Of course, it turns out they're actually last among developed nations in real health outcomes.

The U.S. ranks #1 among 17 affluent, western countries in the percentage of people aged 5 to 34 who rate their health as good. Unfortunately, when doctors look at people’s actual health, at indicators such as obesity, diabetes, and simply the chance that someone will die before his or her next birthday, the U.S. ranks last: young Americans are #17 out of 17 in real health.

New Comment
41 comments, sorted by Click to highlight new comments since:

This belongs to Open Thread.


Yep, you're right. I've never used the Open Threads so I didn't know that. Thanks.

Unfortunately, the Open Thread is rather difficult to find. You must know it exists, because it quickly gets lost among the new articles -- at least a third of which should be better placed in the Open Thread. So the problem makes itself worse. Unless someone reminds other people to use it... which always feels like starting a conflict with the author; and there are not even obvious guidelines. So thanks for not getting offended.

Isn't the delineation subjective?

[This comment is no longer endorsed by its author]Reply

Explanation for my downvote: The article you linked is more ideology than research. If you had linked to the original research I could have something to criticize - the absence of basic controls in evaluating the state of health, for example, like comparing life expectancies of like groups - say, Japanese-descended men living in US to Japanese men living in Japan.

As it is, however, there are so many objectionable and poorly-defended statements (like the implication that the lack of gun control contributes to lower life expectancies, or the suggestion that a government-rendered diet would improve public health) that leave the article linked more politics than science that there's no one point of objection. It's just a mashup of ideological applause lights.

Like the implication that the lack of gun control contributes to lower life expectancies

The US has a murder rate about four times that of the UK.. If as a rough approximation half of that is due to gun control issues, that would correspond to an extra around 6,000 deaths yearly. Around 2.5 million people die in the US yearly. Victims of violent death are much more likely to be young but even if one assumes that the additional deaths are all infants, that's on the order of 3 months less of life. Even if one assumes that all differences in murder rate are due to gun control differences, the difference is still less than a year. It seems like the actual value that gun control is probably impacting is on the order of a month or so. So the conclusion that this isn't a substantial effect seems correct.

Incorrect. You're comparing apples to oranges. The UK only counts as murders or homicides those crimes which have a conviction; the US counts all deaths which are ruled a homicide. Additionally, the UK counts homicides as occurring when the trial is complete; a murder today may not be counted until 2016, and will be included in the 2016 statistics.

The correct proportion is probably somewhere around 33% or 75% - that is, the US homicide rate is about 33% higher than the UK homicide rate. But given the large number of deaths in the UK with an uncoded cause of death, the homicide rate could very easily be equivalent.


The UK only counts as murders or homicides those crimes which have a conviction . . . Additionally, the UK counts homicides as occurring when the trial is complete; a murder today may not be counted until 2016, and will be included in the 2016 statistics.

What a strange way of doing things. Collecting data in this manner systematically distorts the value of the statistics towards uselessness.

(1) Unsolved murders don't get counted at all
(2) There's no connection between when a murder occurred and when it is collected as data, because the criminal justice system does not have a predictable timetable from indictment to conviction. Two murders from sequential days could end up on different year tallies simply because of differences in the local courts' calendars. Which makes planning based on past data quite unreliable.

Do you have a cite explaining why this strange data collection method is still used? Aren't there coroner's verdicts or some-such?

Correction: Apparently the UK has trials (inquests, but in cases where they affect public safety, such as possible homicides, a jury is summoned? Or maybe it's passed on to the Crown Court? It's difficult to trace the laws down, but it does appear there is a substantial legal process) to determine cause of death in suspected homicides. So I misinterpreted the statements about the completion of trials there. See: http://www.legislation.gov.uk/ukpga/1988/13/contents

(US inquests -can- involve juries, varying by state, but rarely do.)

For the UK homicide year thing, I have no idea why, but it appears to be true. Quoting:

"Caution is needed when looking at longer-term homicide trend figures, primarily because they are based on the year in which offences are recorded by the police rather than the year in which the incidents took place."

Link: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/116483/hosb0212.pdf

However, I was incorrect about the "when the trial is complete" part, as I missed this section:

"Homicides are often complex and it can take time for cases to pass through the criminal justice system. Due to this, the percentage of homicides recorded in 2010/11 (and, to a lesser extent, those recorded in earlier years) to have concluded at Crown Court is likely to show an increase when the next figures from the Homicide Index are published in 12 months' time."

So if a homicide is recorded, but hasn't passed through the Crown Court yet, it still gets assigned to the recorded year.

Which all sums up to "The UK has a completely different process just for deciding what counts as a homicide." A few particular issues - the US treats criminally negligent deaths -and- manslaughter as homicide (see http://www.fbi.gov/about-us/cjis/ucr/summary_reporting_technical_specification_version_1.0_05-25-2012.pdf ), whereas the UK treats them as manslaughter. Additionally, the US includes justified homicides, whereas apparently the UK has a policy of removing such cases from the record. "Since 1967, homicide figures for England and Wales have been adjusted to exclude any cases which do not result in conviction, or where the person is not prosecuted on grounds of self defence or otherwise" per http://www.publications.parliament.uk/pa/cm199900/cmselect/cmhaff/95/95ap25.htm , which I'm assuming is accurate as their statistics are a -mess-. I'm trying to dig through them now.

Additionally, a lot of their homicides are uncoded. (Something like 50% of their homicide convictions involved deaths which weren't coded in their statistics as homicides, and only got coded as homicides after the conviction.)

As for why it's all this way? I have no idea. It may be they want more favorable statistics. It's also possible that the information they're gathering wasn't originally intended to be used this way. It may simply be that they prefer to code the knowns than the unknowns, whereas the US has a tendency of coding all unnatural deaths which aren't apparently suicide as a homicide. It's certainly true that the US "murder" rate is inflated by unintentional/negligent deaths, manslaughter, and self-defense/justified homicides.

Hmm, do you have a citation that the UK does that? Note that in that case, the difference between the US and UK effective rates will be even smaller, so the difference will be even less than a month. That makes the conclusion that this isn't a major impact on differences in lifespan even stronger.

http://lesswrong.com/lw/gkb/young_americans_believe_they_have_the_best_health/8p9g <- A few citations here, but it's a bit of a mess.

(I'm having a hell of a time digging through their laws.)


The fraction of Americans who believe they have good health is higher than the fraction of foriegners who believe they have good health. It doesn't follow that Americans believe they have the best health in the world. They might not know how other countries do, or be using a different scale to foriegners, or believe foriegners are unduly pesimistic, etc.

My European coworkers take sick days when they get headaches, and go to the doctor because they get headaches "frequently" (about once a month). They consider the slightest inconvenience or pain to be a massive health problem. Not that this is necessarily true of all Europeans (though thus far it's been true of every European I've yet met to some degreee...), but Americans in general, and particularly men, have a more rugged and independent attitude towards healthcare, and have a considerably wider spectrum encompassing "good health." A broken rib is an inconvenience, not a health problem.


As an American male who went to work the day after breaking his collar bone, I can testify that without a doubt, my rugged outward appearance would get thrown aside if proper health care and sick time were available to me. Scamming an x-ray by using a fake name at the hospital and carefully rationing what little methadone I could buy from local junkies, while Cowboy As Hell, is a pretty awful way to get by. I'd much rather be at home in bed mending then lifting boxes of apples with one arm and ensuring that my bones set at an odd angle.

I think that if European style health care was available here that we'd adapt pretty quickly, rugged independence be damned.

There's a difference between rugged independence and obstinate idiocy - not that you were idiotic, as it sounds like you had no choice, but you're treating "Aggravating injuries" as being equivalent to "Ignoring inconvenient issues."

A broken rib is

Now I'm reminded by a picture I saw on Facebook, making the point that rugby players are so much braver than soccer players because soccer players will pretend to be hurt when they're hit no matter how lightly, whereas rugby players will keep on playing even with a broken rib. And I thought that, while I agree that pretending to be hurt to get a free kick or so that your opponent will get a yellow card is childish, I think that keeping on playing with a broken rib isn't brave -- it's silly.

and particularly men

In Italy there's a meme (at least on Facebook) according to which men are more likely than women to complain about minor health problems. I disagree, but being male myself I might be biased about that.

That's actually a meme in the US, as well. However, there's likewise a meme that men refuse to go to the hospital. I'm going with the latter, given that the CDC reports that men go to the doctor about 75% as often as women.

Men get sick less often than women, but worse. That's part of the reason for this phenomenom. No referencew provided; on phone.

My female co-worker says that men are always ill and are aggravating minor health problems. She also steadily complains about her own health and has spent more time off-work for health reasons than anybody else in the department last year (no chronic disease, repeated instances of common cold or, at worst, influenza).

Needless to say, I don't trust similar gender-related memes.

How could you measure health in absolute terms anyway? Where exactly do you set the cutoff between healthy and non-healthy? Does it vary relative to current medical technology? Does your income or socio-cultural group matter, or do you average this over everyone? Why average over the US? Why not over the world, or in developed countries, or in particular states?

Who did they poll? If they polled a bunch of university students in boulder Colorado they might well have been correct in thinking themselves highly healthy. A lot of the most unhealthy groups in the US are also poor and somewhat outside te reach of casual academic sampling.

That said, although folks may not be as clueless as it seems, it's still a sad result.


The US data is from the NHIS 2009


For 2006-2010, the households and noninstitutional group quarters selected for interview each week in the NHIS are a probability sample representative of the target population. Beginning in 2011, the minimum time length for a probability sample changed from a week to a month. With four sample panels and no sample cuts or augmentations, the expected NHIS sample size (completed interviews) is approximately 35,000 households containing about 87,500 persons. [...] The annual response rate of NHIS is close to 90 percent of the eligible households in the sample.

Other countries' (pdf) surveys seem to have similarly large and representative samples.

A lot of the most unhealthy groups in the US are also poor and somewhat outside te reach of casual academic sampling.

I assumed that at first too. It turns out even removing the poor or minorities from the sample doesn't fix this gap.

This is a cultural thing. In the U.S., even if you're in bad health, if you're health isn't noticeably worse than it was last week, you say you're in good health when you're asked. It's sort of a content-free response, like responding to "How are you?" with "I'm fine".


Americans can only report their health derivative (dx/dt) :)


When I was young I never thought of my health and (although I'd have denied it) thought constantly about what other people thought of me. Now I couldn't care much less about what other people think of me, and I start every day by reviewing what parts of my body hurt the worst.


Title should read: Young Americans worst at health self-evaluation.

Even that isn't necessarily the case. They weren't asked to rate their health relative to people in other countries.

"Young Americans Have Loosest Standards for 'Good' Health" might be an accurate evaluation of the content.

Title should read: Young Americans worst at health self-evaluation.

I think it is more likely that Americans are more concerned with seeming tough relative to others than that they are simply worse are self-evaluation, but I am merely speculating based on my own experience (as an American).

There are more than 17 developed nations.

I guess the study used the modifier "wealthy" along with developed to explain their choice of reference class. I looked at the list and it didn't seem obviously cherry picked. What countries would you add?


Without looking at the data, of course.

The proper reference class probably depends on what this is being used as a proxy for: the ratio of self-described health to medical quality-of-life metrics is an odd enough figure that I assume it's being used as a proxy for something. If we're looking for degree of overconfidence in health care efficacy, which seems like the most likely candidate, using the first N countries ranked by per-capita health care spending might be the way to go: that gives you a list that's not too dissimilar from the one in the article_per_capita), although some of the details are different.

That being said, once you actually start getting into the statistics, the US ends up in the middle of the rankings for most categories of disease and accident -- it's obesity-linked diseases, automotive accidents, and violence where it really shines. All of which isn't too much of a surprise, but I don't know if it's much of an indictment of the American health care system on its own.

(There's some odd features buried in there, though. For example, the US is ranked highly in deaths from chronic obstructive pulmonary disease and lung cancer, both correlates of smoking -- but it's middling-to-low in deaths from other cancers, indicating good oncology, and has a fairly low smoking rate. Air pollution's also low. I have no idea what's causing this.)


Re: parenthetical statement

Perhaps past smoking patterns are the important detail for some of smoking's effects while more recent smoking determines the others. I wouldn't be surprised to find that the US in the 50's had (relatively) high smoking rates. Also the differences in female versus male smoking rates and disease susceptibility could be significant.

The guts of the study lists one (of many) possible causes:

"getting health care depends more on the market and on each person’s financial resources in the U.S. than elsewhere".

Insurance companies should point out to their detractors that they provide a valuable service by making healthcare so inaccessible that Americans no longer have any idea how they're doing. And that given this absence of knowledge, Americans assume they're doing great.


This quote from the article points out causes of poor health, not of poor self-evaluation skills.

given this absence of knowledge, Americans assume they're doing great

Do you believe that people below 34 answer based on knowledge derived from healthcare services? I don't think teenagers visit their doctor very often.

Title should be "Young Americans believe they have the best everything in the world..."

There are a lot of ways to measure health. 17/17 in the specific measure they chose doesn't mean a whole lot.


Which measures would you say are missing?

They seem to be taking a linear combination of several measures. There are an infinite number of such linear combinations.