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