Tag: life expectancy

We’re Living Longer Lives Than Ever

Yesterday, the Washington Post reported that the U.S. age-adjusted death rate has ticked up slightly, breaking a trend of long-term decline. That is worrying and worth looking into, but let’s not lose sight of the broader picture. 
label  The rise in U.S. life expectancy has been going on for more than a century—almost uninterrupted. The only major disruption to the trend was a brief dip a century ago caused by the Spanish Flu pandemic following the end of WWI. What a pity that long-term trends do not make for flashy headlines! 
label  Life expectancy isn’t the same for different groups. As is the case globally, the gender gap in the United States favors women. Scientists are still studying why women live longer than men, but it may be related to differences in the immune system.
label  Racial life expectancy disparities have narrowed considerably since 1900, although they still remain. The gender gap has proved far more persistent than the racial gap: African American women now outlive white American men on average. 
label  Life expectancy has been rising at an even faster pace in most developing countries, thanks in large part to falling infant mortality rates. In my lifetime alone, Africans have gained almost eight years of life on average, while U.S. life expectancy has risen by almost four years. While it may not make for a good headline, rising life expectancy certainly makes for a story worth telling.

Poverty’s Decline and Its Causes

It is always refreshing to see journalists draw attention to the incredible decline in world poverty. An article that did just that appeared yesterday in the Christian Science Monitor. The piece shines a spotlight on three heartening facts in particular. 

First, poverty is decreasing. Not only have poverty rates fallen, but the total number of people in poverty has decreased. This is incredible when one considers population growth—there are more people alive today who aren’t in poverty than ever before. The Brookings Institution projects poverty will be practically eliminated by 2030. 

Second, average incomes are rising. World per capita GDP, adjusted for inflation and differences in the cost of living, has never been higher. And average income growth is not limited to developing countries: the average American has more disposable income left after basic expenses

Finally, humanity is healthier. Globally, average life expectancy is at an all-time high, largely due to plummeting infant mortality rates. More people have enough to eat and enjoy access to clean drinking water and improved sanitation facilities. The developed world has also seen health gains, with cancer death rates falling for both men and women in the OECD countries. 

The article attributes improvements in well-being to three main factors: the fall of communism, the rise of trade and globalization, and the courage of those who stood up against tyranny. 

While the CSM article gives some credit to international aid programs, it is important to recognize that aid is not a good driver of economic development. Even vocal aid-proponent Bono acknowledges that international aid and charity pale in comparison to the prosperity-creating power of people engaging in market exchange. 

When given the freedom to do so, it is truly remarkable what ordinary people can achieve. Consider the utter transformation of Singapore from poverty to riches – that is the power of economic freedom!

What the Washington Post Gets Wrong about Free Markets

This morning, the Washington Post ran an op-ed titled, “How free markets make us fatter, poorer and less happy.” Actually, the data suggest the exact opposite: free markets make us healthier, richer and happier. 

Free markets make us healthier 

First, the authors argue that free markets result in an abundance of temptations, such as candy and fattening food, and that encourages obesity. Obesity is a problem, but let’s put matters in proper perspective. The best proximate measure of the health of a nation is life expectancy. That is increasing. In fact, Americans have never lived longer. 

Moreover, a ban on fatty foods raises questions about personal freedom and responsibility. We allow people to buy alcohol, but discourage them from drinking and driving. Why not allow for sale of fatty foodstuffs, while discouraging gluttony through, for example, increased medical insurance premiums?   

The free market has been amazingly successful in increasing food production across the globe. In 1962, people in 51 countries consumed fewer than 2,000 calories per person per day. By 2011 that number fell to one (Zambia). All the while, life expectancy around the world has increased. 

Free markets make us richer

Video: An Introduction to HumanProgress.org

If you’re familiar with Cato’s project HumanProgress.org, then you probably know that according to the available data, people today are wealthier, healthier, better educated, and less exposed to violence than in the past. HumanProgress.org provides you with the tools to explore how the state of humanity has changed over time. But even if you have visited the website before, you may not be aware of every feature it offers. Did you know that HumanProgress.org allows you to compare datasets of human wellbeing against one another, allowing you to see if the datasets correlate? Or that you can download a customized chart or map with the click of a mouse? Our new introduction video offers a rundown of all our current features. Check it out:

Video: The Fate of Our World

The state of the world is improving. Child mortality, poverty, and violence are declining, while life expectancy, incomes, and education are increasing. While many problems remain, most indicators of human well-being are trending in the right direction—especially in the developing world.

If you are interested in a realistic look at the state of humanity, then I highly recommend that you watch this video:

Learn more.

More Good News for Thanksgiving

In the Wall Street Journal just before Thanksgiving last year, Melinda Beck detailed some of the health care advances that we should continue to give thanks for this Thanksgiving Day:

• Fewer Americans died in traffic fatalities in 2008 than in any year since 1961, and fewer were injured than in any year since 1988, when the National Highway Traffic Safety Administration began collecting injury data. One possible reason: Seat-belt use hit a record high of 84% nationally.

• Life expectancy in the U.S. reached an all-time high of 77.9 years in 2007, the latest year for which statistics are available, continuing a long upward trend. (That’s 75.3 years for men and 80.4 years for women.)

• Death rates dropped significantly for eight of the 15 leading causes of death in the U.S., including cancer, heart disease, stroke, hypertension, accidents, diabetes, homicides and pneumonia, from 2006 to 2007. (Of the top 15, only deaths from chronic lower respiratory disease increased significantly.) The overall age-adjusted death rate dropped to a new low of 760.3 deaths per 100,000 people—half of what it was 60 years ago….

• Around the world, 27% fewer children died before their fifth birthday in 2007 than in 1990, due to greater use of insecticide-treated mosquito nets, better rehydration for diarrhea, and better access to clean water, sanitation and vaccines.…

• Twenty-seven countries reported a reduction of up to 50% in the number of malaria cases between 1990 and 2006.

Read it all. (I should note that Beck attributes more of this good news to government action than I would, and she counts the mere existence of smoking bans as a “health care advance,” despite the lack of evidence that they actually have any health effects. But that’s an argument we can save for next week. Today and tomorrow let’s just celebrate the good news.)

I wrote a couple of years ago about the good news of falling cancer death rates and falling heart disease death rates. Cancer death rates have continued to fall, as have motor vehicle deaths.

In his book The Improving State of the World, Indur Goklany examined, as the subtitle put it, Why We’re Living Longer, Healthier, More Comfortable Lives on a Cleaner Planet.

Topics:

Rwanda and the Psychic Benefits of Universal Coverage

Last week, The New York Times published an article subtitled, “In Desperately Poor Rwanda, Most Have Health Insurance.”  The main theme was the contrast between Rwanda’s compulsory health insurance system and the as-yet-non-compulsory U.S. health insurance market:

Rwanda has had national health insurance for 11 years now; 92 percent of the nation is covered, and the premiums are $2 a year.

Sunny Ntayomba, an editorial writer for The New Times, a newspaper based in the capital, Kigali, is aware of the paradox: his nation, one of the world’s poorest, insures more of its citizens than the world’s richest does.

He met an American college student passing through last year, and found it “absurd, ridiculous, that I have health insurance and she didn’t,” he said, adding: “And if she got sick, her parents might go bankrupt. The saddest thing was the way she shrugged her shoulders and just hoped not to fall sick.”

I don’t see anything absurd here, but I do see something remarkable. Rwanda is so poor, its per capita income is about 1 percent that of the United States ($370 vs. $39,000).  Its health care sector is an international charity case: “total health expenditures in Rwanda come to about $307 million a year, and about 53 percent of that comes from foreign donors, the largest of which is the United States.”  That’s roughly $32 per person per year, which doesn’t buy much.  Dialysis is “generally unavailable.”  As are many treatments for cancer, strokes, and heart attacks, making those ailments “death sentences” more often than in advanced nations.  Life expectancy at birth is 58 years, compared to 78 years in the United States.  Rwandan children are 15 times more likely to die before their first birthday (7 vs. 107 deaths per 1,000 live births) and 25 times more likely to die before turning five (8 vs. 196 deaths per 1,000 live births) than U.S.-born children.  (If you want to meet some Rwandan kids struggling to make it to age 5, read my friend’s blog, Life of a Thousand Hills.)  And yet, the saddest thing is a healthy-but-uninsured American college student.

What the Times sees as a paradox isn’t really a paradox.  Yes, the poorer nation has a higher levels of health insurance coverage.  But the wealthier nation does a better job of providing medical care to everyone, insured and uninsured alike. The Times reports that Rwanda’s national health insurance system isn’t fancy, “But it covers the basics,” including “the most common causes of death — diarrhea, pneumonia, malaria, malnutrition, infected cuts.”  Surely, the Times must know that anyone walking into any U.S. emergency room with any of those conditions would be treated, regardless of insurance status or ability to pay.  The same is true of other acute conditions, like heart attacks and strokes, for which uninsured Americans receive better treatment than insured Rwandans.  True, some uninsured Americans end up filing for bankruptcy, but let’s be clear: while bankruptcy is no day at the beach, suffering bankruptcy because you got the treatment is better than suffering death because you didn’t.  (As for dialysis, the United States already has universal coverage for end-stage renal disease through the Medicare program.)  The Healthcare Economist puts it this way: “Would you rather be sick in the United States without insurance or sick with insurance in Rwanda?”  You get the point.  If there’s a paradox here, it’s that insurance status does not necessarily correlate with access to medical care: uninsured people in the wealthy nation actually have better access to care than insured people in the poor nation.

An even bigger paradox, though, is Rwandan attitudes toward the United States. The United States generates many of the HIV treatments currently fighting Rwanda’s AIDS epidemic, as well as other medical innovations saving lives there and around the world.  More than any other nation, we create the wealth that purchases those and other treatments for Rwandans and other impoverished peoples.  The United States is probably closer to providing universal access to medical care for its citizens – and, indeed, the whole world – than Rwanda.  Rwanda’s “universal” system leaves 8 percent of its population uninsured. Though official estimates put the U.S. uninsured rate at 15.4 percent, the actual percentage is lower; and again, uninsured Americans typically have better access to care than insured Rwandans.  The real paradox is here that Rwandan elites think the United States is doing something wrong. Why?

Here’s one answer: Rwanda’s government explicitly guarantees health insurance to its citizens, and for some people that guarantee has value apart from any health improvements or financial security that may result.  Dr. Agnes Binagwaho, “permanent secretary of Rwanda’s Ministry of Health,” illustrates:

Still, Dr. Binagwaho said, Rwanda can offer the United States one lesson about health insurance: “Solidarity — you cannot feel happy as a society if you don’t organize yourself so that people won’t die of poverty.”

Set aside that a (permanent) third-world bureaucrat is telling the United States how to keep people from dying of poverty.  Binagwaho cannot feel happy without that government-issued guarantee.

How might such a guarantee increase happiness? It could make people happier by reassuring them that they themselves will be healthier and more financially secure (self-interest), or that others will be (altruism).  Yet altruism and self-interest probably cannot explain the “happiness benefits” that people enjoy when governments guarantee health insurance.  As I have argued elsewhere, the jury is out on whether broad health insurance expansions like ObamaCare result in better overall health; they may, but it is entirely possible that they would not.  The jury is also out on whether ObamaCare will produce a net increase in financial security.  It will subsidize millions of low-income Americans, but it will also saddle them with high implicit taxes that could trap millions of them in poverty.  Meanwhile, ObamaCare’s new taxes will reduce economic growth and destroy jobs.  If such a guarantee doesn’t improve health or financial security, it’s not worth much in terms of altruism or self-interest.

But there’s another potential “happiness benefit” that might accrue to supporters of a government guarantee of health insurance: it could make them happier by allowing them to signal something about themselves – e.g., that they are compassionate.  If people use a government guarantee of health insurance in this way, that could explain why Rwandan elites feel bad for uninsured Americans.  They may feel empathy for uninsured Americans because they perceive the American electorate has not sent uninsured Americans a valuable signal (“We care about you!”).  Meanwhile, the act of expressing pity for uninsured Americans allows Rwandan elites to signal something about themselves (“We are compassionate!”).  Robin Hanson has a lot to say about why people might use health insurance and medical care to signal loyalty and compassion.

My hunch is that this is an under-appreciated reason why some people support universal coverage: a government guarantee of health insurance coverage provides its supporters psychic benefits – even if it does not improve health or financial security, and maybe even if both health and financial security suffer.

If that’s the case, then we’re facing the same problem that Charles Murray identified in Losing Ground, his seminal work on poverty:

Most of us want to help. It makes us feel bad to think of neglected children and rat-infested slums…The tax checks we write buy us, for relatively little money and no effort at all, a quieted conscience. The more we pay, the more certain we can be that we have done our part, and it is essential that we feel that way regardless of what we accomplish…

To this extent, the barrier to radical reform of social policy is not the pain it would cause the intended beneficiaries of the present system, but the pain it would cause the donors. The real contest about the direction of social policy is not between people who want to cut budgets and people who want to help. When reforms finally do occur, they will happen not because stingy people have won, but because generous people have stopped kidding themselves.

One thing is for certain.  When Rwandan elites pity uninsured Americans, there is something very interesting going on.

While I’m at it, the health-policy advice I offered to China and India also applies to Rwanda:

Does not the fact that “these countries lack the fiscal resources required for universal coverage because of their…low average wages” suggest that many residents have more pressing needs than health insurance? For things that might just deliver greater health improvements? In a profession where universal coverage is a religion, such questions are heresy, I know.

China and India are in the process of a slow climb out of poverty. It is entirely possible that the best thing those governments could do to improve [health care] markets and population health would be to enforce contracts, punish torts, contain contagion, and nothing else.

Of course, if Rwandan elites support universal coverage largely because they want to signal something about themselves, this advice may fall on deaf ears.