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Americans Less Healthy, But Outlive Brits 521

Posted by timothy
from the cross-cultural-croaking-comparison dept.
An anonymous reader writes with this intriguing snippet: "Older Americans are less healthy than their English counterparts, but they live as long or even longer than their English peers, according to a new study by researchers from the RAND Corporation and the Institute for Fiscal Studies in London. Researchers found that while Americans aged 55 to 64 have higher rates of chronic diseases than their peers in England, they died at about the same rate. And Americans age 65 and older — while still sicker than their English peers — had a lower death rate than similar people in England, according to findings published in the journal Demography."
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Americans Less Healthy, But Outlive Brits

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  • by swordgeek (112599) on Saturday November 06, 2010 @06:46AM (#34146214) Journal

    It has been my experience that Americans hold onto life harder than almost anyone else on the planet. There is no saying "Well, that's enough then." There is no accepting the inevitable. No matter how sick, how weak, how miserable a person is, in the US it seems that it's still better than throwing in the towel.

  • by Anonymous Coward on Saturday November 06, 2010 @07:00AM (#34146260)

    Who says we don't have the best healthcare?

    I didn't know that the only two countries in the world were Great Britain and the United States. What happened to the 20-30 countries with longer life expectancy than either one? Or don't they count?

  • Re:Even so (Score:1, Insightful)

    by Anonymous Coward on Saturday November 06, 2010 @07:03AM (#34146272)

    Not suprising is it? The US right just had a political 'victory' and now we get the politically motivated stories about how socialist universal health care isn't as good as Americas fucked up system. It makes no difference that the story and the study is a flat out lie of statistical manipulation. Nor does it make any difference that hundreds of cultural and societal differences could account for any difference far more than any minor difference in health care quality. It's just inevitable.

    Cynic? Moi?

  • by Anonymous Coward on Saturday November 06, 2010 @07:05AM (#34146280)

    How long old people still have to live heavily depends on medical treatment. Surprisingly (at first sight) bad healthcare can mean old people are more healthy. (It stops to be surpising if you consider that bad health care means only the healthy people live long enough to be old).

    Thus you can get numbers that in the USA looking at the right age, you can get much longer life expectancy if you are black and poor than if you are rich and white.

    Another nice paradox (numbers might not be totally accurate and might have changed over time): Getting older might increase the years you still have to live. Especially if you are 60 (or something short of retirement age in your country) you might have statistically less years before you than if you are 70 (or something a few but not too much years after typical retirement), because all those people dying between 60 and 70 lower the chances for a 60 year old more than the 10 years less do reduce the expected years for the others.

    So be careful with those numbers.

  • Re:Well, duh (Score:4, Insightful)

    by Anonymous Coward on Saturday November 06, 2010 @07:30AM (#34146354)

    Am I the only one who read the article? Ah yes, this is Slashdot. So this article is written by finance people and someone who works for RAND which is funded partly by the health care industries in the US.

    So no fucking shit it finds that US healthcare industry provided healthcare is better than a socialist model.

    Or have I missed something?

  • Re:Even so! (Score:5, Insightful)

    by biryokumaru (822262) <biryokumaru@gmail.com> on Saturday November 06, 2010 @07:33AM (#34146368)

    Why do so many American children die young?

    I would posit that all American children who die do so while young.

  • by Anonymous Coward on Saturday November 06, 2010 @07:34AM (#34146370)

    Okay, fair point and all, but if we want to see who has the best healthcare in the world (and not the biggest contributions to healthcare) then other countries would be interesting to see. Still, studies have budgets etc etc

  • Re:Politics (Score:3, Insightful)

    by hitmark (640295) on Saturday November 06, 2010 @07:38AM (#34146386) Journal

    It could even be that weaker genes and such get taken out before the comparison thresholds comes into play.

    I would love to see the death rates for younger people.

    And yes, climate could be a big issue. USA allows someone to stay within their nation while having a ski vacation in the rockies and a beach vacation in florida or california. How many elderly in USA ups and moves south once they hit retirement?

  • Re:Well, duh (Score:1, Insightful)

    by 91degrees (207121) on Saturday November 06, 2010 @07:48AM (#34146406) Journal
    Always amuses me when Americans criticise our beer and our food. America is the nation of Bud Light, where gourmet cheese comes in a tube. Seriously - a nation that lives of hot dogs, burgers, French Fries and Pizza has no place criticising anyone's food.

    As for attractiveness of women - which country has the worst obesity problem? I guess you're a chubby chaser.
  • Misleading summary (Score:5, Insightful)

    by jcupitt65 (68879) on Saturday November 06, 2010 @07:48AM (#34146410)

    The summary is misleading. Brits, on average, outlive Americans.

    http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy [wikipedia.org]

    This study compares the survival of people with similar diseases once they become ill.

  • Define "better" (Score:4, Insightful)

    by arbogasm (1846496) on Saturday November 06, 2010 @07:59AM (#34146440)
    In the US, physicians tend to emphasize curative (disease-fighting, life-extending) care. Many American physicians view the death of a patient as a personal defeat. Thanks in large part to numerous advances in medical technology over the past half-century, physicians (worldwide, but especially in the US) have become very good at "keeping people alive." That said, keeping someone alive often comes with a price - namely, the patient's quality of life. Relative to their English colleagues, American physicians are generally more resistant to moving patients from curative care to palliative care - care that focuses solely on reducing/eliminating symptoms. It comes as no surprise, then, that patients with chronic disease are living longer in the US. Saying that longer lives implies "better" healthcare is naively simplistic at best. That conclusion is indicative of a fundamental misunderstanding of the goals of medical care. The goals of quality health care demand a balance between curative and palliative care. On one extreme end of the curative-palliative-care spectrum you have the physicians (think: Kevorkian) who want to focus solely on reducing symptoms - even to the point of death. On the other extreme of the spectrum you have those who want to extend life at any cost (think: Terri Shiavo case). On this axis, American doctors lean somewhat to the "right" of most doctors worldwide. The best doctors in any country are straddling the line between "excessive" and "inadequate" care. That being said, conflating palliative care with "giving up" on the patient is an all too common issue among physicians and patients. Though I have full confidence in this research team's statistical results, they (Smith, in particular) seem to be unfamiliar with how heavily differences in culture affect healthcare, especially among patients with chronic diseases.
  • Re:Well, duh (Score:5, Insightful)

    by Gordonjcp (186804) on Saturday November 06, 2010 @08:09AM (#34146476) Homepage

    REAL American beer is done in microbrews.... like here in Portland, Oregon.
    ... and not served chilled. The whole point of chilling beer is so that it numbs your tastebuds so you can't taste how nasty it is when it's badly made.

    Budweiser's "Fresh Beer Tastes Better" adverts were pulled by the ASA in the UK, because fresh beer does not, in fact, taste better. It tastes like yeasty rat piss until it has had time to mature a bit.

  • Re:Define "better" (Score:3, Insightful)

    by jgreco (1542031) on Saturday November 06, 2010 @08:12AM (#34146498)

    I've used this sort of argument in the past to highlight your statement "keeping someone alive often comes with a price" as well; it's also one of the reasons that healthcare costs in the United States continue to increase.

    Fifty years ago, there were a whole bunch of bad things that happened to older people that signaled they were nearing the end, and that their remaining time was limited. Many of these things have become treatable and correctable, extending life for many years, but often at a cost, not just financial, but sometimes in terms of quality-of-life.

    People "know" this uncomfortable fact but many refuse to acknowledge that it's just a fact of medical advances, and instead spin it into fears such as the dreaded "Death Panels" we all heard so much about a few years ago.

  • Re:Even so! (Score:4, Insightful)

    by TheRaven64 (641858) on Saturday November 06, 2010 @08:24AM (#34146544) Journal
    The study only compared people over the age of 55, meaning that if more people under the age of 55 die in the USA, then this will have no impact on their statistics. Given the life expectancy numbers, it seems that this is probably the case.
  • Re:clearly (Score:3, Insightful)

    by h4rm0ny (722443) on Saturday November 06, 2010 @08:24AM (#34146546) Journal
    Indeed. In time honoured fashion, I hadn't actually RTFA at the time of posting. I have done so now. I found it rather unenlightening. What would be really interesting to see is the difference in death rates across different wealth demographics. I.e. do we see larger discrepancies in one country than we do in the other. But I've now noticed that this is the RAND corporation, so I wont hold my breath on anything that shows the US system to have conceptual problems.
  • by h4rm0ny (722443) on Saturday November 06, 2010 @08:33AM (#34146574) Journal

    For instance the US spends more than twice as much on heath care per citizen as the UK

    An alternative way of putting that however, is that the health care costs twice as much per citizen. Factually, the two statements are equivalent, but consider the different implications.

  • Re:Even so (Score:5, Insightful)

    by damburger (981828) on Saturday November 06, 2010 @08:51AM (#34146632)

    Also, the British thinktank who instituted this are a right-wing one, no doubt plotting to destroy the NHS alongside the Tory allies. So they publish a non-peer reviewed piece of 'research' designed to conclude what they want it to conclude. Bullshit.

    The Tories recently gutted NICE, the body that evaluates the cost effectiveness of drugs to see if they should be made available on the NHS. They were doing a fine job, but got nothing but shit because they prevented pharmaceutical companies gouging into the state healthcare providers ample budget. When retards in the US talk about 'death panels' they are usually referring to these guys, and they don't get much of a good press in the UK either.

    Basically, they talked to terminal patients to find out how much of their life they would be willing to give up to remain in good health for the rest of their life, and used this to calibrate a 'quality adjusted life year' which represented the value of a drug. Thus they could reject a hugely overpriced drug that added 2 weeks to the life of a late-stage cancer patient and spend the money saved on a drug that might allow a very sick child to reach adulthood. That second part *never* got a mention by the rightwing critics. When opportunity costs are being used to make the state healthcare system more efficient whilst forcing drug companies to charge realistic prices based on what their products can actually do, the right suddenly decides to reject economic language and talk shit about 'death panels' and NICE 'killing patients'.

    Yes, we ration healthcare in this country - but up until now it has been based on how much extra life (across the whole population) that healthcare can give. The US rations healthcare too - based on how rich or poor you are. Our system is, frankly, better.

  • Re:Well, duh (Score:3, Insightful)

    by IHC Navistar (967161) on Saturday November 06, 2010 @09:27AM (#34146732)
    What you guys call Guinness is what we call "Cold, stale coffee mixed with seltzer water".
  • Re:clearly (Score:4, Insightful)

    by h4rm0ny (722443) on Saturday November 06, 2010 @09:41AM (#34146812) Journal

    "While poorer people are more likely to die sooner than their more well-off counterparts, researchers say their finding supports the view that the primary pathway between health and wealth is that poor health leads to a depletion of household wealth, rather than being poor causes one's health to decline. Researchers found that the substantial changes in wealth that occurred in the years 1992 and 2002 in the United States through increases in stock prices and housing prices did not alter the probability of subsequent death."

    Yes, that's exactly the part I was eluding to. It doesn't tell us anything about comparative differences between the countries as regards wealth. I.e. are the differences in health care between the two countries constant across different wealth demographics or are they different, e.g. we find the the US is ahead of the UK in heatlh care for the wealthy, but the UK is ahead in health care for the median earners or the poor. That's what would be really interesting to know if we want to start examining the role of health care in more meaningful depth and by the sounds of it, they collected data relevant to this, but it is missing from their conclusions. I find it highly unlikely that the difference in health care is constant across all demographics of society.

  • by khallow (566160) on Saturday November 06, 2010 @09:47AM (#34146834)
    And life expectancy is misleading because it doesn't take into account different definitions of infant mortality or the US's greater acceptance of personal risk.
  • by elwinc (663074) on Saturday November 06, 2010 @09:47AM (#34146838)
    Overall, life expectancy in Canada and Britain exceed life expectancy in the USA.

    Canadian life expectancy = 80.3 years, UK ife expectancy = 78.7 years, and US life expectancy = 78.0 years (in 2007) according to http://www.infoplease.com/ipa/A0004393.html [infoplease.com] and that's because Canada and the UK have life-long public health care.

    But when medicare starts to cover US citizens at age 65, suddenly US citizens have a much better outlook. US citizens lucky enough to survive until age 65 and receive medicare coverage have a longer life expectancy than their British peers.

    Actually, if you go back and study the data at http://www.infoplease.com/ipa/A0004393.html [infoplease.com] and http://www.oecd.org/dataoecd/46/33/38979719.pdf [oecd.org] you'll discover that the US has both higher infant mortality and lower life expectancy than Canada and almost every developed European democracy (even Germany who absorbed the disaster known as East Germany a few decades back). For what its worth, the US also pays much more per capita for their lower life expectancies. I wonder if this data would change anyone's mind about the benefits of health care reform...

  • Re:Well, duh (Score:5, Insightful)

    by Will.Woodhull (1038600) <wwoodhull@gmail.com> on Saturday November 06, 2010 @10:24AM (#34146994) Homepage Journal

    TFA is consistent with the observation that 90% of American health care dollars are spent during the last few months of the patient's life.

    If USA health care invested more money in early and preventive treatment, people might not live any longer, but they would be in better health until old age problems caught up with them. That is clear from TFA when viewed within the context of the differences between USA and UK health care delivery systems.

    But USA health care is profit oriented, and there is more profit to be made in selling cures and disease treatments than there is in preventing diseases. Not only does preventive health care lack as much opportunity for profit, it reduces the market for such money makers as AIDS drugs, cancer therapies, antihypertensive agents, and antidepressants.

    The USA needs a major reform of health care. Even if the recent legislation is put fully into effect, it won't go far enough; it will be band aid approach to broken bones. There needs to be a break-up of the current system. Prohibiting the sale of health insurance for profit would be a good place to start.

  • by Anonymous Coward on Saturday November 06, 2010 @10:32AM (#34147016)

    Yes, government healthcare is efficient as proven by the countries that pay less for healthcare and whose citizens live longer than the USA. Government healthcare may have many faults, but efficiency certainly isn't one of them.

  • by stinerman (812158) <nathan.stine @ g m a i l . c om> on Saturday November 06, 2010 @10:46AM (#34147102) Homepage

    Yes, government *insurance* is very efficient. See a comparison of Medicare v. Medicare Advantage. Medicare Advantage is one of the most inefficient programs we have. We basically subsidize private insurers to do what Medicare already does more cheaply.

    Government health-care? That's a different ball of wax.

  • by SomeKDEUser (1243392) on Saturday November 06, 2010 @11:00AM (#34147186)

    The fact is that the US health system costs 10 points of GDP more than socialised systems with better outcomes. So as far as efficiency goes, experience shows public health care is massively more efficient than private one.

    And this is obvious: you cannot ask someone to decide objectively how much to spend on their health when their life is on the line. This is exactly equivalent to legal mugging.

    Basically, you are arguing that 10% of US GDP (way more than the average deficit even with the Bush madness) is well spent just because instead of staying in the pockets of the people, goes to line the pockets of private companies? For no benefit to the public at all? Because you are not getting better outcomes, you are not getting better innovation, you are not getting more employment. You do get better catering, but if you think hospitals should be run as glorified hotels you need to look up on what is expected of a hospital.

    You fail at basic logic and basic knowledge.

  • Re:Go home and die (Score:5, Insightful)

    by Coriolis (110923) on Saturday November 06, 2010 @12:25PM (#34147610)

    Without specifying what precise ailments she was suffering from, it's impossible to judge whether or not the NHS failed in that situation. The problem is, we never want to let our loved ones go, even when no medical technology can save them.

    Last night, I was talking to a nurse who'd spent some time working in Dubai, and who had regularly encountered a particularly common form of cognitive disfunction: the belief that money can solve every problem. He was regularly confronted with people who thought that the reason that their relatives were dying was that they hadn't offered enough money. That there was an infinite sliding scale of increasingly expensive treatments, and somewhere in there there was a magic pill that would save their loved one.

    The truth is, medical science has come a long way, but it still can't fix everything. So there's a possibility that she was sent home because there was nothing they could do but prolong the agony.

  • Re:clearly (Score:4, Insightful)

    by Kagato (116051) on Saturday November 06, 2010 @12:56PM (#34147734)

    It's not that we're better than the brits. They just considering it unethical to prolong death in the ways that we do here in the US. We can keep someone alive an extra 6-18 months with modern medicine. Quality of life during those months ia really crappy, but as long as you have an estate or medicare to draw funds from who cares?

    The concern in Europe is about making end of life care as painless and dignified.

    It's one of the reasons health care costs less there.

  • Re:clearly (Score:2, Insightful)

    by izomiac (815208) on Saturday November 06, 2010 @01:17PM (#34147828) Homepage
    I would assume they used Great Britain because they're culturally more similar. Japan, for example, has a longer life expectancy, but there are enough cultural differences that you can't honestly attribute an increased life expectancy to differences in healthcare systems.

    Plus you start needing to account for genetic and pathogen differences. I.e. if you pick a country in Africa with high rates of malaria and sickle cell anemia, they'll have a lower life expectancy regardless of how good their healthcare system is.
  • by IICV (652597) on Saturday November 06, 2010 @01:23PM (#34147862)

    If the stuff you're pushing worked the way you say it would, the doctor would be recommending it.

    However, as it turns out, the research on whether or not magnesium helps with high blood pressure is inconclusive; this [about.com] article seems to have a reasonable layman's summary of what's going on. Therefore, the doctor cannot in good conscience recommend that the guy take magnesium pills, as they may or may not work (for the same reason why doctors can't prescribe placebos, despite their occasional effectiveness).

    Furthermore, look at the "Should I take oral magnesium supplements" and "What are good dietary sources of magnesium" sections - dietary magnesium supplements just don't work, you need to get it as part of your food. What food contains magnesium? Healthy food. What part of the doctor's recommendation are you leaving out? A diet change. No doctor would just prescribe blood pressure pills without also including a dietary intervention, that's only treating the symptoms without treating the underlying problem. This is actually something alt-med people love to accuse doctors of, probably because everyone just hears "pills" but doesn't pay attention to the "and here's how you should improve your diet, and some exercises you can do" bit. Either you or your friend didn't pay attention to the part where the doctor recommended lifestyle changes, because he certainly did (and if he didn't, he is being remiss in his care).

    So why recommend blood pressure pills in the first place, if the real treatment is going to be a change in diet and exercise? Because high blood pressure is a danger now, while diet and exercise will cure the problem later (if at all - to be quite honest, few people manage to make permanent healthy lifestyle changes. It's really sad, but that's the way it is). Ideally, your friend would start taking the blood pressure pills immediately, then start in on changing his diet and getting more exercise and eventually wean himself off the pills once his blood pressure gets to a normal level.

    As for potassium bicarbonate, the Cigna page [cigna.com] on it says that you should tell your doctor if you have high blood pressure and intend to take it, as there may be side effects. The only study on its effects that I could find was this one [ahajournals.org], which had positive results but was little more than a pilot study (14 people). Further research is needed before a doctor can really recommend supplementation with potassium bicarbonate (especially when just eating more fruits and vegetables already has a significant effect, which is probably why there's been little research in this area - there's no need to recommend expensive supplements when the patient can just eat better).

    There is something I don't understand in your post, though: you say that taking these alternative supplements is good, because it deprives the pharmaceutical complex of years of income (despite the fact that ideally you'd stop taking the blood pressure pills at some point) - but as your alternative, you recommend taking magnesium and potassium bicarbonate supplements. Do those poof into existence from thin air? No, they're sold by the "supplemental" complex - and you're recommending giving them years of income for treating high blood pressure, despite (again) the fact that the real treatment lies in a lifestyle change. You're basically saying "don't buy stuff that we know works from those guys, buy stuff that may or may not work from these other guys".

    I wonder who is treating the symptoms here, and not addressing the causes?

  • Re:clearly (Score:3, Insightful)

    by Jeremiah Cornelius (137) on Saturday November 06, 2010 @01:27PM (#34147890) Homepage Journal

    Possibly, you say.

    In this I see more of the American emphasis on quantity over quality. You know: like their cheese.

    What isn't included in this survey, I surmise, is that the sick Americans are kept "alive" longer, by bankrupting them on expensive medical technologies and pharmaceuticals. It is a life-extending technology that only kicks-in, once the damage has been done!

    So, those last years are spent in drugged misery, draining the bank accounts and inflating the insurance-rates - leaving another generation with less than the preceding one.

  • Re:Go home and die (Score:3, Insightful)

    by joggle (594025) on Saturday November 06, 2010 @01:56PM (#34148028) Homepage Journal

    It's already rationed whether you like it or not. No country has an infinite amount of resources to fund unlimited medical treatment. The question is how to use our limited medical resources to treat people. It's hard to imagine how the US uses our resources more efficiently than other first-world countries (based on cost per person, life expectancy, etc).

    Medicare is 'rationed' but is also more popular than any other private insurance program in the US and is one of the most popular government programs.

  • Re:Go home and die (Score:3, Insightful)

    by nbauman (624611) on Saturday November 06, 2010 @02:00PM (#34148048) Homepage Journal

    I've talked to American and British surgeons at lectures and read their articles.

    One of the questions they always deal with is whether an operation will do more harm than good. That comes before they even get to the cost calculations.

    A lot of major cardiovascular procedures have a surgical death rate of 3% or more. You don't want to take a 1/33 risk of death unless it's going to lower your subsequent risk of dying substantially more than that.

    There are lots of people in their 60s who couldn't survive major surgery. They have poor function in their lungs, kidneys, or heart. They have pre-existing conditions, such as diabetes.

    The New England Journal of Medicine just had an essay by an oncologist about a patient with untreatable metastatic bladder cancer disseminated to the liver. He said, "I'm not afraid of dying. We all have to go sometime, and I've had a good life." His sister had chemotherapy, and he didn't want to go through that. Then his son showed up at the next visit, insisted on aggressive treatment, and talked his father into it. The father had chemotherapy, declined rapidly, and died painfully in a few days. If his son hadn't insisted on chemotherapy, the father could have spent one more Christmas with his family. Doctors have lots of stories like that.

    Surgeons in the U.S. have a financial incentive to operate; they get paid by the operation. Surgeons in the UK (if they work on salary for a government hospital) don't have that incentive. But they do have hospital administrators monitoring their surgery for death rates, appropriateness, etc.

    In case you haven't noticed, seniors in the U.S. are on Medicare. Medicare funding decisions are made by expert panels of doctors, who decide whether a treatment is appropriate based on its effectiveness and safety, not cost.

    There is a conservative meme, "Please, Senator, keep the government out of my Medicare." Actually, if you look at the facts, federally-run health care is usually pretty good, compared to the private alternatives. The problems come with state-run Medicaid, which many states refuse to fund at efficient levels, because of the anti-tax movement. It's the anti-tax voters who are telling people to curl up and die.

  • Re:Go home and die (Score:1, Insightful)

    by Anonymous Coward on Saturday November 06, 2010 @09:59PM (#34151158)

    Your entire post is bullshit and you know it but this part struck me in particular:

    But you know, it would be beneficial for the US to change to that type of system.... I think the real reason the rest of the world is eager for the US to go (more) socialist is that old saying "misery loves company".

    You're clearly not aware of what goes on in the rest of the world and in particular how it was before your elections in -08. Before your elections, people in the rest of the Western world didn't give a crap about your health care. Most people here assumed that you had universal health care too since in most peoples' minds that was implied by the definition of Western nation. However, the reason why we began to say something was that when your candidates were engaged in mudslinging, some of the mud landed on this side of the pond. As an analogy: If you and your wife argue about buying your kids a PS3, your neighbors don't care unless they hear you yelling "look, they have one and their kids are retards" when the fact of the matter is that the kids are very bright. At that point it's hard not to say something. Some of it might also be due to compassion for fellow human beings.

    The simple fact that health care hasn't been any major issue in politics for ages here should already enable you to conclude whether people here are reasonably content with what they have or not.

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