ACCOUNTING FOR AMERICA'S LONGEVITY LAG

Some commenters at POLITICO have replied to my posts that show America behind other advanced countries on many health measures reply that we're fatter and smoke more than the other countries that are ahead of us.  Until now, I've never found any research that examines this objection.

According to this study, neither smoking nor obesity account for America's comparatively poor longevity results.

What Changes In Survival Rates Tell Us About US Health Care

Peter A. Muennig1,* and Sherry A. Glied2
Health Affairs, doi: 10.1377/hlthaff.2010.0073
(Published online October 7, 2010)


We compared the performance of the United States to that of twelve nations that have populations of at least seven million and per capita GDP of at least 60 percent of the US per capita GDP since 1975. These nations are Australia, Austria, Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, and the United Kingdom.

If smoking is an important explanation of poor US health outcomes, this should be apparent in indicators of health that are closely linked to smoking. To assess this, we examined patterns of mortality from lung cancer, a disease mostly related to lifetime cigarette smoking, across countries over time (see the Appendix).24 Because lung cancer takes many decades to develop, on average, lung cancer mortality serves as a good measure of the long-term effects of smoking.

Behavioral Risk Factors Smoking:

For both age cohorts, the mortality from lung cancer over time has increased in the United States relative to some other groups, such as sixty-five-year-olds in Australia and Austria. However, US mortality from lung cancer has declined relative to other groups, including sixty-five-year-olds in Belgium and France. Lung cancer mortality rates varied greatly by country, age, and sex over the four time periods, and no clear relationship emerged.

Behavioral Risk Factors Obesity: 

For obesity to explain the decline in US life expectancy or the increase in health spending relative to the twelve comparison countries, Americans would have to be becoming obese at a faster rate than people in the comparison nations over time. Exhibit 3 shows that the United States has generally had a slower rate of growth in the percentage of obese men and women over this period, relative to many of the comparison countries for which data were available. Across both sexes and all time periods, there were only three instances in which obesity was growing at a more rapid rate in the United States than in the comparison countries for which data were available.