Adam Ash

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Monday, May 23, 2005

When you rank nations by life expectancy, how do we rate?

Here's an amazing article from Le Monde (link here for French readers). It's about how life expectancy is the best to rank countries. The case is argued with that deadly and rather odd logic of the French, the folks who practically invented the Age of Reason. Of course, it's also a none-too-subtle attack on us, but hey, we spend a lot of time thinking badly of those snot-nosed Frogs who bent over to the Germans in the middle of the last century and would still be living with panzers up their asses if we hadn't chased those Nazi tanks out of their garlic-smelly posteriors. Anyway, enter the crystalline world of French logic, and bear with it, because you'll learn somethin':

"If we were to measure a nation's wealth by its inhabitants' health, we would have a different picture of the planet's countries than the one given by the rate of growth in Gross Domestic Product (GDP), which has become the premier, if not the only, measure of a nation's success. This consensual reductionism has been denounced many times for reasons at once technical and philosophical: GDP, in fact, provides only a few inadequate indications of the global income and savings of a country. Gross Domestic Product does not take peace or social justice into account, and questions about the environment are totally foreign to it. The supremacy, moreover, of this uni-dimensional way of conceiving of progress presupposes a consumerist and utilitarian philosophy of the happiness of nations: people are only on earth to produce more so they can consume more and possess still more.

On the other hand, choosing life expectancy - a global indicator of health - could be justified in the first place by a logic appropriate to recall, even if it appears to be a statement of the obvious: in order to enjoy possession, a person must be alive. It seems that the vast majority of human beings have a taste for living, all the more so because, contrary to what we hear about daily, not only do most Westerners live to be older, but also, in the course of their passage on this earth, they have the good fortune to be ever less dependent. Referring back only to 1970, barely 35 years ago, the life expectancy at birth of French people was 7.2 years less than today (that's a lot: 7 years in a life!) and the average French person was dependent in old age for 12 months. The latter figure is now only 9 months. These years of life gained are years of autonomous life, good years.

Life expectancy measures the essential condition for any eventual enjoyment of earthly goods - existence itself - but that is not its only merit: this criterion is easily calculated and easily broken down by sex, age, social milieu, the different territories in a country, which is not the case for GDP, estimations of which are long, onerous, and tedious.

The life expectancy measure says that it's better to be Japanese (81.5 years in 2001) or European from the fifteen countries of Europe (over 79 years, also in 2001) than a resident of the United States (77.1 years). Not only are these differences important (more than 2 years between the United States and France), but they are growing (5 months in 1960, 2.1 years in 2001) in spite of the fact that the inhabitants of the United States spend two and a half times more on health care than the British and the Japanese, and almost twice as much (1.88) as the French.

Medicine at the cutting edge of progress is not always synonymous with good health and obviously remains unable to compensate for the effects of the conditions of life. American epidemiologists deem moreover that, given the growing obesity of the inhabitants of their country, life expectancy will stagnate, then decline. Without being excessively simplistic with regard to the social origins of obesity, it is also undeniably a mark of social status: the poor in the United States are overweight: the average weight of Americans is inversely proportional to their social standing. Doesn't their food intake betray a sort of tragic triumph of consumerism? I am poor, certainly, but as a citizen of the United States, I am rich enough to eat more than I need, to participate in the consumer society. Obesity is not an individual affair: it is promoted notably by the disappearance of the ritual of meals.

American sociologist Philip Slater indicated in 1970 that the pursuit of solitude had already become the distinguishing feature of American society. This solitude is expressed in eating behaviors. More often than in Europe, Americans of every age eat alone, at any time, any sort of food, to the rapid rhythm of television ads that teach them what they must ingest. Food is not the only cause for the United States' bad indicators: a young black man living in New York has the same life expectancy as a Sri-Lankan. American society is a violent society where, proportionally, there are 8 times as many people incarcerated as in France, where wounds and deaths by firearms or slashing are frequent, which leaves its mark on life expectancy statistics.

Finally, at any given moment, 43 million Americans - or about 20% of the population - do not have any health insurance or other social coverage. This figure hides an even greater level of insecurity since, over any 2-year period, close to 40% of the population at one time or another over the 2 years will not have any health insurance. The most powerful, the richest, the most medicalized nation on earth is not the one - far from it - where people live the longest.

The political and social system leave their mark: the Canadian neighbor, also a great country of immigration, enjoys a life expectancy at birth that puts it among the premier countries in the world (79.7 years in 2001, more than France the same year). It enjoys a universal healthcare system.

The countries that offer their populations the longest life expectancies at birth (Japan, Sweden) turn out to often be those where the difference in incomes between the social classes is the least. In study after study, it has been demonstrated that everything that benefits social cohesion contributes to growth in life expectancy. Social democracy is good for health.

The crisis of the Soviet system could be read in the USSR's life expectancy statistics well before the Berlin Wall collapsed. In fact, Russian life expectancy began to drop in 1980 (71 years). This drop persists. You don't have to go there to know that this society still suffers: with a 67 year life expectancy at birth in 2002, Russia at the beginning of the 21st century is behind Vietnam (69 years), Algeria (69.5 years) and Tunisia (72 years), which, however, do not have the benefit of the same sanitary infrastructures. As for black Africa, its drama can be read in the World Health Organization (WHO) data. During the first year following the conflict in Ivory Coast, its life expectancy dropped 10 years! Sierra Leone, at war since forever, revived life expectancy statistics that compare to those of France at the end of the 15th Century or to those of Roman citizens during the Empire: 35 years.

To return to debates in today's news: if Turkey gained 20 years life expectancy between 1960 and 2003, at 68.3 years, in 2002 it was still very far from Western Europe (79 years) or Eastern Europe (75 years). It is appropriate to emphasize also the excellent performance of Italy (79.7 years in 2002) and Spain (79.3), better than France, and to remark on the negative side - without being able to explain it - Denmark's rather poor performance (3 years less than Sweden at 77 years).

With regard to France, with 25,000 fewer deaths in 2004 than in 2002, it has gained 10 months of life expectancy and - men and women taken together - passed the 80-year threshold in 2004, which is remarkable. A little more than 10% of this improvement is attributable to the progress in road safety. As far as the rest is concerned, it's a sign of the proper functioning of French society and French medicine, but we are not able at this stage, to sort out the share of each. This note of real optimism is all the more justified in that progress in the birth rate remains slight in our country, which is not the case in Germany, Spain, or Italy.

Let us remember that the destiny of peoples can first be seen in their demography."

MAN, those Frogs have a different way of talking, don't they? But the dude makes some good points, doesn't he? Let's face it, our #1 priority has got to be our fucked-up health system. It's killing us -- years earlier than we need to die.

2 Comments:

At 12/25/2005 5:30 PM, Anonymous Blue Cross of California said...

It's unfortunate to hear so many lack health insurance. I hope there can be a solution to our major crisis as millions are uninsured.

 
At 1/04/2006 2:31 PM, Blogger David Skul said...

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