We’re Number 37! USA! USA! USA!

I have little tolerance for unabashed patriotism. When you look closely at the facts with regard to important quality of life indicators, the good ole US of A falls short in many areas.  Life, liberty, and pursuit of happiness and unalienable rights seem to apply more to corporate entities than they do to we the people. And freedom now has more to do with economic opportunity in other countries than it does with civil liberties for our own citizens.  Don’t get me wrong, I am happy to be an American.  Thanks to my brave and industrious parents and their forefathers, I have had a steady launching pad and subsequently have done moderately well for myself.  However, I am very fortunate not to have been born Gay, a minority, or poor.  To paraphrase an old Seinfeld episode “Not that there is anything wrong with being any of these,” but the reality is that these folks suffer at disproportionate levels in this country.  And I suggest that this is a direct result of social and economic policies.

Somehow, patriotism has become the exclusive domain of those on the Right who through Conservative policy support deregulation, free markets, hawkish military doctrines, government downsizing and subsequent cuts in social services and regulatory agencies.  Even the Democrats have shifted to the right and this has been particularly true since the Clinton Administration. These policies certainly bolster corporate interests and the financial portfolios of the very wealthy.  But those gains have come at the expense of the vast majority of Americans.  The income divergence between wealthy Americans and the rest of us is no secret.  Charts and graphs, easily accessible, have uniformly detailed the relative economic flat line that most of us have endured for decades while those in the top 1% show skyrocketing and seemingly geometric growth rates.  Meanwhile, policies that may level the playing field for most Americans, have somehow been castigated as “Socialist” and “Anti-American.”  This latter thinking is wrong on so many different levels.

Regardless of the real world consequences, nearly half of Americans latch onto and support the Conservative – pro-business policies that are clearly at odds with their well being.  One important way this plays out is in healthcare.  When it comes to life expectancy, the USA ranks number 37 in the world.  That’s right 37!  There are 36 nations that, as a people, take better care of each other than we do.

In a recent study published in Population Health Metrics on life expectancy in the United States, data regarding life expectancies in every county from 2000 to 2007 shows how U.S. mortality compares with that from other wealthy nations.  The results indicate that life expectancy in the United States has not kept pace with other nations.  In fact, the data suggests that life expectancy has fallen in many counties, particularly in Appalachia and the deep south.   Women in such settings have fared far worse than men.

Here are some of the highlights from the study.  The highest life expectancy for women in 2007 turned out to be in Collier County near Naples, Florida – where women lived on average for 86 years.  In contrast for women from Holmes County, Mississippi the average age at time of death was 73.5 years.  That is nearly a 13 year discrepancy.  Further it was indicated in the report that:

In 2007, life expectancy at birth for American men and women was 75.6 and 80.8 years, ranking 37th and 37th, respectively, in the world. Across US counties, life expectancy at birth ranged from 65.9 to 81.1 years for men and 73.5 to 86.0 years for women (Figure 1a). Geographically, the lowest life expectancies for both sexes were in counties in Appalachia and the Deep South, extending across northern Texas. Counties with the highest life expectancies tended to be in the northern Plains and along the Pacific coast and the Eastern Seaboard. In addition to these broad geographic patterns, there are more isolated counties with low life expectancies in a number of western counties with large Native American populations. Clusters of counties with high life expectancies for males and females are seen in Colorado, Minnesota, Utah, California, Washington, and Florida.

What accounts for this gap and the lower relative ranking among our fellow longer living earthlings from other nation states?   On June 16th, 2011, Melissa Block from NPR – Talk of the Nation discussed the results of this study with Dr. Ali Mokdad, a global health professor at the Institute for Health Metrics and Evaluation at the University of Washington.   Dr. Mokdad noted that: “there are four factors – three are equally affecting men and women in this country.”   He then indicated that the three equal opportunity factors included:  (1) socioeconomic status;  (2) access to healthcare/health insurance or no insurance; and (3) quality of medical care.  In other words, if you’re poor, you don’t have medical insurance, and you live in remote areas with poor medical facilities, with less proficient professionals, you are more likely to die early.  On the other side of the coin, it is true that we have the best quality medical care in the world, BUT, many Americans do not have access to this Tier 1 level of care.  It’s only true for certain pockets of the population who are relatively affluent and living near major medical institutions.

The fourth factor, preventable risk factors (e.g., smoking, obesity, poor diet, lack of physical activity), affects both genders but women and particularly poor women disproportionately.  The study points out that in more than 300 counties in the United States, life expectancy declined over 20 years for women.

It is time to wake up America!  These statistics are appalling and embarrassing.  Look at the the real world human costs of economic policies that create and sustain such divergence.  The 2008 recession, clearly the result of financial deregulation and unfettered free market greed, has had catastrophic global consequences that have reshaped the landscape.  Budgetary discussions centered around deep government cuts to education and social services – further compromising the very people who have been hurt the worst.  Elimination of continued tax breaks to the richest Americans is absolutely off the table.  And now the Conservative agenda is to abolish “Obama Care?”  Look at the evidence people – its all around you.  Before you buy into an ideology – look at the real world consequences – look at the evidence, and ask yourself how you and your loved-ones are affected.  It scares me that such callus disregard for our fellow citizens is the new chic.



  1. I have recently been blogging about international comparisons of well-being. The relative performance of the US with regard to longevity surprises me (as an Australian).
    I am wondering to what extent this may be attributable to preventable risk factors rather than access to health care.
    Have you seen any relevant comparisons?

  2. Great Question Winton! The paper I’m referencing in this post points to four factors – three related to healthcare system performance and the forth – preventable risk factors. The paper notes:

    “How much of the poor performance of the US is due to differences or less favorable trends in critical risks to health such as tobacco smoking, hypertension, diabetes, physical inactivity, obesity, LDL cholesterol, diet, and alcohol? At the national level, these risk factors together lead to close to one million premature deaths [39]. If the leading four risk factors were addressed (smoking, high blood pressure, elevated blood glucose, and adiposity), life expectancy in 2005 would increase 4.9 and 4.1 years, respectively, for males and females. Disparities across eight race-county groupings would reduce by approximately 20% [39]. Given that risk factor exposures vary by county, and based on evidence from state-level analysis that risk factor exposures are larger in places with higher mortality rates [40-42], we would expect that addressing these risk factors would also tend to narrow disparities. An analysis that takes into account county exposures will be critical to fully understand the potential to reduce disparities through preventable causes of death. This, however, will require improving the measurement of exposure to leading risk factors at the local level.”

    Obviously, these preventable risk factors account for a large portion of the variance – yet the disparities between communities is attributable to system performance variables.

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