The U.S. currently ranks 50th out of 244 nations in life expectancy, with an average life span of 78.1 years; furthermore, we rank 30th in terms of infant mortality rate.
Really? Is it that straight forward?
I think these numbers are misleading. And my father, Dr. William I. Rosenblum, agrees with me so what better reason than to have him as my first guest poster. He writes the following...
Supporters of major change in America's system of health care often cite statistics showing that America falls far behind other nations in the effectiveness of our health care. These statistics are used as an important part of the argument for a change in the way our insurance companies, physicians and hospitals do business. Two of the most cited statistics is one showing the life expectancy of Americans may lag behind that of as many as 28 other countries and one showing that Americas' infants die at a shocking rate compared to that of many, many developed nations. While true, both "facts" are extremely misleading.
First look at life expectancy, a statistic that is affected by numerous factors. One is the number of persons dying of trauma rather than disease. Traumatic deaths include traffic accidents, homicides and suicides. Americans die from these causes with far greater frequency than persons in the countries with which we are compared. Responsible factors include the greater number of miles driven, the use of alcohol and the availability of guns. One set of reliable figures showed that the lives of Americans are shorter than that in 27 other countries. But when traumatic deaths are removed from calculations of life expectancy, America moves from a tie for 28th to a tie with Switzerland for first on the list. We live longer! Longer than the Norwegians, Canadians, Danes, Germans, Swedes, Dutch, or English--countries with which we are frequently unfavorably compared by those who advocate change in America. In fact when we look at deaths that reflect our success or failure in treating disease we find that breast cancer mortality is higher in Britain, Germany and Canada; prostate cancer mortality is six times higher in Germany and almost twice as high in Canada; death from colorectal cancer is 40% higher in England.
If we look at infant mortality we are often told that babies do better in 28 other countries including Belgium, the Czech Republic, Cuba and Poland. But this too is terribly misleading. Some of our infant deaths are not counted as such in several countries--instead they are counted as fetal deaths thus reducing the infant mortality in those countries. More important is the number of immature births which, in America, far exceeds that in the countries with which we are frequently compared. Premature infants have a far greater risk of dying than full term infants. Extremely premature infants are at even greater risk. In fact when we only exclude only very premature infants-less than 22 weeks gestation-from the calculations, America rises from twenty ninth to eighteenth on the list. If all premature infants are excluded we do even better. For example, in 2005 when all infants were included in the calculations, infant mortality in America was almost 50% higher than in Denmark. But when only full term infants were counted infant mortality in America and Denmark was virtually the same. The reasons for much higher rates of premature births in America are incompletely known and need to be addressed. They are not simply explained by lack of prenatal care. But when only our overall rate of infant mortality is cited not only is the issue of prematurity obscured but so is the generally high level of care given to our children in the first year of life. Also obscured are the heroic actions of our neonatal intensive care units, responsible for saving the lives of the extremely premature who are born in America in greater numbers than elsewhere and who would otherwise die.
The facts cited above are readily available and it is surprising that responsible critics have not mentioned them. Whether they have not sought them out or have known about them but concealed them from their readers or listeners these critics have made it more difficult for Americans to evaluate the need for change and to identify the areas that require change.
About the author
The author is Professor Emeritus Pathology/Neuropathology , Virginia Commonwealth University and past Chair Neuropathology and Vice Chair Pathology at that institution. He received 25 years of major grant support from NIH and numerous other grants and awards. He served for two terms on the executive committee of the Stroke Council of the American Heart Association and served on the Virginia Governor's Committee for Alzheimers Disease and Related Disorders.
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