Sunday, November 21, 2010

Brits are Healthier but Americans live longer. Go figure!

A report in the scientific Demography Journal finds that older Brits are healthier than older Americans, yet Americans live longer. This week Toni invites fellow bloggers Melissa (Smitten by Britain) and Michelle (The American Resident) to discuss the issue with her.
Toni

No surprises really. Americans in general, aren't a healthy bunch and are always seeing their doctors (when they can afford it). Although obesity is rising in the UK, it hasn't reached the levels of the US, therefore related illnesses such as Type 2 diabetes, some cancers, and heart disease are correspondingly less frequent in the UK. That American doctors run far more tests on their patients and refer to specialists more frequently, also means that illnesses and diseases are reported more often.

So how come these unhealthy Americans still end up living longer than their British counterparts?

Not to be unkind, but Americans seem to go on treating their elderly when the poor sods are well past their sell-by date and are probably quite ready to "go". It's not uncommon to hear of families of really old patients insisting on "life-saving" surgery to extend his or her life by another three months. Unlike the UK, where hospital doctors rule with an iron rod, Americans can and do insist on treatments and surgeries since it's they or their insurance that's paying.

Apparently because people in many countries are now living longer, 80 is the new 50 and more and more geriatricians (that's a real term BTW) are performing successful surgeries on patients in their 80's and older.

Since Britain's NHS funds are limited, unlike the seemingly bottomless coffers in the US, it isn't surprising that treatment options for the elderly are sometimes dictated by cost. British studies have shown that older breast cancer patients have typically been given less effective treatment than younger patients, although this trend is changing. Because of this and other health trends however, I wouldn't be surprised if health and mortality rates in both countries are the same in a few decades.

Melissa:

I view this study from a slightly different perspective than Toni. Americans spend a lot of money on health care yet our life expectancy is only five months longer than a country that spends half the money yet provides health coverage to all of its citizens. As an American, you have to ask yourself, “Are we getting our money’s worth?”  Sure, we could pat ourselves on the back for coming out ahead despite having lousy health but I don't think that's anything to boast about. We spend billions of dollars and go through years of preventative testing for diseases like cancer and heart disease, only to live five months longer than the British.

I think Toni has put her finger on something here. Despite our poor health, maybe we live longer than the British because we move heaven and earth to make sure we do. Indeed many Americans seem to believe they have the right to live as long as medicine will allow, even if it comes at great expense, not just to their our bank balances but to their loved ones who care for them until the end. Then there are those who will spend copious amounts of money to look as though they have drunk from the fountain of youth, as if this too will help delay the inevitable. It’s this lack of acceptance and end of life issues that helped de-rail universal health care in 2009. (Remember death panels?)

And that leads me to what I think is the most important reason we don’t get the biggest bang for our buck in life expectancy - lack of universal health care. When an individual doesn’t have health care insurance he is less likely to go for preventative care, and less likely to visit a doctor with symptoms, meaning serious illnesses are caught later, when they are more difficult and expensive to treat, and the prognosis may be poorer. It’s these preventable deaths that help drive down U.S. life expectancy numbers.

But Britons shouldn't take heart in this study either; yes, as a population Americans are unhealthier than Brits, but as Toni mentioned, the British are coming, and quite quickly as well. Once illnesses like Type 2 diabetes, heart disease and cancer begin to reach U.S. levels, life expectancy will drop and the gap between the U.S. and the U.K. may widen. To keep this from happening, the NHS will need to take a cue from the U.S. and improve on preventative testing –testing younger and more often.

Michelle:

I would love to glow with pride over the amazingness of my home country's health system.

However.

This research gives me nothing to glow about, as the inaccuracies of the interpretation and irresponsible reporting of data are frustrating.

The researchers conclude “It appears that at least in terms of survival at older ages [of people] with chronic disease, the medical system in the United States may be better than the system in England." I am incredulous that a person reporting on scientific studies would leap to this conclusion from such thin data. Their statement is irresponsible and potentially damaging. But in this climate of mistrust of Obama’s healthcare reform, perhaps it was intended to be.

I decided to Google more data for my own information. According to the U.S. Census Bureau, the overall life expectancy in the United States is 75.7 years for men and 80.8 years for women as of 2010. In Great Britain, life expectancy for those born between 2007 and 2009 is 77.7 years for men and 81.9 years for women, according to the U.K. Office for National Statistics.

Statistics can be found to support either side of most arguments.

The authors of this recent report also state that death rates among Americans were about the same as the English in younger age groups. This tells me that healthcare is not better or worse in America (or an effect would be seen in all ages), but that end of life attitudes are different. Toni also identifies this difference in end of life attitudes and comments that UK doctors 'rule with an iron rod' (with regard to end of life care). I would suggest that it is more of an 'ethical iron rod'. All end of life decision-making in the NHS is based on a framework, which is not about funds but about quality of life. If Americans are living longer but living those months or years on ventilators, possibly conscious but most likely not, then what's the point?
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(Although the full report isn't available online, these articles give more detail about the results):

http://www.dailymail.co.uk/health/article-1326454/Brits-healthier-Americans-die-sooner-healthcare-worse.html

http://www.livescience.com/health/americans-sicker-live-longer-than-english-101104.html

12 comments:

  1. Indeed Michelle and it should also be a question of quality of years over quantity of years. If I had the choice I would rather die five months earlier but get more life out of my years. I would like someone to do a study asking Brits and Americans how they feel at say, age 70, and see where the numbers lie.

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  2. The report (althouugh in fairness it may be more the reporting of the report than the report itself) only seems to be considering environment and its effect on health. As genetics also plays such a large part in what diseases we contract or are more susceptible to (different ethnicities are more susceptible to certain diseases: e.g. African-Americans are twice as likely to contract type 2 diabetes than a non-hispanic white American) it would be interesting to see the figures broken down further, otherwise it could be seem as a false comparison.

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  3. This makes an interesting read.
    So we are talking about 5 months difference.
    I expect eventually there are some things that money can't buy and a cure for fatal illnesses is one of those things.
    Maybe the money helps to keep going a little longer in the USA. In the end though, it is quality of living, isn't it?
    I think genetics definitely come into it. I think *awindram* is right in that thinking. We are not all born equal.
    Maggie X

    Nuts in May

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  4. So interesting! Plus I totally love your blog.

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  5. In the current state of economy, selecting a medical insurance plan that has great coverage and is affordable can be a difficult task. In 2007, average health insurance premiums increased by 6.1 percent, above official measures of inflation and well beyond the increase in average salary and wages to American workers.
    While selecting an affordable medical insurance plan that has great coverage can be a difficult task, especially in the current state of the economy, our health is still our most valuable asset and it is very important to protect it as much as possible.

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  6. I'm sure statistics can be made to say anything we want, but on this issue, I think you can generalise and say that Americans are probably a little bit unhealthier on the whole. They eat more and walk less, but every time I come back to England, I see more and more overweight people.

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  7. We have children with Type 2 diabetes and girls with breasts at age 7. We are unhealthier, period.

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  9. Interesting. I think the commenter who mentioned ethnic differences has a good point. The difference in life expectancy between racial and socioeconimic groups in the US is quite large, I believe, larger than this difference between Britain and the US. I'm not sure if that is true in Britain also, but likely it is not as stark due to the universal health care system. There is almost certainly a genetic component to longevity also, the Japanese being a good example.

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  10. Really interesting cross-pond discussion of a very contentious and important issue! Love the format of your blog generally.

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  11. Two comments as there is a character limit here. The urge to fisk this post is strong, but I don’t have enough time. Besides, I am working on multiple posts on healthcare in the US and UK that will address some of the issues raised. For today, for anyone still checking this comment thread, I’ll focus on two points: the numbers and the asserted superiority of a medical committee to decide medical treatment.
    I covered the numbers recently in a post about commonly misused statistics. Here is the longevity portion: [It has lots of links that did not cut and paste. if you want them, this post is Unpacking Statistics at my place]:
    Same too for longevity comparisons.  On healthcare the left often points to the fact that US longevity rates are not sufficiently better than rates in other countries given money spent on healthcare.  Once again they lump all the data together and, as with the standardized test scores, they "rely" on misfortune in the black population too keep the averages down. First, longevity numbers are not simple to work with.  Unpacking the longevity numbers in this instance means recognizing that not all deaths are related to healthcare. Auto deaths and crime related deaths come to mind. In fact, the US has higher auto fatalities and a higher homicide rate, both especially among youths, weighing down longevity numbers.  We have more auto deaths because we have more cars and we drive more places.  We have higher homicide rates in part because black youths have extremely high homicide rates.  When you control the longevity numbers for auto deaths and homicide, however, the US leaps back to the top.  A similar post for Jonah Goldberg and an excerpt from one of the links in Jonah's post:
    In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don’t die in car crashes or homicides outlive people in any other Western country.
    And if we measure a health-care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50 percent; the European rate is just 35 percent. Esophageal carcinoma: 12 percent in the United States, 6 percent in Europe. The survival rate for prostate cancer is 81.2 percent here, yet 61.7 percent in France and down to 44.3 percent in England—a striking variation.
    More analysis and links here.

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  12. As for the assertion that having a medical committee is better than patient decisions, Americans are not likely to agree. Americans will typically see end of life issues as a discussion between the patient/family and the doctors. We don’t like committees, especially some with unintentional Orwellian names like NICE. A committee might have some academic notion of pain and quality of life, but would know nothing of the grandfather who prefers six more months of pain on the off chance he will live long enough for his 4 year old granddaughter to remember him, or of the 70 year old man in need of a risky triple bypass a week before his first grandchild is due. Going by textbook quality of life issues, both men were reasonably “past their sell by date”, a pleasant choice of phrase.

    Furthermore, those committee decisions won’t always be about the elderly. Try telling a pro-choice woman in the US that her right to abortion after 18 weeks is subject to the decision of a medical committee, as in Denmark. Or worse, that it isn’t legal. I think the UK cutoff is 20 weeks. Just the thought of limitation, any limitation, is enough to stoke US feminist condemnation.

    I grant that the US tends to default to using technology to prolong life. That has started changing. Doctors have started focusing more on hospice care. My sister-in-law, a doc in a pediatric intensive care unit and who regularly deals with terminal patients, is heartened about recent trends to proper hospice care. Regardless, I’d rather err on the side of life. Based upon a wealth of news stories about the UK and Europe, it sounds like their solution often involves shuttling the unfortunate into some ignorable place and letting them die. Today news came that many elderly had been abandoned in Japan. This coarsening of compassion for the elderly is ominous. They deserve better.

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