I’m an American that moved to Europe over ten years ago. It’s interesting to see what I’ve anecdotally observed backed up by real stats - old people just seem healthier and more active here. I’ll be hiking in the alps and being passed by old people on the trail. I’ve gone ski touring and saw people in their 70s climbing mountains with me. I had a 90-year-old neighbor that was more active than me in the neighborhood until she finally died outside walking.
Another observation - wealthy Americans live like poor Europeans. Living somewhere where you have to drive everywhere is something that poor people have to do here. Eating manufactured unhealthy food - poor.
I am a dual national with roots in Europe. A far greater contributor is the lack of avoidable chronic disease in Europe. I know many middle class and above Americans who have ongoing battles with their insurance companies to treat and manage relatively mundane issues. If they apply enough time and money they can usually resolve things though often this requires pausing treatment or changing doctors recommendations.
This does not exist in Europe. What your doctors recommend happens regardless of your income.
There is an image I see when in the US. A homeless person who is crippled and pushing themselves with a stick or one leg in a wheelchair. Lame thanks to lack of treatment. You never see that in Europe. Homeless people exist but they aren’t chronically ill.
This has positive effects for everyone. There is less disease in the environment and it’s easier for people to literally get back on their feet.
It’s a bit of wishful thinking to presume Americans poor health is all lifestyle choices and advertising. It’s the system and a pervasive lack of easy to access treatment at all levels of society.
I have what I believe is "decent" employer-sponsored health insurance, but using the healthcare system is still an enormous pain in the ass, as is getting insurance to pay for the things that they are supposed to. I'm pretty healthy and young. I keep wondering "are there really that many people whose experience getting healthcare system doesn't suck ass and feel like getting robbed"? My partner insists that our health insurance must actually not be that good, I believe that our health insurance is above average and Americans have been conned into ignoring their own direct experience, but neither of us have much of a reference.
Insurers aren't there to help you. I've never met a person in all my years who was happy with health insurance. And that includes before the "cadillac" insurance packages were done away with.
People don't want or choose this system (unless they work for insurers), but their voice doesn't matter. No politicians can afford to oppose the health care industry. We need campaign finance regulation, investment in education, and public election platforms to shift away from this unhealthy way of life.
It's, in part, the American diet. Americans eat an insane amount of beef, fat, grease, etc which accumulates into old age. Then older Americans see a reduction in "usable years" because basic things become difficult.
A lot of older Americans are "skinny fat". In that they might not appear obese, but their actual health compares to an obese sedentary person.
Add in the car centric culture, the obsession with luxury goods(beef is a luxury food), and the glorification of sedentary lifestyles, and you get olds who can barely walk for the last 20 years of their life.
We're also seeing a crazy uptick in people in their 20s coming down with heart diseases. I havent looked into that specific issue in a while but the leading theories were over consumption of caffeine and beef.
I grew up in rural America. I watched so many older people I knew come down with diabetes and heart issues in their 40s and early 50s. It meant they couldn't do much physically. A lot of older Americans, especially rural, spend their last 20 years trapped in their home because going outside is too much effort. In hindsight, and the data backs this up, it's clearly their diet. Americans glorify overconsumption of horrible foods. We made beef and meat a luxury good and encouraged it's over consumption by making it a "thing" successful people consumed every night.
> We're also seeing a crazy uptick in people in their 20s coming down with heart diseases. I havent looked into that specific issue in a while but the leading theories were over consumption of caffeine and beef.
I highly doubt it's caffeine, here in the Nordics we consume an absurd amount of coffee, and don't seem to experience a higher-than-average rate of heart disease in young adults.
It's energy drinks specifically. Multiple studies have found that the combination of caffeine + other stimulants produce heart issues that caffeine alone does not produce.
1 in 3 American children drink at least one energy drink per day. 2/3rds of teens have had an energy drink within the last 3 months.
The US sees a weirdly high amount of hospitalizations related to energy drinks. It's a problem.
This stuff stresses the heart way more than necessary and by their early 20s a lot of kids are showing heart issues.
This is also varied heavily in the US? My wife and I joke all the time that the 70yos are out jogging every day where we live, now. There is a set of cyclists that are all in their 60s we see several times a week outside of our house.
To an extent, I suppose. There is also something to be said for just wanting to get outside. Summers in the pacific northwest are also a lot of really long days.
Just writing that, though, makes me realize that most of the northern sections of the US are inline with what we call western Europe? Would be neat to see this broken down by latitude as a crude cohort check.
Most of the northern sections of the USA are on the same latitude as Southern Europe, reaching at most into South France. Germany, the UK are further north than the 45th parallel.
A lot of Europe experiences longer days than PNW during spring to summer.
As someone who lives part-time in Europe (and they can be mostly lumped together because of shared culture and the EU, but I spend significant time in 3 EU countries in addition to living 6 months of the year in a single one) but raised in Canada...
- Europeans have access to better quality food. Good vegetables are the rule as opposed to the exception, commodity meat is better quality and high quality dairy is cheap.
- Europeans walk, a lot. As most towns existed before cars, they're all built for walking. Mixed use neighbourhoods are the rule rather than the exception. Europeans are also far more social and that often means doing physical activities with your friends (I play football and futsal with a group of guys from the village, ages 25-60).
- Europeans do drink a lot, but it's in moderation, if that makes sense. Less binge drinking all at once, more drinks during meals and spread throughout the week. We all know the liver processes alcohol at a specific rate so this is less damaging to health.
- Universal healthcare. Even the EU countries with mixed public/private systems make it universally available. Insurance rates far more reasonable, less strings attached. Unlike in Canada, we have a paediatrician in Europe. We can see a doctor same day without resorting to the ER. Appointments can be made typically next-day, although I've heard of waits that are several days in the city. Versus Canada where we can't even get a family doctor at all and need to go to the ER for anything.
- Stress. 5 weeks vacation. Employee-friendly laws. Active, social lifestyle. Everyday necessities are far more affordable. Rent isn't 60% of the average take-home income (unlike Canada).
> Europeans do drink a lot, but it's in moderation, if that makes sense. Less binge drinking all at once, more drinks during meals and spread throughout the week. We all know the liver processes alcohol at a specific rate so this is less damaging to health.
I'm sceptical that this is a big factor. Ireland and the UK have a big binge drinking problem, but Ireland's in the top end of European countries for life expectancy; the UK's a bit lower down the list, but still just about at the EU average.
Though, you also have to be careful with small differences, because the data is often imperfect. One darkly funny thing to come out of the covid pandemic was that there were significantly more very elderly people in Ireland than it was generally believed; this showed when the covid vaccination rate for the over-85 age cohort went over 100% (I think it hit 109% by the end). It turned out that the central statistics office's population estimates had simply been wrong; they had been running off an assumed death rate since the last census which turned out to be overly pessimistic.
IMO, Italy, France, Spain. In that order. We have a home in Czech Republic (my partner's country of origin) and I'm also partial to the food there (I'm also east European but a generation back), but it's probably not quite as objectively good as the first 3, still better than Canada though.
Not surprising given our diet and car-dependent culture.
From the article:
>While less access to health care and weaker social structures can explain the gap between the wealthy and poor in the US, it doesn't explain the differences between the wealthy in the US and the wealthy in Europe, the researchers note. There may be other systemic factors at play that make Americans uniquely short-lived, such as diet, environment, behaviors, and cultural and social differences.
"While less access to health care and weaker social structures can explain the gap between the wealthy and poor in the US, it doesn't explain the differences between the wealthy in the US and the wealthy in Europe, the researchers note. There may be other systemic factors at play that make Americans uniquely short-lived, such as diet, environment, behaviors, and cultural and social differences."
Off the top of my head, obesity seems like the obvious culprit to investigate. If so, I wonder if semaglutide will close this gap again?
to me, the rabid response to anything remotely resembling socialism, and the inability to see life as anything but a zero-sum game is the obvious culprit. this precludes caring for eachother, and creates a life that's essentially a never-ending rat race for everyone, rich and poor alike.
you cant inject your way out of a society that is, at its core, defined by class/racial segregation, systemic inequality and distrust of governments.
The death rate everywhere in the world is the same and is equal to 100%. Everyone dies someday. The article's title should have used something like "life expectancy" instead of "death rate".
In the Midwest US I also see evangelical Christianity pushing faith healing so hard that to be some kinds of sick are moral failures. Combined with the puritan view of poverty as a symptom of moral failure, and there is a lot of turning up ones nose at the poor and sick as undeserving of public assistance. Only when they bend the knee to God will they be worthy of help, and only with strings attached.
What you describe is more accurately called the "prosperity Gospel", not evangelical Christianity. Mainstream evangelical Christianity doesn't believe anything like what you describe.
What I describe is what I've seen in many evangelical churches over decades and in three different countries, first hand. Evangelicals like to think their flavor is immune from all that ailes other branches of Christianity. Yet they too look down on the sick and the poor, sometimes more than older and more traditional strains of the religion.
Non-prosperity gospel churches don’t say it out loud, but the implications are easy to draw. Massive ideological and cultural structures aren’t logical proofs, there are many contradictions.
But it's the job, the obligation, of a democratic government to create a safety net so people who enter poverty can bounce out of it. No religious nut should be in charge of that, although I can see how that is very convenient to play politics.
I suspect you think that healthcare is helpful, and that if we could only buy poor people more healthcare then their lives would be improved. Healthcare regularly doesn't help that much. Even the richest often die young because healthcare regularly cannot FIX things (think chemotherapy then die).
There's some mental fallacy we buy into that health can be fixed - when the only healthy choice is preventative mitigation. The answer is to live a healthy life: especially regular exercise. But also sensible food choices and removing stress (remove stressors or maybe learn techniques to ignore stress), and avoiding drugs/alcohol/smoking.
Rich Americans are unhealthy too and for the majority how much they spend on medical interventions usually doesn't fix their quality-of-life or length-of-life.
The poor mostly have as much access to a healthy life as the wealthy: so why are both the poor and the rich unhealthy?
The hard question to answer is why we live unhealthy lifestyles ;; is it capitalist advertising ;; should we blame cultural mores ;; are we victims of our own poor choices...
Anecdotes (New Zealand specific):
1: a poorer friend with hip problems that needed replacements in 40s but was forced to live in excruciating conditions for years due to how New Zealand's socialised health budgetary constraints are implemented (via waiting lists). No money was saved by the government because the surgery was eventually paid for (background: surgery cost for both hips was approx equal one pretax year of minimum wages in NZ).
2: two friends with a poor backgrounds that got middle aged diabetes - my guess is caused by booze & maybe smoking. Both THEN started exercise and also changed their habits and lifestyle. One is well off and money didn't really help them. Both could have previously lived healthier lifestyles but only changed their habits after being faced with severe frightening outcomes. Drugs like metformin help (that drug is cheap, however ongoing regular monitoring by doctor is not cheap). Expensive surgical interventions caused by diabetes will never fix the problems caused by poor living.
How much we should blame people's "choices" for poor health outcomes is difficult to answer. If someone chooses to drink booze, how much should society pay for their choice? We have high sin taxes in New Zealand so people have often paid for their medical help however the taxes do not cover the overall societal cost. A better example is acquaintances that have destroyed their health through recreational drug usage (which definitely isn't sanctioned by larger society, and definitely is sanctioned by peer society). I'm a huge believer in personal choice - but I'm no fan of having to pay for the bad choices made by others.
That's the issue with New Zealand's socialism. I can carefully live a prudent life : however it galls to be taxed to pay for people that ignore the cost of their choices.
Aside: it really neeps my bibbles that doctors are seen as saving lives. Engineering, economics and science save most lives. Doctors don't help much. (Ofc "saving" lives is a nonsense term anyway)
The thing missed in all these arguments is a large variety in life expectancy between states, and demographic controls. The states all have more or less the same problems and non problems with their healthcare system, so it cannot really explain that. And I'm pretty sure levels of car dependence won't explain a large part of it either since most states are largely car dependent.
Iirc (phone post) japanese Americans have higher life expectancy than Japanese, or at least in the ballpark.
Maybe some cultures/lifestyles, like whatever they are doing in the South, just suck. OTOH, maybe we should allow people to make choices. I'm pretty sure I'd live longer if I did interval sprints instead of reading HN, but that's a tradeoff I am willing to make.
Well, Switzerland cowardly decided not to react or retaliate, even though those tariffs make no sense.
I don't know why we expect a reasonable response here, if you ask me this is a huge red flag and warning that the US is not a trustworthy trade partner.
It's the build-environment (how cities are designed). Everything is America is segregated, especially by income, age and race to an extent. Culture (fitness and food) also play a role. There's a reason more walkable places like Denver and NYC have healthier people.
I’ve observed in Australia, the closer you are to the CBD (the main city postcode), the healthier the people are, once you get to the outer suburbs is like an entirely different country. The streets look different, the people are all obese, the cars are bigger, etc.
I honestly think that we don’t put enough emphasis on how bad cars are for your health.
At first glance it looks sprawly but then visiting there you realize most of those tract housing developments open up in the back to some walk and bike trail network, which remain sunny dry and mild much of winter (the real snow is in the mountains denver is frequently bone dry), and a good portion of the population is getting 50 days out of their epic or ikon pass plus engaging in some summer outdoor hobby.
Fifty years ago, one heard that Colfax Avenue was the longest street in the US, or maybe the world. I got a lot of exercise in my Denver days, some of it running or hiking, but I also spent a lot of time in cars.
I read something recently that said the rise of American suburbia can be traced to increased rates of crime in the cities due to immigrant populations (this was over the last 50 years or so).
Now that Europe has seen such a huge increase in immigrant populations (and the corresponding crime increases), perhaps suburban-type environments will become more desirable there in the near future.
What you are referring to is called "white flight" and the causes were more complex than crime or immigration.
The casual link between immigration and crime is generally agreed to be false. So whatever you read that claimed immigration caused crime to go up seems incorrect.
Except here in Germany, at least the restaurants (but the art of cooking has declined too, favoring frozen pizza and similar foods). Especially since COVID. Our restaurant food is not good, and will still get five stars in the restaurant reviews all the time.
After COVID it got even worse. In my major city I saw food in well-known central restaurants become really bad, despite significant increases in price, and I mean "bad" and not just "it is not as tasty as I would like".
What is thriving are Döner (kebab shops) - often using questionable "meat", dirt-cheap Asian places (nowadays often with "Sushi", at very low prices), and burger shops. Italian restaurants focus on pizza and pasta - the cheapest-to-prepare easy-carbs-focused options.
I miss the Bay Area and its food options (I used to live there for quite a few years).
There's an aspect of "have to", as well, in many larger cities. I mean, I suppose if you were morally opposed to walking maybe you could spend a couple of hours a day in traffic and rent parking somewhere... Many offices, even offices in which very affluent people work, would not necessarily have parking, and if they did it would not be enough for everyone. I work for a big multinational in Dublin, in an office that has about 500 people and I think about 30 or 40 parking spaces. This is the first office I've worked in that had parking at all (mostly a consequence of it being from the 1970s), and Ireland is one of the _more_ car-oriented European countries.
And Dublin isn't exactly a huge city. If you take the likes of London or Paris, most affluent people are going to be commuting by public transport; driving just isn't really practical.
I'd be curious whether NYC, which has some aspects of this, has longer life expectancies than elsewhere in the US.
But longer-term/bigger-picture I think I'd argue it is that way because that's the culture.
If we wanted to drive everywhere we'd see (over time) more suburbs springing up devoid of high streets and new town centres, with parking facilities near to existing centres, or as brownfield developments on the sites of former walkable residences.
You more or less have to. If you're very wealthy I guess you could travel everywhere on a sedan chair or something, but the US thing where you drive to everything can't work in many parts of Europe.
In very high density areas they don't want private motor vehicles so they're just banned, there's maybe public transit but you'd really have to be unhurried to take public transit over a distance that's say a 10 minute walk.
In very low density areas nobody bothered adding a road. Why not just walk? I mean you could use a serious off road vehicle (no the fact your "truck" says it has AWD does not mean it will work) but even in places where that's legal why not just fucking walk?
Would be interesting to see what the causes of death were?
I'm also still surprised that "current smoking status" is a thing. Quickly checking, seems a lot of western Europe is higher in that than the US? Curious how regional that is in the US, even. I don't see nearly as many smokers around home as I do when I visit the likes of Atlanta.
To me, this is an excellent argument that merely making healthcare more affordable in the US isn't the answer.
I'd like to posit that the culprit(s) of bad US health could likely be narrowed down by carefully analyzing the differences between (a) 1970 and now; and (b) Americans and Europeans in an exhaustive list of the human body's environmental touchpoints, narrowing the list to things that apply to >90% of each population. A few examples:
- food supply differences. For example, European regulation prohibits GMO and a lot of pesticides that are allowed in the US. Meat also differs significantly in their food supply (corn vs grass for beef) and other factors.
- vaccines. How much of the European vaccine schedule's components are not sourced from American suppliers?
- atmosphere. Off-gassing of synthetic materials in homes and offices is a newer thing.
- containers. In 1970, none of the food supply was distributed in plastic containers, for example. And glass containers are a lot more popular in Europe than the US.
I do wonder whether the answers could be staring us in the face, but have been suppressed because of corporate interests in the US. (Much the same as how cigarette smoking was publicly labeled "healthy" prior to the 1970s, even by scientists and doctors, because of studies funded by Philip Morris and other tobacco companies.) At least theoretically, health-related companies do stand to benefit financially from keeping us alive but less healthy. Widespread chronic semi-disease does make a lot of money, especially for vertically integrated insurers who can delay/deny claims, and for suppliers who have achieved regulatory capture of some sort.
> The EU uses the precautionary principle, demanding a pre-market authorisation for any GMO to enter the market and a post-market environmental monitoring.
Much of the monitoring is to avoid or trace cross-contamination between fields, and ultimately the reason for that is significant consumer demand for non-GMO food, so that farmers who are non-GMO don't want their crops contaminated by a neighboring field that has GMO plants.
> GMO is not forbidden. It just has to get approved case by case.
Allowlisting makes so much more logical sense. New ideas shouldn't be allowed by default.
Especially when so many variables are at play, the FDA's denylist model across a massive population makes it very difficult to narrow down what is causing a problem. If I could make only 1 change to US health policy, it would be switching the FDA to allowlisting.
I've read somewhere that the poor and the rich get the worst healthcare in the US. The poor because the just don't get any. The rich because healtcare providers will do whatever (they think) the paying client wants, including unnecessary stuff, and hiding unpleasant news.
I'm not in the US, so I can't validate this, however, it does help explain why healtcare outcomes for the rich aren't very good.
Realistically I’ll take my 82.6 years in San Francisco over 78.1 in Berlin, 85.39 in Madrid, or 80.4 in London. The tradeoffs are better for me and I don’t want to make America into Spain to get those last 3 years to Madrid. It’s all right. 82 is a good life.
To each their own. I’m headed to Spain to live, not to grind unnecessarily. You only get one life, and most of how we spend our days outside of family and loved ones doesn’t matter. I’ll have a glass of Sangria for you (a lie, I’ll take the whole pitcher and drink while reading HN).
America gets what it deserves: self defeating turmoil and churn disguised as effort and progress, while objectively being a worse place to exist (happiness, health outcomes, etc). Line goes up, but life is suffering.
On a per capita adjusted basis UAE/Dubai blows about every other place out the water for number of incoming rich migration (even on absolute basis they are near top). Much easier to get an investor visa, far lower taxes on business income, you can easily import servants and trade duties are miniscule. Everything is available if you are rich because all you must do is fill out some relatively simple paperwork and whoever you want appears.
It looks like in this age for the rich the optimum is something closer to dictator capitalism, as democracies start to embrace more regulation and social redistribution schemes. Singapore and Dubai have been winning choices so long as the people in power don't change their mind and start splitting skulls.
The Middle East human rights situation is in conflict with my belief and value system. Agency and autonomy are important, as well as shared responsibility and collectivism (as no one is an island). Us, not I.
I like taxes, with them I buy civilization, help those in need, and build lasting institutions of value and relevance.
And they don't even bother holding their noses tightly sealed as they let them pass. Source of income (you know what I mean) has no bearing on these places. Enjoy your neighbours, definitely don't piss them off without.. consequences
As a Spanish person I can’t even imagine what would make someone come here to live - I suppose you’re already exceedingly wealthy?
Almost all of my friends with higher educations have left for northern countries, as the situation here is untenable for young people. Of course if you have money that’s not an issue… and evidently the kind of money that makes that non an issue can only obtained in places like the US.
Spain is one of the best places in the world to live if you have a steady income, you don't have to be wealthy to be happy. I've lived there for many years working for Spanish companies, with spanish salaries.
But seeing how you blame mass immigration, mostly uneducated and low-skilled workers, for the fall in wages of the educated people leaving the country, I wonder if your vision isn't too myopic and narrow on economic issues due to political bias.
As for the struggles of the young people in the country, because real state is inaccessible, I agree with you, but it's a problem in most capital cities of the civilised world.
I didn’t blame mass immigration for the fall of wages of educated people. Maybe you misunderstood what I said. It’s uneducated young people who suffer from that. I have clarified my other comment.
>Almost all of my friends with higher educations have left for northern countries, as the situation here is untenable for young people.
>Bottom of the barrel wages for natives are the result of uncontrolled mass migration - we have received millions of immigrants in the last decade, which has basically destroyed wages.
Putting those two sentences of yours together triggered that thought in my mind, I apologise if I was wrong.
when you say "immigration has destroyed wages" you mean "immigration has lowered the floor of low wages" but you also imply "businesses CAN pay higher wages but WON'T".
i wouldn't blame the immigrants there. the whole thing managed correctly would be (or actually already is) a huge boon for the country. the suffering of the young and poor seems to be a choice made by the greedy.
Well that explains it doesn't it? One can cheaply employ your youth at bottom barrel wages and buy up or rent the real estate without competition with native professionals. And I'm not damning anyone who does that, it helps the locals more than them not coming at all. The Spanish government has more or less set up the incentives to play out this way -- that Spain is a place to come on holiday or to retire but not a place for native educated professionals to partake in business.
Bottom of the barrel wages for the uneducated natives are the result of uncontrolled mass migration - we have received millions of immigrants in the last decade, which has basically destroyed wages, and has made the poorest suffer.
On the other hand real estate is held by wealthy old natives and laws are enacted to make sure that real estate increases in price forever, the young be damned - no one cares about them since our population pyramid means they’ll always be a minority.
I’m very interested in understanding the challenges in building more affordable housing in Spain. Do you have any resources you’d recommend or be willing to discuss more offline?
Regarding renting, it’s legally almost impossible to kick out a squatter, which means most people choose to leave their empty homes closed instead of renting them, which, added to mass immigration, has led to a surge in rent prices.
It’s a complex, nuanced topic, but the cost of living in most of Spain is much lower than the US. Healthcare in the US for a family of four costs me >$20k/year. You can live comfortably in Spain for ~1.5x that in euros.
Funny and sad anecdote - I was travelling through Paris and met some Americans on the train.. and they commented on the fact Paris doesn't seem to have many medical facilities compared to the USA.
It was presented as a negative, which seemed shockingly shallowly thought through to us as non American tourists.
"The findings are a stark reminder that even the wealthiest Americans are not shielded from the systemic issues in the US contributing to lower life expectancy, such as economic inequality ...," lead study author Irene Papanicolas, a professor of health services, policy and practice at Brown, said in a news release.
That's a pretty funny take, that economic inequality is a systemic risk for rich people. I wonder if Dr P thinks that the stress of noblesse oblige is too much for the frail US elites (as opposed to the horrible diet endemic in the US)
Another observation - wealthy Americans live like poor Europeans. Living somewhere where you have to drive everywhere is something that poor people have to do here. Eating manufactured unhealthy food - poor.
This does not exist in Europe. What your doctors recommend happens regardless of your income.
There is an image I see when in the US. A homeless person who is crippled and pushing themselves with a stick or one leg in a wheelchair. Lame thanks to lack of treatment. You never see that in Europe. Homeless people exist but they aren’t chronically ill.
This has positive effects for everyone. There is less disease in the environment and it’s easier for people to literally get back on their feet.
It’s a bit of wishful thinking to presume Americans poor health is all lifestyle choices and advertising. It’s the system and a pervasive lack of easy to access treatment at all levels of society.
People don't want or choose this system (unless they work for insurers), but their voice doesn't matter. No politicians can afford to oppose the health care industry. We need campaign finance regulation, investment in education, and public election platforms to shift away from this unhealthy way of life.
A lot of older Americans are "skinny fat". In that they might not appear obese, but their actual health compares to an obese sedentary person.
Add in the car centric culture, the obsession with luxury goods(beef is a luxury food), and the glorification of sedentary lifestyles, and you get olds who can barely walk for the last 20 years of their life.
We're also seeing a crazy uptick in people in their 20s coming down with heart diseases. I havent looked into that specific issue in a while but the leading theories were over consumption of caffeine and beef.
I grew up in rural America. I watched so many older people I knew come down with diabetes and heart issues in their 40s and early 50s. It meant they couldn't do much physically. A lot of older Americans, especially rural, spend their last 20 years trapped in their home because going outside is too much effort. In hindsight, and the data backs this up, it's clearly their diet. Americans glorify overconsumption of horrible foods. We made beef and meat a luxury good and encouraged it's over consumption by making it a "thing" successful people consumed every night.
I highly doubt it's caffeine, here in the Nordics we consume an absurd amount of coffee, and don't seem to experience a higher-than-average rate of heart disease in young adults.
1 in 3 American children drink at least one energy drink per day. 2/3rds of teens have had an energy drink within the last 3 months.
The US sees a weirdly high amount of hospitalizations related to energy drinks. It's a problem.
This stuff stresses the heart way more than necessary and by their early 20s a lot of kids are showing heart issues.
Just writing that, though, makes me realize that most of the northern sections of the US are inline with what we call western Europe? Would be neat to see this broken down by latitude as a crude cohort check.
A lot of Europe experiences longer days than PNW during spring to summer.
- Europeans have access to better quality food. Good vegetables are the rule as opposed to the exception, commodity meat is better quality and high quality dairy is cheap.
- Europeans walk, a lot. As most towns existed before cars, they're all built for walking. Mixed use neighbourhoods are the rule rather than the exception. Europeans are also far more social and that often means doing physical activities with your friends (I play football and futsal with a group of guys from the village, ages 25-60).
- Europeans do drink a lot, but it's in moderation, if that makes sense. Less binge drinking all at once, more drinks during meals and spread throughout the week. We all know the liver processes alcohol at a specific rate so this is less damaging to health.
- Universal healthcare. Even the EU countries with mixed public/private systems make it universally available. Insurance rates far more reasonable, less strings attached. Unlike in Canada, we have a paediatrician in Europe. We can see a doctor same day without resorting to the ER. Appointments can be made typically next-day, although I've heard of waits that are several days in the city. Versus Canada where we can't even get a family doctor at all and need to go to the ER for anything.
- Stress. 5 weeks vacation. Employee-friendly laws. Active, social lifestyle. Everyday necessities are far more affordable. Rent isn't 60% of the average take-home income (unlike Canada).
I'm sceptical that this is a big factor. Ireland and the UK have a big binge drinking problem, but Ireland's in the top end of European countries for life expectancy; the UK's a bit lower down the list, but still just about at the EU average.
Though, you also have to be careful with small differences, because the data is often imperfect. One darkly funny thing to come out of the covid pandemic was that there were significantly more very elderly people in Ireland than it was generally believed; this showed when the covid vaccination rate for the over-85 age cohort went over 100% (I think it hit 109% by the end). It turned out that the central statistics office's population estimates had simply been wrong; they had been running off an assumed death rate since the last census which turned out to be overly pessimistic.
From the article:
>While less access to health care and weaker social structures can explain the gap between the wealthy and poor in the US, it doesn't explain the differences between the wealthy in the US and the wealthy in Europe, the researchers note. There may be other systemic factors at play that make Americans uniquely short-lived, such as diet, environment, behaviors, and cultural and social differences.
Off the top of my head, obesity seems like the obvious culprit to investigate. If so, I wonder if semaglutide will close this gap again?
Americans walk less than in Europe, making less than half as many foot trips as Europeans, largely due to differences in infrastructure.
Americans visit the doctor less often than in Europe, largely due to the lack of universal healthcare all other high-income countries have.
I think obesity might be the symptom, not the actual culprit.
to me, the rabid response to anything remotely resembling socialism, and the inability to see life as anything but a zero-sum game is the obvious culprit. this precludes caring for eachother, and creates a life that's essentially a never-ending rat race for everyone, rich and poor alike.
you cant inject your way out of a society that is, at its core, defined by class/racial segregation, systemic inequality and distrust of governments.
The death rate everywhere in the world is the same and is equal to 100%. Everyone dies someday. The article's title should have used something like "life expectancy" instead of "death rate".
This is not true.
There's some mental fallacy we buy into that health can be fixed - when the only healthy choice is preventative mitigation. The answer is to live a healthy life: especially regular exercise. But also sensible food choices and removing stress (remove stressors or maybe learn techniques to ignore stress), and avoiding drugs/alcohol/smoking.
Rich Americans are unhealthy too and for the majority how much they spend on medical interventions usually doesn't fix their quality-of-life or length-of-life.
The poor mostly have as much access to a healthy life as the wealthy: so why are both the poor and the rich unhealthy?
The hard question to answer is why we live unhealthy lifestyles ;; is it capitalist advertising ;; should we blame cultural mores ;; are we victims of our own poor choices...
Anecdotes (New Zealand specific):
1: a poorer friend with hip problems that needed replacements in 40s but was forced to live in excruciating conditions for years due to how New Zealand's socialised health budgetary constraints are implemented (via waiting lists). No money was saved by the government because the surgery was eventually paid for (background: surgery cost for both hips was approx equal one pretax year of minimum wages in NZ).
2: two friends with a poor backgrounds that got middle aged diabetes - my guess is caused by booze & maybe smoking. Both THEN started exercise and also changed their habits and lifestyle. One is well off and money didn't really help them. Both could have previously lived healthier lifestyles but only changed their habits after being faced with severe frightening outcomes. Drugs like metformin help (that drug is cheap, however ongoing regular monitoring by doctor is not cheap). Expensive surgical interventions caused by diabetes will never fix the problems caused by poor living.
How much we should blame people's "choices" for poor health outcomes is difficult to answer. If someone chooses to drink booze, how much should society pay for their choice? We have high sin taxes in New Zealand so people have often paid for their medical help however the taxes do not cover the overall societal cost. A better example is acquaintances that have destroyed their health through recreational drug usage (which definitely isn't sanctioned by larger society, and definitely is sanctioned by peer society). I'm a huge believer in personal choice - but I'm no fan of having to pay for the bad choices made by others.
That's the issue with New Zealand's socialism. I can carefully live a prudent life : however it galls to be taxed to pay for people that ignore the cost of their choices.
Aside: it really neeps my bibbles that doctors are seen as saving lives. Engineering, economics and science save most lives. Doctors don't help much. (Ofc "saving" lives is a nonsense term anyway)
Iirc (phone post) japanese Americans have higher life expectancy than Japanese, or at least in the ballpark.
Maybe some cultures/lifestyles, like whatever they are doing in the South, just suck. OTOH, maybe we should allow people to make choices. I'm pretty sure I'd live longer if I did interval sprints instead of reading HN, but that's a tradeoff I am willing to make.
I'm not sure that reactionary tarifs are the correct action. Flagging products as American or pulling them from the selves seems much more affective.
If you counter-tariff you just tax your own citizens. If you decrease supply then it actually hurts US.
If China or India stop pharmaceutical shipments to the USA, there would be extreme shortages, and the die off would be biblical in proportions.
I honestly think that we don’t put enough emphasis on how bad cars are for your health.
Now that Europe has seen such a huge increase in immigrant populations (and the corresponding crime increases), perhaps suburban-type environments will become more desirable there in the near future.
The casual link between immigration and crime is generally agreed to be false. So whatever you read that claimed immigration caused crime to go up seems incorrect.
I'm really curious - do you know of anything I could read on that?
Except here in Germany, at least the restaurants (but the art of cooking has declined too, favoring frozen pizza and similar foods). Especially since COVID. Our restaurant food is not good, and will still get five stars in the restaurant reviews all the time.
After COVID it got even worse. In my major city I saw food in well-known central restaurants become really bad, despite significant increases in price, and I mean "bad" and not just "it is not as tasty as I would like".
What is thriving are Döner (kebab shops) - often using questionable "meat", dirt-cheap Asian places (nowadays often with "Sushi", at very low prices), and burger shops. Italian restaurants focus on pizza and pasta - the cheapest-to-prepare easy-carbs-focused options.
I miss the Bay Area and its food options (I used to live there for quite a few years).
And Dublin isn't exactly a huge city. If you take the likes of London or Paris, most affluent people are going to be commuting by public transport; driving just isn't really practical.
I'd be curious whether NYC, which has some aspects of this, has longer life expectancies than elsewhere in the US.
If we wanted to drive everywhere we'd see (over time) more suburbs springing up devoid of high streets and new town centres, with parking facilities near to existing centres, or as brownfield developments on the sites of former walkable residences.
In very high density areas they don't want private motor vehicles so they're just banned, there's maybe public transit but you'd really have to be unhurried to take public transit over a distance that's say a 10 minute walk.
In very low density areas nobody bothered adding a road. Why not just walk? I mean you could use a serious off road vehicle (no the fact your "truck" says it has AWD does not mean it will work) but even in places where that's legal why not just fucking walk?
I'm also still surprised that "current smoking status" is a thing. Quickly checking, seems a lot of western Europe is higher in that than the US? Curious how regional that is in the US, even. I don't see nearly as many smokers around home as I do when I visit the likes of Atlanta.
I'd like to posit that the culprit(s) of bad US health could likely be narrowed down by carefully analyzing the differences between (a) 1970 and now; and (b) Americans and Europeans in an exhaustive list of the human body's environmental touchpoints, narrowing the list to things that apply to >90% of each population. A few examples:
- food supply differences. For example, European regulation prohibits GMO and a lot of pesticides that are allowed in the US. Meat also differs significantly in their food supply (corn vs grass for beef) and other factors.
- vaccines. How much of the European vaccine schedule's components are not sourced from American suppliers?
- atmosphere. Off-gassing of synthetic materials in homes and offices is a newer thing.
- containers. In 1970, none of the food supply was distributed in plastic containers, for example. And glass containers are a lot more popular in Europe than the US.
I do wonder whether the answers could be staring us in the face, but have been suppressed because of corporate interests in the US. (Much the same as how cigarette smoking was publicly labeled "healthy" prior to the 1970s, even by scientists and doctors, because of studies funded by Philip Morris and other tobacco companies.) At least theoretically, health-related companies do stand to benefit financially from keeping us alive but less healthy. Widespread chronic semi-disease does make a lot of money, especially for vertically integrated insurers who can delay/deny claims, and for suppliers who have achieved regulatory capture of some sort.
> For example, European regulation prohibits GMO
GMO is not forbidden. It just has to get approved case by case.
https://en.wikipedia.org/wiki/Genetically_modified_food_in_t... (section "Approach" shows what is required)
There is a large per-country component too.
> The EU uses the precautionary principle, demanding a pre-market authorisation for any GMO to enter the market and a post-market environmental monitoring.
Alternative link (EU site): https://joint-research-centre.ec.europa.eu/projects-and-acti...
Much of the monitoring is to avoid or trace cross-contamination between fields, and ultimately the reason for that is significant consumer demand for non-GMO food, so that farmers who are non-GMO don't want their crops contaminated by a neighboring field that has GMO plants.
> GMO is not forbidden. It just has to get approved case by case.
Allowlisting makes so much more logical sense. New ideas shouldn't be allowed by default.
Especially when so many variables are at play, the FDA's denylist model across a massive population makes it very difficult to narrow down what is causing a problem. If I could make only 1 change to US health policy, it would be switching the FDA to allowlisting.
I'm not in the US, so I can't validate this, however, it does help explain why healtcare outcomes for the rich aren't very good.
With pollution add in car culture which decreases the amount walked
> calorie intake differences
Yeah, that's a big one. Also, processing foods heats them multiple times prior to sale, which increases caloric bioavailability.
America gets what it deserves: self defeating turmoil and churn disguised as effort and progress, while objectively being a worse place to exist (happiness, health outcomes, etc). Line goes up, but life is suffering.
To win is to know what Enough is.
It looks like in this age for the rich the optimum is something closer to dictator capitalism, as democracies start to embrace more regulation and social redistribution schemes. Singapore and Dubai have been winning choices so long as the people in power don't change their mind and start splitting skulls.
I like taxes, with them I buy civilization, help those in need, and build lasting institutions of value and relevance.
Almost all of my friends with higher educations have left for northern countries, as the situation here is untenable for young people. Of course if you have money that’s not an issue… and evidently the kind of money that makes that non an issue can only obtained in places like the US.
But seeing how you blame mass immigration, mostly uneducated and low-skilled workers, for the fall in wages of the educated people leaving the country, I wonder if your vision isn't too myopic and narrow on economic issues due to political bias.
As for the struggles of the young people in the country, because real state is inaccessible, I agree with you, but it's a problem in most capital cities of the civilised world.
>Bottom of the barrel wages for natives are the result of uncontrolled mass migration - we have received millions of immigrants in the last decade, which has basically destroyed wages.
Putting those two sentences of yours together triggered that thought in my mind, I apologise if I was wrong.
i wouldn't blame the immigrants there. the whole thing managed correctly would be (or actually already is) a huge boon for the country. the suffering of the young and poor seems to be a choice made by the greedy.
then if you tell me "cannot afford it, not realistic", we can conclude immigrants were not the problem.
On the other hand real estate is held by wealthy old natives and laws are enacted to make sure that real estate increases in price forever, the young be damned - no one cares about them since our population pyramid means they’ll always be a minority.
From last year. There is a version in English.
Regarding renting, it’s legally almost impossible to kick out a squatter, which means most people choose to leave their empty homes closed instead of renting them, which, added to mass immigration, has led to a surge in rent prices.
It was presented as a negative, which seemed shockingly shallowly thought through to us as non American tourists.
That's a pretty funny take, that economic inequality is a systemic risk for rich people. I wonder if Dr P thinks that the stress of noblesse oblige is too much for the frail US elites (as opposed to the horrible diet endemic in the US)