Can you explain the conclusion of this article to me? I don't fully understand what he is trying to say.what are the implications? That the only improvement we can make on the american healthcare system is to fight obesity better?
1) Healthcare spending has rapidly diminishing returns, not only comparing the US to Europe, but comparing countries within Europe (such as the Netherlands versus Spain).
2) The lower life expectancy in the US can be explained mostly by higher obesity. US states with similar obesity to European countries have similar life expectancy.
Re: #2, my understanding from friends at the CDC is that lower life expectancy is due to lower incomes (meaning food, medicine, and doctor visits are unaffordable even with health insurance), suicides, and the opioid crisis.
Suicides and obesity can also be caused by low income and drug abuse, so it sounds like the author may be seeing causation where correlation is more accurate.
Causation isn't mutually exclusive. The relationship between obesity and heart disease is clearly causative. Any causation between income and obesity does not negate this..
That's true and I agree, but if you're asking why people are dying, you're going to be most interested in the root cause (which should be the variable that is least dependent on the others).
While obesity likely does reduce income somewhat (due to stereotypes), income can be considered an independent variable here.
Relatedly, we know that obesity is very hard to treat, while poverty is incredibly easy to treat on an individual level. The only reason we don't is because people see treatment of poverty as unfair, while treatment of obesity is not seen that way.
I would never claim that income/poverty is the root cause of obesity, as obesity poorly correlated with income in the US.
Obesity is prevalent in both the middle class and poor, with the middle class slightly leading the poor[1]
>39% of people ≤130% of the federal poverty line (FPL) are obese.
>40.8% of people 130 to 350% of the FPL are obese.
While individuals should be brought out of poverty for other reasons, it is not a cure-all for obesity. If anything can be implied by the correlation, it will make the problem worse, and the healthcare system should prepare for this.
I haven't looked at the numbers. Barely read the article. I bet he's wrong though. I would think it'd be a love affair with firearms (Fuck Yeah. ) and a lot of driving.
Every time I read about weight the dangers of an extra 10 lbs. seem to be pretty ambiguous. Though I'm totally going to drop that 10 lbs. I only had 2 donuts today.
It is much worse than that. 40% of american men are obese, which,for the average body type, is ~50 lbs above normal.
From wikipedia:
>The National Center for Health Statistics at the CDC showed that 39.6% of US adults age 20 and older were obese as of 2015-2016 (37.9% for men and 41.1% for women).[1]
Obesity in an adult is defined as a BMI of 30 and above.
The Average american male is 5'10. A "normal healthy" BMI of 22 is 153 lbs. A BMI of 30 is 209 lbs. [2]
By far the biggest health improvements that could be made in America would be reductions in obesity and reductions in vehicle fatalities. Whether that's the best area of focus depends on the relative difficulty of the improvements - if one second and one penny could save one person, that would be a higher priority than spending a million dollars and one year to save a thousand (even though both would be on the list for doing some time.)
Honestly, if our biggest barrier to healthy longevity has been reduced to automobile accidents, society is in pretty damn good shape considering how safe modern vehiclular travel is.
I'm not sure the article addressed it, but it appears that we could improve the US healthcare system by making it cheaper without losing quality, simply by letting another country run it for us. If there's no gain from spending more, then there should be no loss from spending less, assuming that we get to restructure the system accordingly.
So I just skimmed but I think the point he's making is that Public Health and Healthcare are 2 different things. Public Health is - get some exercise. Don't drink. Keep a reasonable weight. Don't do drugs. Avoid getting shot. Get vaccinated. Don't drive a lot.
Almost all of these things aren't really "Healthcare". I don't need to go to a Dr. to know I should lose 10 lbs. Maybe - maybe, maybe - a Dr. can help me quit heroin (frankly I doubt it) and certainly a Dr. can give me a flu shot.
Most of "healthcare" money has nothing to do with longevity. If my buddy had a heart attach you can spend $500,000 on treatment. Heck, you can give him a new heart. It's all great. Who would say no? Not me. (He's my buddy after all).
At population scale though that does nothing for longevity. At population scale you'd be better off setting the speed limit to 40mph. Taxing alcohol to high heaven. Playing tons of old Erol Flynn movies (To encourage people to get into sword fights instead of gun fights.)
None of that stuff is sexy though. Even the non-crazy version of that list is un-sexy. It probably doesn't cost a lot of money but it royally pisses off people. People also vote. They don't like it if you try to run their lives for them - even if you would technically do a better job then those idiots do. Except for me. And I'm going to lose that 10 lbs. really soon.
In the UK now, if you go to the GP with an ailmentr, you are quite likely to be prescribed joining the local Parkrun group, or other 'public health' measures.
