Split Thread: Life expectancy statistics in the USA

[Rolfe]

Originally Posted by Dictator Cheney

well public health care is socialism and socialism kills.

Awful funny how we have better life expectancy than Americans then....

Rolfe.

Split from: Universal healthcare slows development of medical technology

Posted By:Gaspode

[DC]

Originally Posted by Rolfe

Awful funny how we have better life expectancy than Americans then....

Rolfe.

that hasnt to do with UHC, its just that chips n fish are healtier but less tastefull than a tripple whopper with freedomfries.

i should have added some sarcasm tags i guess

[Rolfe]

No, understood your sarcasm writing. I do know where you live.

I was responding in the same vein.

Rolfe.

[DC]

well then its clear, you should have used them

[Rolfe]

One smilie per sentence is my normal limit....

Rolfe.

[BeAChooser]

Originally Posted by Rolfe

Awful funny how we have better life expectancy than Americans then....

Only if you don't remove accidents and murders from the statistics. If you do, then one finds that we have better life expectancy than the British. Not

[JoeTheJuggler]

Originally Posted by BeAChooser

Only if you don't remove accidents and murders from the statistics. If you do, then one finds that we have better life expectancy than the British. Not

Ah--so you're arguing that we'd have better life expectancy in the U.S. if we had U.K. style gun laws?

By the way, death due to accidents and shootings is at least partly a measure of how well the healthcare system performs. I mean, why not say, "If you leave out deaths due to lifestyle diseases, we would have a better life expectancy than the British"?

[BeAChooser]

Originally Posted by JoeTheJuggler

By the way, death due to accidents and shootings is at least partly a measure of how well the healthcare system performs.

Not all that much. Sorry Joe, but it's just a fact that if you adjust for fatal injury accidents and homicides (two factors that have very little to do with the health care system), the US has a longer life expectancy than virtually every other industrialized nation.

Originally Posted by JoeTheJuggler

I mean, why not say, "If you leave out deaths due to lifestyle diseases, we would have a better life expectancy than the British"?

Well that too is the problem with simplistically using "life expectancy" as the measure of which health care system is best. Just look at the example of Cuba, which has a longer life expectancy ... but also has a significantly lower calorie diet.

[Dymanic]

Originally Posted by BeAChooser

Sorry Joe, but it's just a fact that if you adjust for fatal injury accidents and homicides (two factors that have very little to do with the health care system), the US has a longer life expectancy than virtually every other industrialized nation.

As much as I hate to admit it, that looks like a pretty strong point -- but I'd really like to see the math. Since you introduced it, may I assume that you've already worked that out, and if so, would you mind showing your work?

[DC]

Originally Posted by Dymanic

As much as I hate to admit it, that looks like a pretty strong point -- but I'd really like to see the math. Since you introduced it, may I assume that you've already worked that out, and if so, would you mind showing your work?

he didnt doo any math.

he got it from here i guess.

http://www.aei.org/docLib/20061017_O...esentation.pdf

[Toke]

BAC,
Does this mean that the US health would benefit more from banning guns than from UHC?
If so, why is the GOP not suggesting it as an alternative to Obamas plan?

[Earthborn]

Originally Posted by BeAChooser

Not all that much.

I think it is actually quite a bit. While the chance of getting in an accident or having someone try to murder you is not much affected by the healthcare system, what is affected by the healthcare system is the chance of surviving it. You cannot simply subtract the number of people killed in accident or homicide from each of the countries' death rates and have a comparable figure, because the country with the better health system will have more people surviving comparable injuries.

Quote:

Well that too is the problem with simplistically using "life expectancy" as the measure of which health care system is best.

Few countries obsess about whether one system of healthcare financing causes more deaths than another (probably because it is assumed that paying for it one way or another should make very little difference). Usually "public health" is considered to be a much broader concept, in which life expectancy, infant mortality rates, obesity rates, accident and murder rates are all included. If the US has a lower life expectancy because there are more accidents and murders, then in this view it has a worse public health situation.

[Dymanic]

Hmm...
Well, the CDC has motor vehicle traffic deaths in the U.S. at around 43,000 for 2008 (14.6 per 100,000 population), and firearm deaths at around 30,000 (10.3 per 100,000 population). The total death rate: 810.4 deaths per 100,000. I don't easily find sources I like with recent numbers from other countries, particularly for homicides, but the OECD median for motor vehicle looks to be 9.3 per 100,000. That's certainly better than in the U.S., but it looks like you'd have to monkey with the numbers pretty heavy (cherry pick the years or something) in order to get it to skew life expectancy by very much. I could be wrong.

[Rolfe]

Originally Posted by BeAChooser

Only if you don't remove accidents and murders from the statistics. If you do, then one finds that we have better life expectancy than the British. Not

Now you see, this is what you get for deserting threads where you're being pwned. This has been examined in detail in a thread you walked away from, and I don't intend to go back into it all again.

(I'll just make one little comment though, and that is, you guys need to get together with the gun nuts and get your story straight. According to them, gun ownership doesn't cause excess deaths because even if guns were outlawed people would just hack each other to death with machetes.)

I do remember, however, that to cut short the arguing over the details, a general agreement was reached to allow that America and Britain had similar health outcomes, without trying to analyse the finish too closely. Will you agree to that, or are you planning on proving that the US has significantly better health outcomes using some sort of cherrypicked data?

If you want to do that, carry on. If not, I merely observe that we pay half what you do, for broadly similar outcomes.

Rolfe.

[JoeTheJuggler]

Originally Posted by BeAChooser

Well that too is the problem with simplistically using "life expectancy" as the measure of which health care system is best. Just look at the example of Cuba, which has a longer life expectancy ... but also has a significantly lower calorie diet.

I see--so you're just arguing against a strawman position where life expectancy is the sole measure of which health care system is best.

You've got to ignore the actual standards the WHO used to rank health care systems:

Quote:

The report indicates – clearly – the attributes of a good health system in relation to the elements of the performance measure, given below.

Overall Level of Health:
<snip>
Distribution of Health in the Populations: I
<snip>
Responsiveness:
<snip>
Distribution of Financing:
<snip>

I didn't see a simple listing without the paragraphs of explanation, so I merely snipped the headings.

[BeAChooser]

Originally Posted by Rolfe

Originally Posted by BeAChooser
Only if you don't remove accidents and murders from the statistics. If you do, then one finds that we have better life expectancy than the British.

Now you see, this is what you get for deserting threads where you're being pwned. This has been examined in detail in a thread you walked away from, and I don't intend to go back into it all again.

Now you are simply lying, Rolfe. Go back to either of the two threads you claim I deserted

http://forums.randi.org/showthread.php?t=149823

http://forums.randi.org/showthread.php?t=150013

and you'll find that neither talks about life expectancy or what removing accidents and murders does to those statistics.

[BeAChooser]

Originally Posted by JoeTheJuggler

You've got to ignore the actual standards the WHO used to rank health care systems:

Unlike you, Joe, I haven't ignored that topic AT ALL. I've discussed it specifically several times on this forum ... sometimes in discussions WITH YOU. For example, not too long ago I posted the following TO YOU during a discussion when you brought up the topic of WHO rankings (http://forums.randi.org/showthread.p...ionists&page=3 ):

Quote:

http://www.voiceofthetimes.net/index...=1014&Itemid=2

Quote:

Healthcare interventionists frequently cite the World Health Organization's World Health Report 2000, which studied the performance of 191 countries' healthcare systems — and awarded the U.S. a dismal rank of number 37.



While the WHO rankings are touted as an objective measure of the relative performance of healthcare systems, in reality they depend on a number of ideological or logically incoherent assumptions.


... snip ...

Some people are happy to give up a few potential months or even years of life in exchange for the pleasures of smoking, eating, having sex, playing sports, and so on. The WHO approach, rather than taking people's preferences as given, deems some preferences better than others, and then praises or blames the health system for them.


Those who cite the WHO ranking to justify greater government involvement in the health system — like the plans pitched by the leading Democratic presidential candidates — are assuming what they're trying to prove. 

The WHO healthcare ranking system does not escape political bias. It advances ideological assumptions that most Americans might find questionable under the guise of objectivity.

http://www.jewishworldreview.com/080...inter_friendly

Quote:

Why the U.S. ranks low on WHO's health-care study

By John Stossel

...snip ...

So what's wrong with the WHO and Commonwealth Fund studies? Let me count the ways.

The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem.

Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.

When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.

Diet and lack of exercise also bring down average life expectancy.

Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations. What has that got to do with the quality of health care? For the authors of the study, it's crucial. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed." The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.

http://smartgirlnation.com/2009/06/0...h-care-system/

Quote:

In summary, therefore, the WHO ranking system has minimal objectivity in its “ranking” of world health. It more accurately can be described as a ranking system inherently biased to reward the uniformity of “government” delivered (i.e. “socialized”) health care, independent of the care actually delivered.

And as anyone can see looking at that thread, your response was to simply ignore all that I posted about the WHO study and instead go on regurgitating some false claims about things I never said.

Sorry Joe, but your so-called WHO *standards* aren't about rewarding good health care but rewarding socialism. What's called "Distribution of Financing" is nothing but a "fairness" factor that necessarily makes countries that rely on private payment look inferior to socialized systems. And the "Distribution of Health in the Populations" index is a second helping of this "fairness" doctrine. Both actually have nothing to do with the quality of the health care provided by a system. Both of them inherently favor socialist systems ... even if the people in those systems are dirt poor as a result (like they often are in Cuba) and receive inadequate health care. As long as it's "fair".

In fact, suppose that a country currently provides everyone the same quality of healthcare. And then suppose the quality of healthcare improves for half of the population, while remaining half get the same health care as before. This is unambiguously an improvement in the health care of the country, yet this change could cause the country to fall in the WHO rankings due to the distribution index. Which illustrates how flawed and illogical the WHO methodology is, Joe.

Now for those who really are interested, this and many other flaws in the WHO study are discussed here:

http://www.cato.org/pubs/bp/html/bp101/bp101index.html

The author correctly concludes:

Quote:

The WHO health care ranking system does not escape ideology. On the contrary, it advances ideological assumptions under the guise of objectivity. Those interested in objective measures of health system performance should look elsewhere.

[Dymanic]

Originally Posted by BeAChooser quoting John Stossel

We have far more fatal transportation accidents than other countries. That's not a health-care problem.

Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.

When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.

I don't mean to be a pest about this, but I'm still not seeing the numbers backing this up. "Far more fatal transportation accidents than other countries" appears to be at least a bit of an exaggeration; "somewhat above the OECD median" would be more accurate. The homicide rate comparisons may be accurate for all I know; still haven't found reliable sources for other OEDC countries. But both traffic fatalities and homicides together represent a pretty miniscule portion of the all-causes death rate in the U.S. -- maybe a couple of percent. As strong as this argument would be if properly supported, I'd think you would want to do a better job of providing that support. If you can, that is.

[Architect]

BAC quotes Stossel, but of course the latter has very strong political views and is by no means an independent and expert authority (and I'm only using the Wiki link because it's easy, his own website is full of similar stuff). So, I ask myself, why aren't we seeing any figures to back up the homicide/vehicle death claim? Are we just to take Stossel's word for it?

[kellyb]

Originally Posted by Dymanic

I don't mean to be a pest about this, but I'm still not seeing the numbers backing this up. "Far more fatal transportation accidents than other countries" appears to be at least a bit of an exaggeration; "somewhat above the OECD median" would be more accurate. The homicide rate comparisons may be accurate for all I know; still haven't found reliable sources for other OEDC countries. But both traffic fatalities and homicides together represent a pretty miniscule portion of the all-causes death rate in the U.S. -- maybe a couple of percent. As strong as this argument would be if properly supported, I'd think you would want to do a better job of providing that support. If you can, that is.

bump

[Rolfe]

Originally Posted by Architect

BAC quotes Stossel, but of course the latter has very strong political views and is by no means an independent and expert authority (and I'm only using the Wiki link because it's easy, his own website is full of similar stuff). So, I ask myself, why aren't we seeing any figures to back up the homicide/vehicle death claim? Are we just to take Stossel's word for it?

Not on a bet. Remember this?

Stossel solves the healthcare crisis with capitalism

When examined in its entirety, that programme was a mish-mash of lies (about universal healthcare systems), non-sequiturs (about "food insurance") and apparently real horror stories about the US healthcare system, for which Stossel presented no workable solution.

After having dissected that one in detail, if John Stossel told me it was raining I'd look outside to check.

Rolfe.

[Architect]

Aha, I'd forgotten about that one! Nice call.

[back2basics]

So the U.S has a higher homicide rate. But it has lower rates of deaths on the roads. More people eat burgers in the U.S, but not so much the deep fried mars bars. People don't binge drink as much in the U.S there are far fewer deaths due to alcohol abuse.

So let’s see your figures cause this argument really needs fleshing out. I would suggest the numbers equal out more than the lopsided view that homicides in America make your figures look worse, when homicides are only a small part of it. Looks like a faith based argument to me, unless you have some cold hard facts?

[jimbob]

But not all the US life expectancy differences can be explained by differences in gun ownership...

A significant part can be, but that is not all:

Note that this is quite an old post that I am quoting

Originally Posted by jimbob

Originally Posted by jimbob

Originally Posted by fls

I think the point is that the US could be getting far more value for the money it spends, or spend less money and redistribute good-quality care to everyone (while ensuring that people are still free to buy excess care if they want). The only thing holding them back seems to be ideology, and that ideology seems to be based on misunderstanding and misinformation.

Linda

Yup: some further evidence from an earlier thread:

The US state alone spends more of its GDP on healthcare than the UK: for as system that is far form universal.

Originally Posted by jimbob

Here is where I got the 6.6% figure (for 2004)

Originally Posted by jimbob

Medicaid costs a larger percentage of GDP than the NHS does the British taxpayer.
(44.7% of 14.7%=6.6%) was public, as opposed to the UK's (83.4% of 7.7%=6.3%) of GDP Source:

OECD Health Data 2007 - Frequently Requested Data

The death rate is higher in the US too, and not all can be explained by higher gun ownership:

Originally Posted by jimbob

Originally Posted by JEROME DA GNOME

Originally Posted by jimbob

I have found one estimation, in what seems like an appropriate journal.

Thank for for your research.

"The United States thus suffers from a life expectancy gap of 1.7 years."

Now add 1.7 years to your previous stats and tell me were we are.



Keep in mind that this is only one factor to be considered.

"These deaths account for 26.86 percent of the U.S. males' excess mortality when compared to peer nations, and 8.7 percent of the racial gap between black and white males in the United States."

So, yes Jerome, it is significant, but only explains about a quarter of the difference between the US and the other thirty-four other richest countries.


In fact I am surprised at the magnitude of the effect, but it still leaves 74% unexplained by gun-deaths.

In answer to the assertion that the rest of the world is freeloading on the US medical research, which is lowering death rates, a lot of the mortality and morbidity is preventable with better primary healthcare.

[fls]

One could look at a systematic review comparing specific medical conditions (in order to avoid the problems with differences in baseline risk):

http://www.openmedicine.ca/article/viewArticle/8/1)

Linda

[jimbob]

Oh, and might as well quote Tsukasa Buddha's OP from that thread too: (EDIT my post#24)

Originally Posted by Tsukasa Buddha

Quote:

The study, entitled "Measuring the Health of Nations: Updating an Earlier Analysis," was written by researchers from the London School of Hygiene and Tropical Medicine. It looked at death rates in subjects younger than 75 that could have been prevented by timely and effective medical care.
The researchers found that while most countries surveyed saw preventable deaths decline by an average of 16 percent, the United States saw only a four percent dip.
The non-profit Commonwealth Fund, which financed the study, expressed alarm at the findings.
"It is startling to see the US falling even farther behind on this crucial indicator of health system performance," said Commonwealth Fund Senior Vice President Cathy Schoen, who noted that "other countries are reducing these preventable deaths more rapidly, yet spending far less."
The 19 countries, in order of best to worst, were: France, Japan, Australia, Austria, Canada, Denmark, Finland, Germany, Greece, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, the United Kingdom and the United States.

Linky

But we have teh best healthcare in the world!!

Clearly the solution is to let the free market take its course and get rid of government regulations like all those countries did...

[BeAChooser]

Originally Posted by Dymanic

"Far more fatal transportation accidents than other countries" appears to be at least a bit of an exaggeration; "somewhat above the OECD median" would be more accurate.

It's not an exaggeration at all. Here is a chart based on World Health Organization and US Department of Health and Human Services statistics (http://up-ship.com/blog/?p=3507 ) that shows the death rate due to transportation accidents in the US in 2000 was 15.3 per 100000. The transport death rate in Canada is only 9.3 per 100000, in Germany it's 10.1 per 100000, in Sweden it's 4.9 per 100000 and in the UK it's 6 per 100000. "Far more fatal transportation accidents" is indeed a correct description when the fatal transportation accident rate in the US is 3 times that in Sweden, nearly two and half times that in the UK and 50% higher that in Germany or Canada. "Somewhat above the OECD median" is NOT more accurate.

Originally Posted by Dymanic

The homicide rate comparisons may be accurate for all I know; still haven't found reliable sources for other OEDC countries.

Well according the link above (one would hope WHO is reliable, right?), the US homicide rate is 7.3 per 100000, compared to 1.4 per 1000 for Canada, 0.9 per 100000 for Germany, 1.2 per 100000 for Sweden and 0.7 per 100000 for the UK. In other worlds, the homicide rate in the US is 10 times that in the UK.

Originally Posted by Dymanic

But both traffic fatalities and homicides together represent a pretty miniscule portion of the all-causes death rate in the U.S. -- maybe a couple of percent.

But as Ohsfeldt and Schneider showed (see Table 1.5 in their presentation), you need not make more than a couple percent change in life expectancy statistics to move the US to the top of the life expectancy list.

And you know, Dymanic, it's not just transportation accident and homicide rates that are higher in the US and thus affect life expectancy statistics.

The US also has higher infant mortality rates lowering the life expectancy ranking. But 2007 study by Baruch College economists June and David O"Neill showed why U.S. infant mortality rates are higher ... more low weight births than other countries ... in part because we have significantly more teens having babies. Low birth weight significantly increases an infant's chance of dying. Thus lowering life expectancy statistics.

Life expectancy also depends on personal habits. Americans tend to be a lot fatter than the citizens of other developed countries which increases their risks of heart disease and diabetes. A recent survey reported that 31 percent of Americans are obese, compared to only 23 percent of Britons, 14 percent of Canadians, 13 percent of Germans, 9 percent of the French, and 3 percent of Japanese. But obesity is not caused by the health care system. The Cubans have been getting a diet that has less than half the calories of the US diet for decades. Is it any wonder that has led to a higher life expectancy in Cuba? Is it any wonder that Cuba beats the US in WHO's ranking ... especially since Cuba is a communist nation that the WHO methodology will naturally favor in it's indexes?

There are also more deaths from drug abuse in the US than in other countries. Drug use is not caused by a poor health care system.

Also, some ethnicities have naturally higher life expectancies too. For example, the Japanese, whether they are living in Japan, the US or Europe, have higher life expectancies than Europeans. In fact, people of Japanese descent living in the US have a higher life expectancy than do Japanese living in Japan. That should tell you something. People of African descent have lower life expectancy than people of European descent. Just about anywhere on earth. So the US, with a significantly higher population of such people than Europe, might be expected to have a lower overall life expectancy. Nothing to do with the health care system.

The whole point is that using life expectancy, like WHO did in their ranking, to determine which nation has the best health care system is bogus because life expectancy significantly depends on factors that are not related to the health care system. As pointed out in those sources, measures that truly reflect health system characteristics ... such as looking at cancer survival rates ... show that the US leads in health care, not lags as claimed by Obama's followers.

And I leave you with this:

http://papers.nber.org/papers/w15213#fromrss

Quote:

Low Life Expectancy in the United States: Is the Health Care System at Fault?

Samuel H. Preston, Jessica Y. Ho
NBER Working Paper No. 15213
Issued in August 2009

... snip ...

Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.

[Darth Rotor]

How is life expectancy a useful metric in this conversation? Is there some inherent value to keeping people alive, regardless of that quality of life?

If you want health care system to think for people, then you seek a system that can't work and that we can't afford.

Bad habits and bad luck kill as easliy as a disease treated to late.

(Full disclosure: I thought Dr Jack Kevorkian was right.)

[Segnosaur]

Originally Posted by fls

One could look at a systematic review comparing specific medical conditions (in order to avoid the problems with differences in baseline risk):

http://www.openmedicine.ca/article/viewArticle/8/1)

Linda

I remember seeing this exact same article posted before in the JREF forums. I had concerns about it before, and nothing that was discussed made me drop my concerns.

Edited to add: If anyone hasn't read the article, let me summarize: The authors went through a bunch of medical journals, and looked for articles that allowed them to compare the outcomes of patients in Canada and the U.S. If an article showed better results under the Canadian system, they 'awarded' the study to Canada. If an article showed better results under the American system, they 'awarded' the study to Canada. The results showed more studies showing superior outcomes under the Canadian system when compared to the American system.

The concerns that I had with this article:

- One of the primary authors (http://en.wikipedia.org/wiki/Gordon_Guyatt) has run multiple times for the NDP, the main 'Socialist' party here in Canada, and the party most opposed to any privitization of health care. Guyatt may have done valuable research in the past, but that doesn't mean that each and every claim made by him should be accepted at face value, especially when the line between true medical science and politics can get blured.

- This is a meta-study. I'm always suspecious of such studies, regardless of topic... How do you know that they didn't just happen to stumble upon (either by accident or purpose) those studies that actually prove their point? They claim to have taken steps to prevent their researchers from bias, however, the fact is that they're still taking a sample of a sample (giving a smaller pool from which to draw results, making it more prone to errors).

- Much of the basis for the claims made in the article (that the U.S. does not have a better medical system) is based on the number of studies showing improved outcomes in Canada. Yet if you look at the studies favouring Canada (Table 3), you'll see that many of their studies are basically repetitions... For example, it points to 5 studies showing Canada's health care system is better at handling renal failure than the U.S. But they're 5 studies showing the same thing! Even if Canadian patients were better treated for renal failure than the American counterparts, the fact that 5 studies repeated the same thing gave more weight to the pro-Canada side than it deserved.

At the very least, the study should have divided the studies into disease categories...

- Very little effort is made to relate the success of treating certain diseases with improved mortality/quality of life. Thus, in that study, a disease that affects only a tiny number of people (such as AIDS) is given as much weight as a diseases that kills a relatively high number of people (such as heart disease).

- In addtion, I had problems with certain individual studies. For example:
* One study showing better results in Canada was restricted to only low income
patients. But if you're trying to analyse the OVERALL health care system, you
can't very ignore what could be a huge portion of your population
* Once study dealt with AIDS; however, success in handling HIV may be due
more to patent law than the quality of health care.

[NoZed Avenger]

There is an old thread when the WHO study first came out, and I have to agree that some of its metrics were (IMO) either poorly chosen or skewed. I'll try to find it -- there are some valid points in it, but the criteria chosen in the study were not all that impressive.

[NoZed Avenger]

The original thread I referred to may be lost, I found a partial quote from me on a different one [re: the WHO study]:

Quote:

. . . [T]he WHO itself states that it ranked countries based on "fairness in financing" -- they explicitly include this as a criteria for their judging. Again, when they use that for a criteria as part of their judging process, how surprising is it when they countires with government-controlled health care end up ranked higher?

They are assuming as true the very thing you are trying to assert -- this is nothing but circular. As a large part of the ranking procedure, the WHO looked at fairness -- not just in access to health care, but in financing -- to attain the goal of "fairness," financing would have to be based on prepayment, rather than payments based on the use of services or risk-related payments. It began the process with criteria that ranked systems based on general taxation as better than those financed through othjer means.

And not only do the ranking not appear to reward countries with faster treatment rates (unless you can show where that is taken into account under responsiveness, I may have missed it), the WHO (for efficiency) explici[tl]y calls for rationing of medical care, something that US citizens have not been to fond of in the past: "all countries need explicit policies to ration interventions."

Responsiveness to the patient seems to rank far behind how the system is financed in terms of weighting:France ranks 1st, but only 16th in responsiveness to patients; Italy ranks 22nd for responsiveness. The US was number one on responsiveness to patients, but ended up right next to Cuba overall. Rankings that measured "equality" of health care distribution and "fairness" in financing were weighted more heavily than responsiveness, and this penalizes countries with diverse populations or that use private insurance.

* * *

My primary criticism is not really directly aimed at the WHO, but if I am hardly a lone voice crying in the wilderness if it were (most of these are online and can be located through a title/author search):

The public versus the World Health Organization on health systems performance. Blendon RJ, Kim M, Benson JM. Health Affairs 2001; 20.

Health Service Goals: Life, death and football; J Health Serv Res Pol, Appleby J.

Sick list: health care à la Karl Marx. Wall Street
Journal, Helms, R. (6/29/2000).

A few more may available only by abstract:

"Decisions about how to weight the importance of the various components of the overall indicator and the sources used to select information on those components reproduce a set of highly questionable assumptions and heavily loaded ideological choices that weaken the scientific credibility of the overall indicator and of the WHO report itself. This transforms the report into a political ideological document that simply conveys and perpetuates the current conventional wisdom in health policy." Navarro, J. ( http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? )cmd=retrieve&db=pubmed&list_uids=11809014&dopt=ab stract


“[T]he composite index for attainment … is based on very little actual data, which is often heavily manipulated to make it usable, and then subjected to a great deal of rather adventurous modelling to fill out the rather large canvas of world health which the report purports to cover. A more virtuousic display of skating on thin ice you are unlikely ever to witness.” Science or marketing at WHO? A commentary on “World Health 2000”. Williams, A. York: Center for Health Economics, 2001.

Methodological concerns and recommendations
on policy consequences of the World Health report 2000. Lancet 2001; 357: 1692; Almeida C, et al.

* * *

The rankings themselves were determined by applying a set of a priori assumptions that need to be examined before the conclusions are accepted. The actual numbers for some countries appear to be "guestimated" in some areas - though not as much for western countries, where better statistics are kept. Some of the weights chosen in making the rankings appear questionable, however. As stated above, for example, a 12 or 18 month wait for an operation does not appear to be considered as part of the overall quality of care as compared to having the government finance the health care system.

That is not to say that specific weaknesses in the US system do not exist, or that the Report does not correctly identify at least some of them. But the rankings appear very suspect, IMO.

I don't want to go back through the WHO study again, but I spent a fair amount of time on it then, and I was not particularly impressed with a large portion of it.

[Dymanic]

Originally Posted by BeAChooser

Well according the link above (one would hope WHO is reliable, right?)...

Well, let's hope Ohsfeldt and Schneider are reliable, right? A couple of minor concerns, on a first pass.

Table 1-3, Comparison of Health Outcomes Relatively Insensitive to Health Care System Characteristics, 2000 Shows the U.S. ranked against five other countries on two outcomes (homicides and transport), but the vehicle deaths (at least) look cherrypicked if you compare the results with those listed, say, here:
http://www.nationmaster.com/graph/he...vehicle-deaths

Also, the title of the table says 2000, but the sources say 2004 and 2002 respectively. You could also skew the results a lot by cherrypicking data from different years.

And though it may seem like a quibble, at the bottom of that table, it says "NOTE: Death rate per 1,000" -- but it's not; it's per 100,000. Those extra zeros are important, and though it may just be a typo, it doesn't speak highly of the authors' attention to detail, a highly desireable quality when performing this type of calculation.

[Dymanic]

Originally Posted by Darth Rotor

How is life expectancy a useful metric in this conversation?

In the context of the broader discussion, it's useful mainly because it's convenient. There are other metrics, but you can only split a thread so many times.

Quote:

Is there some inherent value to keeping people alive, regardless of that quality of life?

For the reason I just mentioned, I don't think we need to get into that here.

[stup_id]

I just had to make some comments on this pieces (for background info i'm an MD, have visited and actually have close friends in the Health Care systems of Mexico, Spain, United Kingdom, France, Serbia, Turkey, Canada and some other countries after have worked for an International Organisation).

Originally Posted by BeAChooser

The US also has higher infant mortality rates lowering the life expectancy ranking. But 2007 study by Baruch College economists June and David O"Neill showed why U.S. infant mortality rates are higher ... more low weight births than other countries ... in part because we have significantly more teens having babies. Low birth weight significantly increases an infant's chance of dying. Thus lowering life expectancy statistics.

If you had a comprehensive Health Care system you'd be aware that Teen pregnancy and low weight births are indeed competences of the Health Care providers, Universal Health Care systems elsewhere (for instance in Spain) have the responsability of providing assesment and proper treatment (yes, even abortions.. OMG) about reproductive issues, so as it may not seem to you teen pregnancy and low weight babies in an inclusive Health Care System are completely related. For instance (and I'm aware it lies in the boundaries of ethics for some people) in Serbia, there's a program from government implemented by the neurology department at belgrade, of finding out which people carry the Huntington disease traits in their genome, those within reproductive age and who desire can not only get paid treatment but also are eligible of having free early fetal diagnosis of the disease and the option of aborting the product as many times as necesary to have a healthy baby.

Finally relating to this, low weight birth is not medically a cause, it is a consequence of something, it can be malnourishment or a mother's disease and the extent at which teen pregnancy is relevant is not as much as you'd think, our "modern" standard views may tell us that a 15 years old girl is not prepared for pregnancy but truth is that a few generations ago that was the reproductive age, I wish I could back this up with studies about low weight in teen pregnancy, but you also have to take into account (or at least mention it) that medical attention plays a big role in low weight births, since a significant amount of early births can be prevented or even reverted in the Gynaecology department (google for delivery inhibition, and premature membrane rupture) to make your commentary honest you really have to at least mention it. For my personal experience (not much, just about a 150 births) I do recall low weight being more related to premature birth and I had about 50% of those procedures in girls younger than 17, also remember that post-natal care is also evalued within the child mortality rate and you cannot tell me that Health Care is not responsible for that.

Originally Posted by BeAChooser

Is it any wonder that Cuba beats the US in WHO's ranking ... especially since Cuba is a communist nation that the WHO methodology will naturally favor in it's indexes?

This sentence really warns me off that you might prefer debating over ideologies and political ulterior motives than accepting other peoples insight, experience and evidence into this topic, I try to be as honest as I can be to myself, and I can tell you that even that I'm a Healthcare profesional I would prefer practicing in Spain, France or UK better than dealing with the current US HealthCare system, I'd really be glad to be proven otherwise, and I'm trying to evaluate the arguments you support here, but if they stem of a partialistic view of things rooted in ideology then I guess it would be futile.

Originally Posted by BeAChooser

There are also more deaths from drug abuse in the US than in other countries. Drug use is not caused by a poor health care system.

Then again you seem to believe that simply stating things as apart is the whole truth, Drug use is not caused by a poor health care system, nobody debates that, but the outcome of Drug Abuse is indeed a competence of the Health care system, as I told you before in this post, in a comprehensive Health Care System, drug abuse and its rehabilitation fall into the responsabilities of a coordinated action within the Health care providers, and the mortality related to drug abuse (i'm guessing you mean OD not the violence that sometimes accompanies drug abuse) evaluates at least at some level the capabilities of the Health Care to asses emergencies.

Originally Posted by BeAChooser

Also, some ethnicities have naturally higher life expectancies too. For example, the Japanese, whether they are living in Japan, the US or Europe, have higher life expectancies than Europeans. In fact, people of Japanese descent living in the US have a higher life expectancy than do Japanese living in Japan. That should tell you something. People of African descent have lower life expectancy than people of European descent. Just about anywhere on earth. So the US, with a significantly higher population of such people than Europe, might be expected to have a lower overall life expectancy. Nothing to do with the health care system.

Then how do you explain the consistent life expectancy and almost every other statistical indicator raise that can be assesed in countries such as UK, Spain and France?, are you aware that in the last 15 years immigrant populations of African, Latin American people and Eastern Europe countries have almost doubled?, yet it doesn't seem to affect the data, we would expect at least a negative tendency. One should carefully ask if it is indeed true that this "ethnical differences" are as responsible for the differences in life expectancy in the US, or is the inequality of access to the Medical Care what makes most of the difference.

Originally Posted by BeAChooser

The whole point is that using life expectancy, like WHO did in their ranking, to determine which nation has the best health care system is bogus because life expectancy significantly depends on factors that are not related to the health care system. As pointed out in those sources, measures that truly reflect health system characteristics ... such as looking at cancer survival rates ... show that the US leads in health care, not lags as claimed by Obama's followers.

I will agree with you that life expectancy is not an ideal tool to assess the Health Care system, but I've given you the reasons why a lot of the factor that you undermine as not related to Health Care indeed are. Is it the fault of the WHO that a lot of those factors that you mention are not related to Health Care system in the US are indeed considered relevant to Health Care to most other industrialized countries in the world?

BTW I'm not an Obama follower, but what I can appreciate of all my travelling, research and work into the topic, I can see a lot of things I would like to you Americans to have regarding Health Care attention, seeing people denying that there is need for a change in your way to take care of your vulnerable people just bogs me out.

[Segnosaur]

Originally Posted by stup_id

... For my personal experience (not much, just about a 150 births) I do recall low weight being more related to premature birth and I had about 50% of those procedures in girls younger than 17, also remember that post-natal care is also evalued within the child mortality rate and you cannot tell me that Health Care is not responsible for that.

Strangely enough, there may actually be a negative effect to improved neo-natal care and life expectency.

In the U.S., significant effort is made to get babies born prematurely to survive. Many however, do not, and this probably contributes to a decrease in the 'life expectency' statistics.

On the other hand, in other countries (such as Cuba, and some European countries), such medical intervention would not be attempted, and the death would be considered a "fetal death" rather than a live birth/death.

So, ironically, having a superiour system for handling premature births may actually harm the statistics.

http://www.skepticism.net/articles/2...ant-mortality/

[jimbob]

BeAChooser:

You seem to be arguing that the lower life expectancy in the US is the result of the US gun laws, which I guess you support, and indicators that are generally considered to be linked with poverty: teenage pregnancy, obesity (to a lesser extent), low-birth weight, and race too.

EDIT: and drug-use

[stup_id]

Originally Posted by Segnosaur

Strangely enough, there may actually be a negative effect to improved neo-natal care and life expectency.

In the U.S., significant effort is made to get babies born prematurely to survive. Many however, do not, and this probably contributes to a decrease in the 'life expectency' statistics.

On the other hand, in other countries (such as Cuba, and some European countries), such medical intervention would not be attempted, and the death would be considered a "fetal death" rather than a live birth/death.

So, ironically, having a superiour system for handling premature births may actually harm the statistics.

http://www.skepticism.net/articles/2...ant-mortality/

Interesting article indeed, I'd have to ask to some of my colleages in Spain and France about the guidelines they have regarding premature birth, having those fragile babies added to the mix might skew the data as for child mortality, what would be interesting to have is the child mortality due to lack of medical attention normalized within the total child mortality I think that indicator would be more more insightful... maybe when I get some spare time i'll look into it.

[JoeTheJuggler]

Originally Posted by BaC quoting John Stoessel

The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries.

The sentence I bolded is the problem. The "Overall Level of Health" was based on the disability-adjusted life expectancy but was itself not the sole criterion for their rankings of health care systems. Nor was it the sole criterion related to health outcomes (there was also the Distribution of Health in the Population).

And back to the issue of accidents, I still contend that mortality by accidents is, in part, a reasonable criterion for evaluating a health care system. Emergency services are an important part of the system.

For that matter the prevalence of accidents can even be seen as an outcome of the portion of a health care system related to education and public health. (As very simplistic examples: the AMA's position on seatbelt and helmet use or cigarette smoking, or public health departments promoting hand-washing and immunization programs.)

[fls]

Originally Posted by Segnosaur

I remember seeing this exact same article posted before in the JREF forums. I had concerns about it before, and nothing that was discussed made me drop my concerns.

Edited to add: If anyone hasn't read the article, let me summarize: The authors went through a bunch of medical journals, and looked for articles that allowed them to compare the outcomes of patients in Canada and the U.S. If an article showed better results under the Canadian system, they 'awarded' the study to Canada. If an article showed better results under the American system, they 'awarded' the study to Canada. The results showed more studies showing superior outcomes under the Canadian system when compared to the American system.

I think there's a typo? If study outcomes showed a benefit to a US centre(s), then it counted as a study showing benefits to the US, not Canada.

Quote:

The concerns that I had with this article:

- One of the primary authors (http://en.wikipedia.org/wiki/Gordon_Guyatt) has run multiple times for the NDP, the main 'Socialist' party here in Canada, and the party most opposed to any privitization of health care. Guyatt may have done valuable research in the past, but that doesn't mean that each and every claim made by him should be accepted at face value, especially when the line between true medical science and politics can get blured.

That is why I referenced published study results, rather than an opinion piece from one of the authors. I don't know the political affiliation of the other 16 authors.

Quote:

- This is a meta-study. I'm always suspecious of such studies, regardless of topic... How do you know that they didn't just happen to stumble upon (either by accident or purpose) those studies that actually prove their point? They claim to have taken steps to prevent their researchers from bias, however, the fact is that they're still taking a sample of a sample (giving a smaller pool from which to draw results, making it more prone to errors).

Exactly. Which is why there are strict criteria to follow when finding and selecting the studies.

Quote:

- Much of the basis for the claims made in the article (that the U.S. does not have a better medical system) is based on the number of studies showing improved outcomes in Canada. Yet if you look at the studies favouring Canada (Table 3), you'll see that many of their studies are basically repetitions... For example, it points to 5 studies showing Canada's health care system is better at handling renal failure than the U.S. But they're 5 studies showing the same thing! Even if Canadian patients were better treated for renal failure than the American counterparts, the fact that 5 studies repeated the same thing gave more weight to the pro-Canada side than it deserved.

I'm not sure why you think that their claim is based on the number of studies, as it isn't. If they had wanted to, they could have claimed superiority for Canada, given that there were more studies which demonstrated superiority (even if you group them by disease), and that the meta-analysis showed a statistically significant benefit. That they did not do so reflects their caution in drawing conclusions. However, if they didn't find it reasonable to draw conclusions about the superiority of Canada's outcomes, it would have to be even more unreasonable to then attempt to conclude that the US was superior.

Quote:

At the very least, the study should have divided the studies into disease categories...

- Very little effort is made to relate the success of treating certain diseases with improved mortality/quality of life. Thus, in that study, a disease that affects only a tiny number of people (such as AIDS) is given as much weight as a diseases that kills a relatively high number of people (such as heart disease).

But that would be answering a different question than the one that was asked. It's usually considered reasonable for a study to answer the question that was asked, rather than answering a different question.

Quote:

- In addtion, I had problems with certain individual studies. For example:
* One study showing better results in Canada was restricted to only low income
patients. But if you're trying to analyse the OVERALL health care system, you
can't very ignore what could be a huge portion of your population

As was mentioned in the discussion, there is a strong association between socio-economic status and health. It makes sense to look at indicators which are sensitive to health status. Also, you seem to be suggesting that individual studies be excluded on the basis of arbitrary criteria. Aren't you attempting to do just what you suggested earlier would invalidate the results?

Quote:

* Once study dealt with AIDS; however, success in handling HIV may be due
more to patent law than the quality of health care.

You'd better not let Beerina hear you say that.

Linda

[Rolfe]

I remember that thread too. As I recall, we agreed to call it a fair fight and merely to state that the US outcomes were "no better" than other countries.

It's not just straight life expectancy though, it's infant mortality and a bunch of other things.

I think I'll leave this to Linda, it's not my area of expertise.

Rolfe.