Ill-Health of the USA

 Even before Covid-19, ‘excess deaths’ in the US were higher than in peer European countries.

Despite spending far more than other wealthy countries on healthcare, the United States has relatively higher mortality rates and lower life expectancy – attributed to a plethora of factors including obesity, opioid overdoses, gun violence, suicides, smoking, road accidents and infant deaths.

Given the US does not have a universal healthcare system like most high-income European countries, researchers also think access to healthcare and medicines is patchwork, a problem exacerbated by pronounced racial and socioeconomic disparities and the rural-urban divide.

In the latest analysis, the authors worked on the basis of a counterfactual assumption – what if the US had the death rates by age and sex of an average peer European country (in this case, the combined mortality rates of France, Germany, Italy, Spain, England and Wales)? – and estimated how many fewer deaths there would have been in the US in 2000, 2010 and 2017 under that assumption.

The lead author, Samuel Preston, professor of sociology at the University of Pennsylvania, first compared mortality rankings between the US and a broader set of European countries in 2010, finding that the US ranked among the worst in people aged below age 75 among the 18 countries considered. “I just decided it would be interesting to update that analysis and was surprised to find how much the excess had grown between then and now,” he said.

The authors found mortality conditions in the US have worsened significantly since 2000 – and resulted in more than 400,000 excess deaths in 2017 alone. That year, Americans aged 30 to 34 were three times more likely to die than their European counterparts.

The analysis also assessed the performance of the US on years of life lost – a metric that weighed the number of excess deaths at a particular age by US life expectancy at that age (somebody who is younger has more potential years of life to live versus someone who is older). Overall, the US experienced roughly 13m years of life lost to excess deaths in 2017, which represents a 64.9% increase since 2000, after adjusting for changes in size and age distribution, the authors found.

Jessica Ho, assistant professor of gerontology, sociology, and spatial sciences at the University of Southern California, attributed higher US mortality rates to a combination of behavioral and structural factors.

“Americans … often practice poor health behaviors, and this may interact with structural conditions like patchwork access to health care to produce worse outcomes,” she said. “For example, high rates of homicide are related to inequality and residential segregation; high rates of firearm-related deaths are influenced by both behavioral factors and the greater availability of guns in the US.”

Mauricio Avendano Pabon, professor of public policy and global health at King’s College London, suggested another explanation might be the strong governmental intervention across many dimensions of people’s lives in European countries, such as minimum wage and maternity leave.

“This is, of course, true for the US as well, but in general to a much less degree. While one may argue that less intervention increases efficiency and improves economic outcomes, the market is unlikely to emphasise values that relate to people’s health or inequality.”

Study reveals alarming trend in US death rates since 2000 | US news | The Guardian