European Tribune - Community, Politics & Progress.

Musings on the US medical system

by edwin
Wed May 30th, 2007 at 06:49:24 PM EST

An amateurish attempt of understanding WHO results in healthy life expectancy:

http://www.who.int/whosis/whostat2006_mortality.xls (warning xls spread sheet)
Data sorted on healthy life expectancy

HALE - Healthy life is the number of healthy years one can expect to live.
Here are a few selected countries: (life male/female healthy life male/female)

Rank	country	life	hale
1	Japan	79/86	72/778
2	San Marino	79/84	71/76
11	Canada	78/83	70/74
29	United States	75/80	67/71
32	Cuba	75/80	67/70

First of all Canada is a thoroughly mediocre country when it comes to health care - coming in at position 11. Japan appears to be the best country closely followed by San Marino. Following San Marion is Sweden, Switzerland, Monaco and Iceland.

The US is a stunning 29th. Looking at Cuba at 32 should cause a certain amount of embarrassment and shock. While my list doesn't show it due to rounding, the average women in the US has just under 2 years more healthy life expectancy than the average Cuban. For men that figure shrinks to about a quarter of a year.

Cuba looks truly impressive, being #1 in the 3rd world for health care. The United States should be worried that Cuba may catch up and surpass them.

Ok, what's up? This is where conjecture and trying to make sense of various articles I have read comes in. Cuba seems to work very hard on preventative medicine. Perhaps Cuba has driven preventative medicine close to a realistic limit. When looking at what are the success of a country under cold war harassment and economic blockade this is truly an impressive result. At some point toys start playing more and more of a major effect on health care. Those few extra years require ever increasing amounts of money to pull off.

The US has the toys. Who knows, it may have more toys than anyone else. I have an aunt in Los Angeles who receives top-notch medical care - probably better than what I receive in Canada. What's up? Part of that answer can be found in my own health. As a child I occasionally had "stomach" pains. We never went to see a doctor and they always went away. To try to diagnose what may be nothing at all was prohibitively expensive to a family that had a working class income and didn't have good medical insurance. As an adult, in Canada, I have been diagnosed with a rare disease. It does not matter how good the toys are if you are unable to use them. My impression is that crisis medicine is truly at a high art in the US. Tests are relatively easy and waiting lists are shorter. You have to have the insurance though. But it is not only the tests and access. Preventative medicine is also required, and it does not pay nearly as well as crisis medicine. US medicine has proven to be a very expensive way to get limited results.

So what is the life expectancy of my aunt who is blessed with good health insurance? That is unknown, but one imagines that the rich get something for their money. Probably there is a strong correlation between access to health care and life expectancy. The rich get better medical care and probably live longer. What that translates into is this:

The median Cuban probably lives longer and has a healthier life than a median American. At any given time it may be true that for a specific condition you would be better off in the US than Cuba, but on whole you would be better off in Cuba health wise.

Lets look at it in terms of numbers. The average American gives 5.5 years of their life in order reap the benefits of a libertarianized medical system. The US has a population of 301,140,000 more or less. To oversimplify, if this was Japan we would expect 3,650,000 deaths a year. In Canada we would expect 3,741,000 deaths a year. In the US we would expect 3,886,000 deaths a year. The US pays 235,000 deaths a year compared to Japan or 145,000 deaths a year compared to Canada. Forget about US soldiers dying in Iraq, or dying from gun violence. The big deaths are within the medical system - murdered by American health care.

Full table

Rank		Life F	M	Health F	M
192	Sierra Leone	37	40	27	30
191	Lesotho	39	44	30	33
190	Angola	38	42	32	35
189	Zimbabwe	37	34	34	33
188	Swaziland	36	39	33	35
187	Zambia	40	40	35	35
186	Malawi	41	41	35	35
185	Burundi	42	47	33	37
184	Liberia	39	44	34	37
183	Niger	42	41	36	35
182	Afghanistan	42	42	35	36
181	Burkina Faso	47	48	35	36
180	Botswana	40	40	36	35
179	Somalia	43	45	36	38
178	Mozambique	44	46	36	38
177	Democratic Republic of the Congo	42	47	35	39
176	Central African Republic	40	41	37	38
175	Mali	44	47	37	38
174	Rwanda	44	47	36	40
173	Côte d'Ivoire	41	47	38	41
172	United Republic of Tanzania	47	49	40	41
171	Guinea-Bissau	45	48	40	41
170	Chad	45	48	40	42
169	Ethiopia	49	51	41	42
168	Cameroon	50	51	41	42
167	Nigeria	45	46	41	42
166	Uganda	48	51	42	44
165	Djibouti	54	57	43	43
164	Namibia	52	55	43	44
163	Haiti	53	56	43	44
162	Benin	52	53	43	45
161	South Africa	47	49	43	45
160	Kenya	51	50	44	45
159	Mauritania	55	60	43	46
158	Togo	52	56	44	46
157	Guinea	52	55	44	46
156	Equatorial Guinea	42	44	45	46
155	Congo	53	55	45	47
154	Lao People's Democratic Republic	58	60	47	47
153	Cambodia	51	58	46	49
152	Senegal	54	57	47	49
151	Sudan	56	60	47	50
150	Madagascar	55	59	47	50
149	Yemen	57	61	48	51
148	Gambia	55	59	48	51
147	Ghana	56	58	49	50
146	Timor-Leste	61	66	48	52
145	Eritrea	58	62	49	51
144	Iraq	51	61	49	51
143	Gabon	55	59	50	53
142	Myanmar	56	63	50	53
141	Nepal	61	61	52	51
140	Papua New Guinea	58	61	51	52
139	Bhutan	62	65	53	53
138	Tuvalu	61	62	53	53
137	Pakistan	62	63	54	52
136	India	61	63	53	54
135	Kiribati	63	67	52	56
134	Bangladesh	62	63	55	53
133	Bolivia	63	66	54	55
132	Sao Tome and Principe	57	60	54	55
131	Turkmenistan	56	65	52	57
130	Comoros	62	67	54	55
129	Tajikistan	62	64	53	56
128	Marshall Islands	60	64	54	56
127	Nauru	58	65	53	57
126	Guyana	62	64	53	57
125	Kyrgyzstan	59	67	52	58
124	Mongolia	61	69	53	58
123	Kazakhstan	56	67	53	59
122	Solomon Islands	66	70	55	57
121	Azerbaijan	63	68	56	59
120	Guatemala	65	71	55	60
119	Iran (Islamic Republic of)	68	72	56	59
118	Micronesia (Federated States of)	68	71	57	58
117	Maldives	66	68	59	57
116	Indonesia	65	68	57	59
115	Honduras	65	70	56	61
114	Russian Federation	59	72	53	64
113	Fiji	66	71	57	61
112	Suriname	65	70	57	61
111	Democratic People's Republic of Korea	65	68	58	60
110	Vanuatu	67	69	58	59
109	Egypt	66	70	58	60
108	Grenada	66	69	58	60
107	Ukraine	62	73	55	64
106	Philippines	65	72	57	62
105	Uzbekistan	63	69	58	61
104	Dominican Republic	64	70	57	62
103	Palau	67	70	59	60
102	Samoa	66	70	59	60
101	El Salvador	68	74	57	62
100	Brazil	67	74	57	62
99	Republic of Moldova	64	71	57	62
98	Thailand	67	73	58	62
97	Morocco	69	73	59	61
96	Belize	65	72	58	62
95	Lebanon	68	72	59	62
94	Niue	68	74	59	62
93	Algeria	69	72	60	62
92	Belarus	63	74	57	65
91	Cape Verde	67	71	59	63
90	Peru	69	73	60	62
89	Armenia	65	72	59	63
88	Jordan	69	73	60	62
87	Saint Vincent and the Grenadines	66	73	60	62
86	Seychelles	67	78	57	65
85	Viet Nam	69	74	60	63
84	Albania	69	74	59	63
83	Saudi Arabia	68	74	60	63
82	Nicaragua	67	71	60	63
81	Saint Kitts and Nevis	69	72	60	63
80	Sri Lanka	68	75	59	64
79	Cook Islands	70	75	61	63
78	Syrian Arab Republic	70	74	60	63
77	Tonga	71	70	62	62
76	Antigua and Barbuda	70	75	60	64
75	Paraguay	70	74	60	64
74	Ecuador	70	75	60	64
73	Trinidad and Tobago	67	73	60	64
72	Turkey	69	73	61	63
71	Colombia	68	77	58	66
70	Mauritius	69	75	60	65
69	Tunisia	70	74	61	64
68	Saint Lucia	71	77	61	64
67	Latvia	66	76	58	68
66	Romania	68	76	61	65
65	Malaysia	69	74	62	65
64	Lithuania	66	78	59	68
63	The former Yugoslav Republic of Macedonia	69	76	62	65
62	Bahamas	70	76	61	66
61	Libyan Arab Jamahiriya	70	75	62	65
60	Dominica	72	76	62	66
59	Serbia and Montenegro	70	75	63	65
58	United Arab Emirates	76	79	64	64
57	Oman	71	77	63	65
56	Estonia	66	78	59	69
55	China	70	74	63	65
54	Venezuela (Bolivarian Republic of)	72	78	62	67
53	Bahrain	73	75	64	64
52	Bosnia and Herzegovina	70	77	62	66
51	Georgia	70	77	62	67
50	Bulgaria	69	76	63	67
49	Hungary	69	77	62	68
48	Jamaica	70	74	64	66
47	Qatar	76	75	67	64
46	Brunei Darussalam	76	78	65	66
45	Argentina	71	78	62	68
44	Mexico	72	77	63	68
43	Barbados	71	78	63	68
42	Poland	71	79	63	68
41	Panama	73	78	64	68
40	Uruguay	71	79	63	69
39	Slovakia	70	78	63	69
38		72	79	64	69
37	Kuwait	76	78	67	67
36	Costa Rica	75	80	65	69
35	Chile	74	81	65	70
34	Cyprus	77	82	67	68
33	Republic of Korea	73	80	65	71
32	Cuba	75	80	67	70
31	Czech Republic	73	79	66	71
30	Portugal	74	81	67	72
29	United States of America	75	80	67	71
28	Slovenia	73	81	67	72
27	Ireland	75	81	68	72
26	Denmark	75	80	69	71
25	Singapore	77	82	69	71
24	United Kingdom	76	81	69	72
23	New Zealand	77	82	69	72
22	Greece	77	82	69	73
21	Finland	75	82	69	74
20	Belgium	75	81	69	73
19	Netherlands	77	81	70	73
18	Malta	76	81	70	73
17	Israel	78	82	70	72
16	Austria	76	82	69	74
15	Luxembourg	76	81	69	74
14	Germany	76	82	70	74
13	Norway	77	82	70	74
12	France	76	83	69	75
11	Canada	78	83	70	74
10	Andorra	77	83	70	75
9	Spain	77	83	70	75
8	Australia	78	83	71	74
7	Italy	78	84	71	75
6	Iceland	79	83	72	74
5	Monaco	78	85	71	75
4	Switzerland	78	83	71	75
3	Sweden	78	83	72	75
2	San Marino	79	84	71	76
1	Japan	79	86	72	78

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Musings on the US medical system | 5 comments (5 topical, 0 editorial, 0 hidden)

Re: Musings on the US medical system (none / 0)

I think you are assuming these numbers judge the efficacy of the various healthcare systems, and they do not. These numbers simply measure the life spans of people in the various countries. Life span is influenced by many other things, and just a few examples:
1. How healthy is the life style of the population?
-Americans live a notoriously unhealthy life style. Take weight as just one example. Americans have got to be the fatest people in the world, and an incredible number of diseases come with being overweight--diabetes, cardiac artery disease, etc.
-The murder rate is very high in America. Many would say due to the basically unrestricted control on guns. But it's also due to a very diverse society, where frictions can develop. But let me not discuss the cause, but just note the fact.
-Drug and alcohol abuse are very high in America. This hurts health in general, of course. But it also has a very direct impact on births, unfortunately. The number of pre-mature babies, crack babies, etc, are outrageously high. And of course not only is this very sad, but deaths before the age of one have significant impact on overly longevity numbers.
-There are many more points to be made here, but I'll leave these as examples supporting the overall point.
2. Certain ethnic groups seem to have longer lifespans due to good genes. Japan and Iceland in particular would benefit from that. The US is of course extremely diverse, and will not compare favorably to those two countries.

Comparing medical systems is certainly doable, but to get it right it requires going to a much lower level of detail. so for example, if you want to see how well a group of medical systems handle coronary artery disease, you would have to look at groups of, for example, men, in a certain age bracket, who present with very similar health overall (half of one group can't be diabetics while 10% of another group or diabetics--this impact would likely heavily bias the results), and the men would have to be broken into groups with similar levels of stenosis and likely in the same set of coronary arteries--but for example, one group couldn't have 50% of the patients being treated for occlusions in four vessels, and another group have 5% being treated for four vessel occlusions.

You would also have to look at access to healthcare. are there groups of people who are not treated? How quickly are they diagnosed and treated? So for example in the US, we have found that one of the key variables in handling heart attacks is how quickly the patient is rushed to the ER, and how quickly he makes it to the OR.

There are many more points to be made that explain the reason that such gross statistics are totally inadequate to assess medical systems. But hopefully this has provided some help.

Certainly such statistics as these do raise questions. Why are there these differences? And they may very well be a criticism in a broader sense of the overall US life style, if you could factor out ethnicity impacts for example. But they are not valuable in assessing healthcare systems.

by wchurchill on Wed May 30th, 2007 at 08:31:33 PM EST

Re: Musings on the US medical system (none / 1)

How a country deals with things like weight are considered health issues in most countries. The same with the more general heading of life style. I think that this is partially why Cuba rates so high. Health care goes way beyond broken arms and cancer. Most countries have treated couch potato syndrome as a health issue. In Canada there has been an ongoing attempt to get people off the couch doing something.

When it comes to the murder rate - it appears to be about 13,000 people per year, or about 10% of the difference in life expectancy between Canada and the US. (.042802 per 1,000). It seems perfectly reasonable to treat this too as a health issue.

I am thoroughly confused as to how access to health care is not part of health care.

The actual survival rate or the actual ability to handle coronary arteries seems to fail to deal with prevention - a key component of health care.

I find it amazing that Japanese - for example, would be predisposed to live over 5 years longer than Americans.

Certainly what I have presented is a rough look, but I think that it is far from useless.

We are for Justice and Mercy, and Truth and Peace, and true Freedom. Edward Burroughs 1659

by edwin on Wed May 30th, 2007 at 09:12:08 PM EST
[ Parent ]

Re: Musings on the US medical system (none / 0)

You said

I am thoroughly confused as to how access to health care is not part of health care.

But of course access is part of measuring the healthcare system. As is time to the ER for heart attacks. As is time from the ER to the OR, which was the point of my comment following

You would also have to look at access to healthcare. are there groups of people who are not treated? How quickly are they diagnosed and treated? So for example in the US, we have found that one of the key variables in handling heart attacks is how quickly the patient is rushed to the ER, and how quickly he makes it to the OR.

You said

The actual survival rate or the actual ability to handle coronary arteries seems to fail to deal with prevention - a key component of health care.

No, this would not be measuring prevention. It would be measuring treatment.

You said

I find it amazing that Japanese - for example, would be predisposed to live over 5 years longer than Americans.

last time I looked, Americans were not classified as an ethnic group. And I didn't say Japanese were presdisposed to live five years longer than Americans.

You said

Health care goes way beyond broken arms and cancer. Most countries have treated couch potato syndrome as a health issue.

Actually I think you'll find that America has been in the forefront of suggesting lifestyle changes. You might take warnings regarding cigarettes and public information campaigns, and compare how quickly the US got on this as opposed to other countries. I get plenty of advice on exercize and the right diet, right here in the USA. But at the end of the day, in America we are all free to make our own decisions regarding these words of advice. the fact that we may ignore them and put on weight might be a very valid criticism of our society, but not of our healthcare system.

by wchurchill on Thu May 31st, 2007 at 01:57:54 AM EST
[ Parent ]

Re: Musings on the US medical system (4.00 / 2)

thanks for this interesting diary.

i think that we can learn immense amounts from studying how different diseases are connected to different diets, and how when people travel and live abroad, changing their diets to match their new environments, succumb to the problems that occur in the adopted area.

i'd love to know more about this.

iceland is full of hot springs, and has a strong superstition still active in the peoples' imaginations.

san marino is tiny, and resembles italy entirely. the only distinction i'm aware of is in banking laws.

japan....strong traditions, reverence for culinary basics.

italy, if you can get over the 'best-dressed third world' issues, (basically chill out about the problems and have a goodish life anyway, like the italians do), is understandable, (strong traditions, reverence -to the point of fetishisation and way beyond! - for culinary basics.

it's very hard to see obvious connections, but i find it endlessly fascinating to search for them anyway.

meanwhile, i'd love to find links about regional and national diseases, and how changing your habitat can influence your chances to live a long, healthy life.

what would you google to find them, migeru, master wikiman?

Peace is not the absence of war -- peace is the absence of fear. Ursula Franklin

by melo (melometa4(at)gmail.com) on Thu May 31st, 2007 at 04:54:30 AM EST

Re: Musings on the US medical system (4.00 / 2)

San Marino, Monaco and Andorra are all tiny, virtually city states. Andorra, as might be expected, falls between Spain and France on the list. The other two both have a higher proportion of rich compared to the surrounding countries but also benefit from the health systems there too.

I would also suspect that all three have a population that is far more active than might be expected. They are after all very "vertical" countries and slogging up and down hills all the time is good exercise. There is also the tradition of the evening stroll to meet, greet and show off.

by Londonbear on Fri Jun 1st, 2007 at 04:11:43 AM EST
[ Parent ]

Musings on the US medical system | 5 comments (5 topical, 0 editorial, 0 hidden)

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