HN Reader

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.

"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?

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.

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.

The title of the article is terrible.

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".

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.

1) You have to walk in Europe. 2) People eat better.

Could be the food regulations, the ones Trump hates so much because it prevents USA exporting USA foods to EU.

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.

Could be the "beautiful beef" we are not eating here in Europe.

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.

Those tariffs on Denmark and Switzerland in particular (major medicine producers) aren't going to help...

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.

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)

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.

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).