The U.S. longevity gap

Robert H. Shmerling, MD
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publications

It’s not hard to find someone praising the quality of this country’s healthcare. I’ve often heard it called the best in the world – and that’s a widely held belief among politicians, public officials, doctors, and patients. While there’s plenty of debate about why healthcare in the U.S. is so expensive and how we should pay for it, the high quality of our healthcare seems incontestable – more on this point later.

But if our healthcare is so good, why isn’t life expectancy in the U.S. the highest in the world? In fact, life expectancy in the U.S. lags by a number of years behind Japan, the United Kingdom, Spain, Italy, and many other developed countries. For example, the life expectancy in the U.S. is about 76 years for men and 81 years for women; meanwhile, in the U.K., it’s about 79 years for men and 83 years for women. This “longevity gap” is not something you hear much about, but it’s been true for quite a while.

Why the U.S. longevity gap?

A new study has identified three reasons that the United States is not at the top of the heap when it comes to longevity. They include:

  • motor vehicle accidents
  • drug overdoses
  • gun violence.

These are so much more common here and affect so many young people that they’re enough to account for about half of the difference in male life expectancy between the U.S. and other top-ranked countries. These causes of death account for about 20% of the difference for women.

These findings surprised me, especially when I learned that these three causes of death account for only 4% of all deaths each year. But they have a big impact on life expectancy because they tend to affect people who are so young. The reason they have a bigger impact on male life expectancy is that each of these causes of death is more common among men: they account for 6% of male deaths while for women, they account for 3%.

Perhaps these findings should come as no surprise. Deaths in car accidents, drug overdoses, and shootings have been well-recognized as important problems, and efforts to reduce them have been ongoing for years. But it’s one thing to understand the causes of premature death – and quite another to prevent them.

But life expectancy is only one measure of quality healthcare….

It’s true – life expectancy is not the only measure of healthcare quality. Unfortunately, there are other measures in which the U.S. lags behind comparable countries: the United States scores poorly in many key measures of health, including infant mortality, health at age 60, and deaths that could be prevented with good medical care.

Deaths due to shootings, automobile accidents, and drug overdoses explain some of this “longevity gap.” The rest may be explained by medical care that’s inaccessible, unaffordable, or just not as good as it’s been cracked up to be.

So, is there good news?

If there is any good news in this latest research about contributors to lower life expectancy in the United States, it’s that some of the primary causes – car accidents, drug overdoses, and shootings – are not new or untreatable conditions. They are potentially reversible problems that we actually know a lot about. While there may be no simple or quick solutions, it seems possible that with effective interventions, many of these deaths could be prevented. In addition, improving access to healthcare and identifying and addressing other gaps in healthcare quality could go a long way toward making the U.S. healthcare system as good as most of us thought it already was.

Related Information: A Plan for Successful Aging

Comments:

  1. paris hillary

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  2. Mick

    Asian, Jewish, and Hispanic Americans have exceptional longevity, White Americans mediocre longevity, Black and Native Americans poor longevity–all compared to other top countries. Basically, the longevity of these groups tends to follow their IQs, education levels, affluence–take your pick. This is true for each group except for Hispanics, whose longevity is much better than these factors would predict. There is little analysis on the Hispanic exception. Probably it’s multifactorial: shorter stature, many recent immigrants who work on their feet and eat more traditional foods, better cohesion of extended families, lower susceptibility to inflammation due to Indian heritage.

  3. John Trainor

    It is surprising, and not surprising at the same time, that the author speaks of USA healthcare as among the best in the world. It is not. It is ranked 37th by the WHO and dead last among 11 developed countries in a recent Commowealth report. This is made worse by the fact that the US outspends every other country on earth and still has millions of uninsured people. The waste of the privately run system is extreme. Time to stop the magical thinking: the US has the worst health system for the money, and even with the huge expenditure is 37th internationally. A Harvard author should do better.

    • Joan Masover

      The author did not “speak of US healthcare as among the best in the world.” The author wrote: ” I’ve often heard it called the best in the world – and that’s a widely held belief among politicians, public officials, doctors, and patients.” He then proceeded to debunk what he’s heard, both in terms of longevity and then later in terms of a long laundry list of ways in which we lag comparable countries.
      So I think you missed much of Dr. Schmerling wrote.
      The main point of the article as I read it was to point out three important and perhaps heretofore un-measured and un-studied causes of our longevity lag: Cars, guns, and drugs. Perhaps we could encourage our politicians to unshackle the NIH from studying the impact of guns on health and, well, mortality…

  4. AB

    Ever since I was a grade student at Stanford and became the victim of their medical professionals I haven’t considered for a second our med system is good. They told me: steroids for life for crippling RA. I went over to med school library, researched journals and texts, found out what was going on with RA, then surveyed about 10 health food stores for what their customers did for RA, took the elements common to all and designed my own protocol. The Stanford rheumatologists screamed at me and decided my future was hopeless and I’d be back crawling, begging for help. Took about 6 months to see noticeable difference and in a year neither my clawed hands or painful hips still existed.

    And when they wanted to operate on my daughter I pushed my protocol on her and the last test they did on her convinced them surgery was not necessary as she was turning around. My son was on the table in surgery at Stanford and the surgeon came running out – telling me he didn’t need the ear surgery – everything was fine. He said he’s never seen anything like it. When I told him what I did he scoffed. Ok, much better to believe in miracles instead of evidence?

    The biggest con in medicine in US is that we are the best. The PR machines from the pharmaceutical companies go into overdrive to push this agenda to sell their products. Exactly what does Hillary have to say to them that is so valuable they give her 350K to talk? Follow the money.

    CDC says medical errors are third leading cause of death in US.

    Bottom line: of that study: chemo spreads the cancer through the body. This info can be found in so many ways, in so many studies and oncologists know it but the profit margin on chemo is so high it makes up the bulk of their income.

    How many oncologists know about LDN and cancer? Have they seen the videos of a presentation of tumor slides at USC med by an MD/PhD who uses it for pancreatic cancer (with alpha lipoid acid). Yea, right, thought so…the number is almost non-existent. Much easier to say, “This is the most difficult cancer to cure.”

    Best medical care? Only recently are they discovering the role of the immune system and inflammation in cancer – and those who said it for the past 50 years are conspiracy theorists, practicing ‘woo’ and so on and so forth.

    My diabetic friend in Marin General was served a “diabetic lunch” consisting of noodles/pasta. And ginger ale. Yes, it was labeled diabetic lunch – Tell me again how good we are?

  5. john teeling

    Who believes that average US health care is as good as that available in most European and some Asian countries ????Certainly not those of us who live abroad and travel
    In Europe horror stories abound about people in the US with no insurance being denied care,about injured people getting no treatment until their insurance is checked,about vets waiting years
    the statistics are there
    But it is not only in health
    In the US people are under the illusion that their way of life and standard of life is the best in the world
    It was
    It still is for the well off
    But increasingly it is obvious to outside observers that the average family in the US is not as well off as an average family in Europe

    The US is a mature declining economic force

  6. carlo zezza

    My single observation has no statistical significance, but my wife’s five-year terminal illness (leukemia -> lymphoma) afforded a dramatic contrast between health care in France (single-payer) and USA (insured coverage). Treatment was identical – assured by weekly email correspondence between US and French doctors. Nurses, orderlies, and administrative staff were uniformly more caring in France, more impersonal in USA. Billing in France was one-third to one-quarter of costs in the USA. Both economics and personal experience favor France, not USA.

  7. Bob Wayland

    It is valid to point out that U.S. life expectancy is less than comparable countries and that there is much we might do to close that gap. But ascribing all causes of death to defects in “healthcare” is also misleading and overreaching. We should also look at the efficacy of health care actions per se. For example, detection and cure rates for specific conditions or diseases. We should look at the access conditions for all citizens. But we should not expect the healthcare system to be responsible for all of the choices that people make.

  8. Fred Ris

    Before I reached the list of factors, I was guessing that widespread obesity (and/or dietary habits) would be a factor. Perhaps it is less so because of the statistical lever cited — early deaths reduce the average a lot more that later ones. But isn’t this going to become a growing factor as early-onset obesity (which term I just made up for this) increases?

  9. to thanh son

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