Brits Healthier Than Americans? (Part II) Gail Heriot
Life expectancy at birth is generally thought to be higher in the U.K. than in the U.S.A. According to 2004 Time Magazine Almanac, the 2003 figure for the U.K. was 78.2 while the 2003 figure for the U.S.A. was 77.1. The difference was not simply one of race. Again according to the 2004 Time Magazine Almanac, white Americans have a life expectancy that was only 5-7 months higher than the national average–not enough to close the gap with the U.K. Other western European countries also have higher life expectancies than ours.
My understanding, however, is that a large part of the difference can be accounted for by infant mortality. In 2003, the U.S.A. had an infant mortality rate of 6.8. The U.K. rate for that year was 5.3. That in turn was due in significant part to the larger number of high-risk crack babies (and babies born to other drug-addled mothers) in the U.S.A.–or so I was once told.
The statistics I’ve found on the internet concerning adult life expectancies tend to bear out the notion that the difference between the U.S.A. and the U.K. life expectancies can be accounted for by the difference in infant mortality. If so, an American who survives infancy is no worse off (and possibly better off) than a Brit who survives infancy. According a CDC report, the life expectancy at age 65 in the year 2002 was 18.2 (16.6 male; 19.5 female). The comparable figure for Brits at age 65 in 2002 appears to be less than that. It’s hard to tell exactly from the graph, but it looks like about 16 for men and about 19 for women. It’s possible that my eyes are playing tricks on me and the the British figures are just the same as the American, but they are definitely not higher. (I could not find comparables for any age other than 65.)
This is difficult to reconcile with the new JAMA study that finds middle-aged, white Americans to be in much poorer health than their middle-aged, white English counterparts. (Yes, I do mean English here. For some reason, the study does not include Wales, Scotland, and Northern Ireland, all of which I suspect have higher morbidity rates than England. Perhaps had poorer American states like Mississippi and Arkansas been left out, the results would have come out the other way.) The authors find a morbidity gap even when they control for differing rates of obesity, smoking and drinking.
Between the two, I am more inclined to credit the life expectancy data. Data on death have the virtue of being relatively certain. With very few exceptions, a person is either dead or he isn’t. Few judgment calls are necessary. And in wealthy countries like the U.S.A. and the U.K., the fact of death and the decedent’s age at death are overwhelmingly likely to be recorded and recorded accurately.
My fellow Right Coaster Tom Smith suggested in his earlier post the the JAMA study’s figures may not be trustworthy, because they involve self-reported morbidity. The British “stiff upper lip” tradition might cause English interviewees to play down their illnesses. Moreover, because Americans spend much more on health care than Brits do ($5274 per capita in the U.S.A. vs. $2164 adjusted for purchasing power in the U.K. according to the JAMA study), Americans simply know more about what’s wrong with them because they’ve been diagnosed).
These concerns are certainly important ones. There is no reason to trust cross-cultural comparisons of self-reported morbidity. Zero. Zilch. It would be remarkable to find that American interviewees and English interviewees are equally likely to know about and disclose their illnesses. But the study is not limited to self-reported morbidity rates. It contains objective data as well. And that objective data support the study’s more subjective data. I will report on that in a separate post later today or tomorrow.