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.
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.
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.
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.
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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.
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.
- 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.
Dead Comment
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.
Deleted Comment
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.