Stayin' Alive: Data Dump

The Global Burden of Disease study is a massive project, funded by the Gates Foundation, that involves more than 1,800 researchers from around the world. It takes over a project formerly led by the World Health Organization. The GBD uses a metric called Disability Adjusted Life years as its main outcome variable, along with life expectancy and mortality, so it includes health status in its concept of disease burden.

Results for the U.S. in 2016 have now been summarized in JAMA. Howard Koh and Anand Parekh discuss them here. As far as the major takeaways, there is not much new here. The U.S. still lags behind other wealthy countries in health and longevity. Embedded in this societal failure is immense inequality. While age-standardized death rates have certainly declined since 1990, mortality rates for non-elderly adults (20-55) have recently increased in several states, principally relatively rural states of the Midwest and Appalachia. A lot of this has to do with substance use disorders, including alcohol, and suicide. Rising obesity rates also contribute.

These are social problems, not medical problems. Further evidence of our social dysfunction includes the immense disparities in health and longevity among the states. Life expectancy was 81.3 years in Hawaii, and 74.7 years in Mississippi. Other states with high death rates include Mississippi, Alabama, Kentucky, Louisiana and West Virginia.

Koh and  Parekh write:

Greater commitment to addressing the social determinants of health, including poverty, substandard housing, and low educational attainment, could . . . build a stronger foundation for broader, more equitable health outcomes. The United States, among the wealthiest but far from the healthiest in the world, ranks 43rd in life expectancy despite the highest per capita health spending rates. This disconnect, in turn, highlights US underspending on social services (relative to medical services) compared with peer countries. Previous GBD estimates have suggested that 60% of life expectancy variation at the county level relates to socioeconomic and race/ethnicity factors.

Put simply, we underinvest in social welfare in the United States, and we pay the price -- a price wich is rising.  It isn't because of our trade deficit with China, or because rich people pay too much in taxes, or because of immigration, legal or illegal.

On another important topic, you might want to check this out.