 16, 2007 at 10:44:51 PM PDT

      •  Insurance is a form of gambling

        by DaleA on Sun Sep 16, 2007 at 10:46:35 PM PDT

        •  What???

          Entering into contracts to transfer risk (i.e., insurance) is essential to a functioning modern economy. Try financing a home or a een a car without the existence of insurance. I don't understand your commenet.

          by RudiB on Sun Sep 16, 2007 at 10:52:16 PM PDT

          •  Please see full post below

            This posted accidentally without the text.

            In Acturial classes, the concept of 'bet' is always used.

            by DaleA on Sun Sep 16, 2007 at 10:54:26 PM PDT

      •  Data is from AEI

        Ignore this diary. See my comment below, if you are interested.

        by DBunn on Sun Sep 16, 2007 at 10:50:19 PM PDT

      •  not really.

        All of those things improve health, but they're not health care.

        Sewage systems don't treat disease.  They prevent disease.

        Government managing infrastructure is a dead issue.  Government managing the delivery of health services is entirely different from government managing roads, sewers, and insect control.

        And the FDA has a questionable history... the Food Pyramid?  Give me a break.  

        by consta on Sun Sep 16, 2007 at 10:55:24 PM PDT

        •  many of thos e functions have been privatized...

          by Salo on Sun Sep 16, 2007 at 11:06:05 PM PDT

        •  Thee is absolutelyn no difference

          from the govnemnt controlling infectious diesases

          by DaleA on Mon Sep 17, 2007 at 12:38:07 AM PDT

          •  Did you really mean

            ..to deliver a donut to Salo above? Heck, even some of your donuts to the diarist look a bit questionable - TR's are not for expressing disagreement. consta's one really objectionable comment has been given a second helping and sent to HC land.

            by Ahianne on Mon Sep 17, 2007 at 02:52:16 AM PDT

          •  medicine versus civil engineering

            These are two entirely different fields.  Govt. research is responsible for less than 5% of all medical treatments in existence.

            by consta on Mon Sep 17, 2007 at 09:14:54 AM PDT

  •  homicide is a by product of a defunct

    mental health, childhood intervention etc...its partially caused by deprevation.

    by Salo on Sun Sep 16, 2007 at 11:04:58 PM PDT

    •  and

      Universal coverage will solve these problems?

      by consta on Sun Sep 16, 2007 at 11:06:30 PM PDT

      •  it is symptomatic of other forms of neglect.

        Screening psychotics like VA TECs Cho with an adequate mental health system would help a great deal.

        by Salo on Sun Sep 16, 2007 at 11:10:04 PM PDT

•  Something odd with your stats

  When I click thru to your link, I find a table that shows your point about US life expectancy: the "raw" data (including violent deaths etc) shows a life expectancy of 75.3 years, while the "standardized" data (violent deaths etc filtered out) gives a figure of 76.9 years. The net gain is 1.6 years, pretty impressive.

  Japan has a net gain of 2.7 years, which is really impressive, especially since we don't think of Japan as a particualrly violent society. What's going on there? Suicides perhaps? If so, could we call that a mental health problem?

  But what I really don't understand is the countries for which life expectancy is greater when violent deaths are included, compared to when they are filtered out. How is that even possible? Iceland, 1.9 years longer life expectancy when violent deaths are included. Sweden, 1.6 years. Netherlands, 1.1 years. What's going on here?

  Makes me wonder, is this source completely screwed up and unreliable?

  Clicking through to another of your links, I see where the sponsor of the report with the screwed up data is the American Enterprise Institue, the well known right wing think tank. While that does not logically require a conclusion that they are wrong, somehow it always turns out that way. Not a good sign.

  I'd say it's back to the editing desk for this diary.

  by DBunn on Sun Sep 16, 2007 at 10:49:13 PM PDT

•  Insurance is a form of gambling

  Don't know why that posted without the text.

  Even Ayn Rand recognized the governments were capable of running gambling enterprises efficiently. I have no problem with government running the insurance part of Universal Access.

  And Public Health has clearly demonstrated the efficiency of governments at running health care. Here social provision of health care is clearly superior to private provision. So, empirically I have no problem with governmental health care.

  by DaleA on Sun Sep 16, 2007 at 10:52:28 PM PDT

  •  Empirically?

    At face value the point about govt. simply managing insurance makes sense.  Insurance isn't a difficult concept.  You just pool risk and distribute it evenly across the population.  Why can't the government do that?  Doesn't seem hard.

    In reality its much different.

    The hidden assumption in your argument is that there is only one type of health insurance.  There isn't.  The market provides a selection of different types of insurance.  And we get the freedom to choose the kind we prefer.

    In a government managed system there is only one type of insurance to choose and what it covers is what you get.  So what does this mean?

    Government now has to choose how to ration medical expenses.  You don't get to choose what you want covered and how its treated.  The government chooses for you.  Sure, private insurance does the same thing, but there is choice in the private insurance industry.

    And what else happens? What about all the remaining pharma companies and private hospitals?  How does government managed insurance affect them?

    Now the pharma companies just have to lobby one company to distribute their product.  The government insurance agency decides whose drugs you get to use and what price we pay for them.  

    The doctors and hospitals become confused too.  How much should a hospital charge if the government is footing the bill?  As much as they want.

    This is probably why most forms of universal coverage include government management of doctors and hospitals.  Which is a new can of worms with lots of scary consequences.

    by consta on Sun Sep 16, 2007 at 11:02:26 PM PDT

    •  government approved drugs

      I wanted to point out that there is already talk of creating a government agency to analyze and approve drugs if we implemented universal healthcare.

      What this means is some beaucrat gets to decide what drugs are acceptable for what treatment.  Or in other words, lobbyists get to line the pockets of incompetent pricks who decide what drugs we get to use and what price we pay for them.

      The irony of liberals bashing government and wanting to put their life in government's hands never ceases to amaze me.

      We know the government fucks up all the time and is often ran by incompetent pricks.  So why the faith in government?

      by consta on Sun Sep 16, 2007 at 11:05:46 PM PDT

      •  Bleach really does wori

        in reducing ifectious diease.

        by DaleA on Mon Sep 17, 2007 at 12:45:31 AM PDT

      •  Um,

        there already is such an agency. It's called the FDA. And it is already as corrupt as you point out - although it did a much better job prior to the late 90s and its utter collapse in this decade.

        So, your point again, is what?

        by stitchmd on Mon Sep 17, 2007 at 05:41:33 AM PDT

        •  my point..

          The FDA approves drugs for use and yes it is corrupt and inefficent.

          With UHC you go beyond the FDA.  The govt. doesn't just approve drugs for use.  They say what drugs to use for what.

          So if the FDA is incompetent this new entity that will be like a super FDA should scare you.  It certainly scares me.

          Again, I never ceased to be amazed by people that know the government is corrupt and stupid, but what to give government ever expanding power.

          by consta on Mon Sep 17, 2007 at 09:17:15 AM PDT

          •  The FDA

            already says what drugs can be used for what. It's called approved indications. And it's supposed to be based on science.

            If you want examples, I can give you plenty.

            Physicians who use drugs for anything other than approved indications can be subject to legal liability, not just civil but also to actions by licensing bodies.

            Drug company agents who promote drugs for non-approved indications can be fired, and drug companies have been fined for making these promotions.

            Personally, I think this is the kind of role the FDA should have.

            by stitchmd on Tue Sep 18, 2007 at 01:22:58 PM PDT

          •  consta

            What you persistently refuse to understand is that when our public institutions are INTENTIONALLY corrupted, yes, they cease to work properly.

            That's why I never cease to be amazed by people who continue to elect industry shills to office, like Bush.

            One other thing you've failed to address completely is that as corrupt as government is, it can be re-dressed by electoral action.  You apparently don't have any experience working in the private sector.  You'd see corruption and incompetence that made your hair stand on end.

            And there's nothing you can do about that.  You can't vote a giant corrupt company out of business.  You can't even vote with your feet.  Business-provided health insurance is a prime example.  How can you shop around for insurance without shopping around for a JOB?  That's not a very good criteria for deciding where to work!

            But the desire we have for universal healthcare is very simple: take private industry, who have clearly demonstrated their inability to peform this function, out of the insurance loop and expand an already-functioning program called Medicare to everyone.

            I think the economic payback would be enormous, especially since dozens of other industrialized nations have already clearly demonstrated the overwhelming success of such a program.

            by slippytoad on Sat Sep 29, 2007 at 06:26:52 AM PDT

            •  Health

              But the desire we have for universal healthcare is very simple: take private industry, who have clearly demonstrated their inability to peform this function, out of the insurance loop and expand an already-functioning program called Medicare to everyone.

              If Medicare is about to go broke, what will happen when millions of people are added to the program?

              I think the economic payback would be enormous, especially since dozens of other industrialized nations have already clearly demonstrated the overwhelming success of such a program.

              What's the economic payback been like for those countries that have gone over to completely socialized medicine? Do they have less unemployment and higher per capita GDP than the US?

              by StainlessSteelUrsus on Mon Oct 01, 2007 at 10:07:48 AM PDT

    •  Only if you can afford it, Consta.

      My family of three is now paying $820 a month for health insurance--more than our total housing costs (mortgage, insurance,and utilities).

      Did I CHOOSE that?  Hell, no.  It was forced on me.  It is the only coverage I can get, because of my husband's variety of chronic conditions.  There is also a high deductible.

      I am very nearly at the point of having to choose between keeping up with those insurance premiums and heating my house this winter.  Of course, if I don't heat the house, our health is likely to deteriorate.  Not to mention the pipes freezing.

      If we had government-run, single-payer insurance, my taxes would go up--but no way they could possibly go up by $800 a month!

      You walk in the shoes of the uninsured or underinsured for a while, then see what single payer government run healthcare looks like to you.

      by Dar Nirron on Mon Sep 17, 2007 at 05:25:41 AM PDT

      •  yes

        But I'm concerned with net effects.  You situation is unfortunate, but the net effects of UHS will be bad for society.  

        You might get help. Other people will be hurt.  

        by consta on Mon Sep 17, 2007 at 09:18:33 AM PDT

        •  BULLSHIT!!!! n/t

          by Dar Nirron on Tue Sep 18, 2007 at 03:30:43 AM PDT

          •  um.

            Do you know what utilitarianism is?

            by consta on Wed Sep 19, 2007 at 10:37:05 PM PDT

            •  Yea, sounds like

              The kind of principle robots might use to design a human society.

              No thanks.  It's also based on a completely false premise.

              by slippytoad on Sat Sep 29, 2007 at 06:27:46 AM PDT

•  Come on -every other developed country has it

  Are you saying our government is stupider and less capable than all the others? If everyone else can do it we can.
  Your argument is so last century.

  by ellend818 on Sun Sep 16, 2007 at 11:06:34 PM PDT

  •  no...

    Other countries made a bad decision to switch to it.  We don't need to do the same.  

    Read more please.

    by consta on Sun Sep 16, 2007 at 11:10:38 PM PDT

    •  So all these countries are wrong

      and we're right?
      Just ask their citizens.

      by ellend818 on Sun Sep 16, 2007 at 11:12:34 PM PDT

      •  one citizen responding

        in a few words, consta has no idea of what he is talking about or has some other motive.

        by Euroliberal on Mon Sep 17, 2007 at 12:47:00 AM PDT

•  Universal Health Care

  in other countries is far more efficient and far less costly and covers everyone. To start read the diaries by Dr A
  http://dr-a.dailykos.com/
  That very thoroughly describe the UHC in other countries.

  by TheMomCat on Mon Sep 17, 2007 at 12:19:23 AM PDT

•  Life expectancy is not the most useful

  metric to measure health.

  by SeattleLiberal on Mon Sep 17, 2007 at 12:22:55 AM PDT

•  Diseases are infectious

  What do you not understand?

  by DaleA on Mon Sep 17, 2007 at 12:59:31 AM PDT

  •  i dont get your point.

    explain.

    by consta on Mon Sep 17, 2007 at 09:19:32 AM PDT

•  You're wrong on multiple levels.

  The disparities in life expectancy between various industrialized nations are in fact extremely significant. When you start approaching biological longevity limits, apparently minor gains in life expectancy in fact demonstrate major advances. There is no question about the fact that populations in England, France, Japan or the Scandinavian countries are substantially healthier than comparable American countries.

  There are other measures than life expectancy. Consider adult height; in most of Europe, adult height for both men and women continues to increase, to the point where most Scandinavian countries now have greater adult stature than Americans, when they were much shorter in the 1940's. In the U.S., by contrast, adult height is actually declining, which is an apparent reflection of worsening health and nutritional status in childhood over the last few decades. (Note that with exploding childhood obesity rates, there is a big difference between nutrition and empty calories.)

  Next, the poor rank of America in life expectancy has a lot to do with poor access to health care and shocking rates of poverty here. In Europe everyone has access to health care and nutrition is generally excellent. Here we have a huge underclass with far worse health outcomes and little if any access to care, compounded by unsafe workplaces and immense social stresses ranging from lack of child care and transportation to poor housing. The rapidly rising disparity between the extremely well off and the expanding ranks of the very poor, the near poor and the working poor is whittling away at that life expectancy.

  Finally, it's bullshit to artificially exclude accidents/homicide/suicide from the statistics. Lousy auto safety, drunk driving, alcohol/drug abuse and the widespread availability of lethal firearms are every bit as much a health issue as nutrition and medical care.

  by Ralphdog on Mon Sep 17, 2007 at 03:51:01 AM PDT