Life Expectancy and Child Mortality Tells Us Less Than We Think

James Peron
Jan 28, 2020 · 11 min read

People quote life expectancy or child mortality rates to prove many things which they don’t actually prove. They say much about life in general but little about any one specific issue. Both are related to dozens of issues and which of them is the reason for the numbers in question is rarely clear.

Rising life expectancy over the centuries only told us that life, in general, was improving. But life includes dozens and dozens of factors. If you compare two regions and one has a higher life expectancy than the other you don’t necessarily know which has the better health system, or which has better diets, or lower crime. All three factors, and dozens more, determine life expectancy.

At best life expectancy and infant mortality rates are general indicators of life but do not tell us much about any specific policy.

Life expectancy is only tangentially connected to health care, with the exception of birth. Once an infant survives the first year or so of life, health care is almost secondary. Primary factors include diet, safety, clean water, sanitary conditions, and lifestyle choices.

If you look at the history of the rise of life expectancy basic improvements in life caused much of the increase. The problem our ancestors had was to survive birth and the first year or two of life, and then to have food to eat, clean water and to avoid disease. Get those out of the way and life expectancy shot up.

The second great advance in life expectancy was when we discovered how to immunize people against diseases such as flu, polio, measles, small pox, etc.

Most of the major medical expenses in the world today actually have minor impact on life expectancy. While for some people we are talking about adding a few years to their life, for most we are talking of adding weeks or months at best. For a small minority medical invention adds years but they are a minority and the impact on the total life expectancy is relatively minor compared to all other factors.

The reality is spending a bit less on expensive care, and a bit more on basic, preventative care and check ups, will do a lot more good. Americans could reduce their health spending dramatically without having much, if any, of a negative impact on their life. Individuals could easily repriortize concerns. It isn’t that health care is too expensive as much as it is Americans are over buying expensive treatment while under consuming basic, preventative care. A major factor that puts US spending, per capita, above Europe is Americans tend to prefer to solve problems with expensive care rather than taking cheaper precautions in advance.

Life expectancy is only a general indicator regarding the quality of life. It is not an indicator saying much about specific policies. That is where some advocates of nationalized care get dishonest. They will argue Americans have a slightly lower life expectancy than do people living in nations with nationalized health care.

Normally they are very selective as to which countries they choose. The truth is Americans live, on average, longer than people in many countries with socialized care, but not as long as people in some countries. If one were to compare the EU average life expectancy to that of the average American the difference is only a matter of a few weeks to one year.

But that small difference is used to champion nationalized care. Somehow turning health care over to the people who run the DMV is supposed to add a few weeks to our life expectancy, and this is supposed to be a vast improvement.

But are the differences in life expectancy between the US and some European countries—and not others—actually the result of different health care systems? Or are there other factors that directly lower US life expectancy?

Everyone knows obesity, a result of affluence and life style choices, is rampant in the United States. This problem is worse in the US than in Europe. Having lived on both continents I can verify that observation personally. The size of some Americans is astounding to me. Micheal Moore’s “supersize” is becoming far more the norm than the exception. This is having a major impact on life expectancy. This is a personal choice issue more than a health system issue.

Another cause for lower life expectancy can be crime. This is especially true for one group of Americans — black males. The average life expectancy of black Americans is five years shorter than white Americans. And crime is a major reason. One study showed a white male of 15-years-of-age had a 1-in-345 chance of being murdered before he turned 45. For black males those odds were 1-in-45. And in Washington, DC the odds were 1-in-12. It should be noted a primary reason for this criminal carnage is the failing War on Drugs, which fuels gang warfare. Legalization of drugs would improve life expectancy.

The study said ending the criminal carnage in the black community would bring the average life expectancy of black males up by three years. This is not a health system issue. Yet, it severely impacts US life expectancy rates which are then used to “prove” nationalized care is better. In addition, the African-American community has higher rates of various unhealthy lifestyle choices, such as drug use, smoking and consumption of alcohol. All these factors drag down life expectancy rates for them.

A study out of Harvard said: “young black men living in poor, high-crime urban America have death risks similar to people living in Russia or sub-Saharan Africa.”

Another lifestyle choice that dramatically impacts life expectancy is the use of drugs and alcohol. In recent years life expectancy rates stagnated and began to decline and a major reason was more deaths due to drugs and alcohol. The Washington Post reported:

The CDC’s annual report on life expectancy had been dismaying the previous three years, with the number dropping or remaining flat each year as the United States dealt with a wave of drug overdoses from illicit fentanyl flooding communities with high levels of opioid addiction.

More importantly drug deaths reduce life expectancy far more than other causes of death.

Drug overdoses play an outsize role in life expectancy because they often claim the lives of young people, cutting off many years of life, whereas a disease such as cancer typically affects people who are much older, noted Otis Brawley, an oncologist at Johns Hopkins University School of Medicine. “The average age of someone who dies from cancer is in their early 70s,” he said.

One study I looked at , from the Commonwealth Fund, showed if you reach the age of 60 your life expectancy in the US is another 17 years. Under the nationalized health systems in the UK and New Zealand the remaining years are also 17 years. No difference. Canada was higher at 18 years but there are still various factors that impact this, which are outside the health system — as already mentioned.

NBC repeated an Associated Press report stating that “A relatively high percentage of babies born in the U.S. die before their first birthday, compared with other industrialized nations.” What they refer to is the infant mortality rates. Again this is slightly inaccurate since different nations define infant mortality differently.

The U.S. has a much broader definition of “live birth” than does other nations. They aren’t measuring the same thing. US News & World Report explained the differences:

First, it’s shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don’t reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.

Infant mortality in developed countries is not about healthy babies dying of treatable conditions as in the past. Most of the infants we lose today are born critically ill, and 40 percent die within the first day of life. The major causes are low birth weight and prematurity, and congenital malformations. As Nicholas Eberstadt, a scholar at the American Enterprise Institute, points out, Norway, which has one of the lowest infant mortality rates, shows no better infant survival than the United States when you factor in weight at birth.

Infant mortality rates are also connected to many factors not related to health care. For instance, teen mothers are more likely to give birth to sick infants. Mothers who smoke, or are obese, or simply lack education, have riskier pregnancies. The U.S. has more of these problems than some other nations, yet these are not directly linked to the health system.

June O’Neill and Dave O’Neill did a study Health Status, Health Care and Inequality: Canada vs. the U.S. which compared infant mortality rates in the U.S. and compared them to Canada. Their report noted “infant mortality is strongly linked to low birth weight and to preterm births.” This is important because teen mothers tend to have lower weight babies, and the U.S. has the highest teen pregnancy rate of developed nations — almost 3 times that of Canada. That skews the infant mortality rate in favor of Canada, but it not related to the health system.

When the O’Neills looked the mortality rates within specific birth weight groups the U.S. actually does as well, or better than Canada. Canada does better overall because fewer high risk mothers are giving birth to low weight infants. The NBER study says if weight distribution in Canada were similar to the U.S. the infant mortality rate there would rise to 7.06, which would actually be higher than the rate in the US, which is 6.85. Their advantage was not health care related but due to the lower rate of teen pregnancies.

Another study in the Journal of Economic Perspectives confirms these comparisons. Melissa Kearney and Phillip Levine found, “Teens in the United States are far more likely to give birth than in any other industrialized country in the world. U.S. teens are two and a half times as likely to give birth as compared to teens in Canada, around four times as likely as teens in Germany or Norway, and almost 10 times as likely as teens in Switzerland.”

Nationalized health care won’t reduce crime rates. It won’t reduce obesity or stop people from using drugs. The main reason some communities, in the U.S., have lower life expectancy is due to injuries and some chronic diseases “including heart disease, cancer, and diabetes. These killers, in turn, are a consequence of well-known and largely controllable risk factors such as smoking, alcohol use, obesity, high blood pressure, and high cholesterol. In high-risk urban black communities, male mortality is increased by homicides and exposure to AIDS.” These are “largely controllable risk factors.” Controlled by whom? By the individual at risk, not by the health system.

The Harvard study looked at eight distinct groups of Americans and concluded: “The variation in health plan coverage across the eight Americas is small relative to the very large difference in health outcome. It is likely that expanding insurance coverage alone would still leave huge disparities in young and middle-aged adults.” Universal coverage, as envisioned by advocates of nationalized care, will have little direct impact on U.S. life expectancy. But cheaper, if not free, individual changes in life style can have a major impact.

Another Harvard study found Americans could add 6.7 years to their life expectancy by following healthier guidelines for living. Europeans could add only 5.5 years, implying that 1.2 years of the current difference in life expectancy rates between the US and Europe is due to lifestyle factors, not to health care systems. That difference would put US life expectancy on par with the UK and Germany, indicating the differences in life expectancy rates is due more to lifestyle choices than to health systems.

Another indicator that health systems are not the main issue is Hong Kong, not known for nationalized health care, or much of a welfare state at all, it has one of the highest life expectancy rates in the world, at 80.2 years. That exceeds all the European states. Switzerland also has a high life expectancy, yet most health care is provided privately and covered by private, individual insurance policies.

Singapore also has a high life expectancy yet they have little in the way of nationalized health care. Individuals in Singapore are expected to establish their own private, health accounts which belong to them or their heirs when they die. These private accounts pay for most care in the country. Out of these accounts citizens purchase catastrophic insurance to cover major problems and draw down the account for minor problems. About 10% of the population is deemed impoverished and are directly helped in health care by the state, but the bulk of the population pays for their care out of their own resources. They also have health care expenditures that are far lower than any of the nationalized systems.

Some countries, often with very little in the way private or public health care, have life expectancy rates that are still rather impressive. South Korea has a higher life expectancy than Luxembourg, while two U.S. territories—Puerto Rico and Virgin Islands—have higher life expectancies than the U.S. mainland. Yet, I know of no one who attributes this to greater access to health care, nationalized or not.

Another indication life expectancy is only tangentially tied to health systems is every nation in the world, no matter their health care system, sees dramatic differences in life spans between men and women. And much of that is due to life style differences. Men are more violent, on average, than women. That means they get killed more often. They also tend to be risk takers, more so than women, which means they are more likely to die young.

In most nationalized health systems women live five to seven years longer than men. Yet this is not because women receive superior health care. At least I’ve yet to hear that claim.

Life expectancy is primarily a matter of factors outside the health care systems. As such it can not be considered evidence, one way or the other, that nationalized care is superior to private health care.

The Radical Center

A blog for the Moorfield Storey Institute: a liberaltarian…

James Peron

Written by

James Peron is the president of the Moorfield Storey Institute, was the founding editor of Esteem a LGBT publication in South Africa under apartheid.

The Radical Center

A blog for the Moorfield Storey Institute: a liberaltarian think tank.

James Peron

Written by

James Peron is the president of the Moorfield Storey Institute, was the founding editor of Esteem a LGBT publication in South Africa under apartheid.

The Radical Center

A blog for the Moorfield Storey Institute: a liberaltarian think tank.

Medium is an open platform where 170 million readers come to find insightful and dynamic thinking. Here, expert and undiscovered voices alike dive into the heart of any topic and bring new ideas to the surface. Learn more

Follow the writers, publications, and topics that matter to you, and you’ll see them on your homepage and in your inbox. Explore

If you have a story to tell, knowledge to share, or a perspective to offer — welcome home. It’s easy and free to post your thinking on any topic. Write on Medium

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store