Yves here. This is a must-read article. It systematically unpacks why US life expectancy has been falling on a relative and even in some years on an absolute basis. Some of the causes may come as a surprise, such as the significance of the comparatively limited number of primary care practitioners, which is now becoming a crisis, and how Americans really do eat more per capita than citizens of any other country (if you travel, you’ll notice how standard portion sizes in other nations are smaller).
And this is only set to get worse. Yours truly has been predicting that the US is in a Russia-in-the-1990s collapse trajectory, which included a marked drop in male lifespans. And the disgrace is we are doing this to ourselves.
By Lynn Parramore, Senior Research Analyst at the Institute for New Economic Thinking. Originally published at the Institute for New Economic Thinking website
For all the talk about American exceptionalism, here’s a shocking truth: when it comes to health and longevity, the U.S. has been losing ground for decades. Not just behind wealthy nations, but behind less affluent countries. Even poor ones.
The gap isn’t shrinking; it’s widening.
That’s what public health researcher Steven H. Woolf, professor of family medicine at Virginia Commonwealth University in Richmond, has documented. By 2019, just before COVID‑19 hit, U.S. life expectancy ranked 40th among the world’s most populous countries, trailing places like Albania and Lebanon. The pandemic only made things worse: by 2020, the U.S. had fallen to 46th, as six more nations overtook it.
Woolf hasn’t just compared the U.S. to wealthy countries like Canada, Germany, or the U.K. He looked at life expectancy across dozens of nations with very different histories and economies, and the results are startling. The U.S. began falling behind as early as the 1950s, with countries in Europe, Asia, and the Middle East steadily overtaking it.
If you were born in Albania today, you’d have a longer life expectancy than if you were born in the United States — and that’s been true for several years. Let that sink in.
Woolf argues that America’s exceptionalism is not about health but rather how it’s approached. Policy choices, social conditions, and deep inequalities are driving a health disadvantage that hits hardest in the Midwest and South, where life expectancy has stalled or even declined while other nations, and some U.S. states, keep moving.
The Institute for New Economic Thinking spoke with Woolf about why Americans are living shorter lives, why life expectancy varies so dramatically from state to state, and what it would take to reverse a decades-long slide that has quietly — but profoundly — reshaped American life.
Lynn Parramore: Your research shows that the U.S. began losing ground on life expectancy well before obesity rates surged, before the opioid epidemic, and long before COVID. What changed in the 1950s, and in the decades that followed, that other countries got right but the United States didn’t?
Steven Woolf: It’s complicated, but systemic factors in the U.S. appear to drive this pattern.
When we look at trends in life expectancy, we can examine specific causes of death, like heart disease, drug overdoses, gun-related violence, and begin to unpack the drivers. That leads to things like the American food environment or high rates of gun ownership.
But when you step back and consider how many health conditions the U.S. fares worse in than other countries, it really points to broader factors at play — features of life or structural conditions that put Americans at risk for poor health across multiple categories of disease and injury.
An easy example is the health care system. Many countries that outperform us have universal health care systems. Post-World War II, countries like the U.K. and others really made a shift toward offering a national health program for their populations. We did not. So that’s a potential contributor.
There are others. The U.S. regulatory environment has tended to be more lax, prioritizing industrial growth and economic development over robust regulation of products that pose health and safety risks. This was evident early on with the tobacco industry and has since played out with pharmaceuticals, food, firearms, and more. Overall, there’s been a greater tolerance in the United States for a regulatory approach that many European countries and others wouldn’t accept.
LP: You talk about five key factors that help explain why Americans are less healthy than people in many other countries. Can you walk us through them?
SW: Yes. One factor is the health system itself, including public health. The U.S. model is very different — not just because we lack universal health care, but also because access to primary care is more limited. The system is highly fragmented, with real weaknesses in primary care, behavioral health, mental health services, and related areas, all of which contribute to poorer outcomes.
Because the U.S. relies on an insurance-based system, often employer-based, major disruptions in the labor market can profoundly affect access to care. For example, in the 1980s and 1990s, as the manufacturing and mining sectors collapsed, workers and communities that had depended on stable employer support lost jobs, so they lost health insurance and access to care. We know that probably had a big effect on disease outcomes.
So that’s number one. The second factor is health behaviors — Americans simply act differently than people in other countries.
LP: How so?
SW: Americans consume more calories per capita than almost anyone else. We’ve made progress on smoking, which is good, but other behaviors also take a toll. Motor vehicle safety is weaker than in many countries, civilian firearm ownership is much higher, and drug use is another behavior that sets Americans apart.
The third category is adverse socioeconomic conditions. Here, we’re talking about things like poverty, income inequality, inadequate educational attainment.
Looking at OECD data, the U.S. has a very high child poverty rate and among the highest Gini coefficients, a standard measure of income inequality. American families face more socioeconomic adversity than in many countries with stronger social welfare systems.
People everywhere face job loss or tough times, but other countries have systems in place so that people going through tough times do not have to sacrifice their health.
The fourth is the environment — the physical environment and social environment. There are features of the physical environment in American cities that differ, for example, from European or Japanese cities.
LP: You mean like walkability, food deserts and so on?
SW: Yes. The social environment in U.S. cities is also very different in terms of social isolation, low social cohesion, racism, segregation, and, especially in recent years, social division and friction. All of these are harmful to health.
Finally, probably the biggest one is public policy. The way other countries go about approaching policy is different than we do. We also have political and cultural values that differ in important ways from other countries.
LP: You included communist and former communist countries in your comparison, and many have made faster gains than us, and now have a higher life expectancy — even Albania, one of Europe’s poorest nations. Several Eastern and Central European countries surpassed the U.S. despite being far less wealthy. I remember living in the Czech Republic in the ’90s: when I caught the flu, my employer and doctor told me to stay home for two weeks. Back in the U.S., I likely would have been pushed to return quickly. There, it felt like a social duty to rest, recover, and protect others – an example of different values and practices around health.
SW: You hear this time and time again. I’ve had my own experiences like this when I traveled. What you just described is a combination of factors. Some of it is structural in terms of how their system is set up, but the other aspect that you talked about is the value system, and it differs in these other countries.
It’s fascinating that our health outcomes now are slipping below so many other countries we wouldn’t have considered competitors. In much of the past research on the U.S. health disadvantage, the focus has been on comparisons with other high-income countries. The assumption was that it wouldn’t be fair to compare the U.S. with less wealthy nations. Of course we’d do better, right? I pushed myself to question that assumption: are we really doing better?
That’s when I dug into the data and thought, wait a minute. That was the moment that really got me.
LP: Do you think this reflects political and economic choices even more than medical ones?
SW: I think so. Social epidemiology and medical research show that only about 10–20% of our health outcomes are shaped by health care. Health care matters, but it’s only part of the story. One of the interesting things about the U.S. and our 50-state laboratory of democracy is that we get to see some experiments in action.
You can look at different states’ health trajectories and see some dramatic differences, and it’s hard to say it’s all about health care. Some of it is, but much of it comes from other social and economic policies that shape health outcomes. We saw this for many years leading up to the COVID-19 pandemic.
An example I often used before COVID-19 was the polarization of states. After the 1990s, and especially after 2010, we saw increasing political divides, tied to Reagan-era policies and Gingrich’s Contract with America, which pushed for devolution and more state power. The states then went in very different directions.
A striking example: in 1990, New York and Oklahoma had the same life expectancy. Since then, New York’s has climbed dramatically. It’s now the third highest in the country. Oklahoma’s has fallen to around 47th. You can point to demographic or economic reasons for New York’s change, but much of it comes down to policy decisions that New York and New York City made, and that Oklahoma did not.
LP: Can you give an example?
SW: The ones people think of right away are things like Medicaid expansion and tobacco taxes. In New York City, there was a very aggressive tobacco-control campaign that had a dramatic impact on life expectancy. And because of New York’s population dynamics, what happens in the city heavily influences the state’s overall statistics.
But we also have to consider economic policies: tax policy, minimum wage, the earned income tax credit. These are all policies we know strongly affect health outcomes. New York and Oklahoma take very different approaches on these issues.
In terms of national versus state failure, much of the decline is driven by the Midwest and the South. And again, many states now rank behind countries like Albania — I don’t mean to pick on Albania, since they should be proud of their longer life expectancy — but should we see this as a national health failure, or the cumulative result of state-level policy decisions, or both? It’s got to be both. Even our best-performing states, like New York and Hawaii, are still outperformed by other countries.
There are consequences of not having a national health system—not just for routine care, but also what was dramatically shown during the pandemic, when other countries, like South Korea or New Zealand, were able to implement a single national strategy to respond. In the U.S., by contrast, the way the Constitution was designed meant we ended up with 50 separate response plans.
LP: How does our Constitution figure in?
SW: Aspects of it set some of these problems in motion for us in terms of health care. The Tenth Amendment — the police powers amendment — basically places police powers in the hands of the states, and public health falls under those powers.
So under the Constitution, decisions about health rest with the states. By design, that’s why we have 50 different health systems. The Second Amendment is another example: the Constitution protects the right to bear arms, which is rare in other countries. As a result, the U.S. has a huge epidemic of gun ownership, and firearm-related mortality here is massive compared to other countries and contributes to our shorter life expectancy.
Part of this also reflects our history: we were founded by people who wanted to limit government control. It’s part of our culture not to want heavy taxes or big government — our idea of liberty, however you define it, often includes freedom to take risks, even if that means freedom to die.
Social values make a difference. In many other countries, there’s a stronger ethic of a social compact where “we’re all in this together.” When I studied in Europe and rode the trains talking to people, they complained about high taxes and the health system like everyone does. But if you ask them whether they’d rather have the U.S. model, they say, “Oh God, no.” Even if the National Health Service has problems, they believe society has an obligation to care for those struggling. That ethic is far stronger elsewhere than it is in the U.S.
When the pandemic hit, I think the White House could have done more to organize a national response plan than it did. The Trump administration in 2020 really stepped back and deferred to the states to let them figure out how they want to address this. I think more could have been done even within our American model. But we’re not organized that way.
LP: During the pandemic, how did differences in, say, vaccination rates across states affect longevity and other health outcomes?
SW: It had a huge impact. If you compare 2020 and 2021, you’re essentially comparing the pandemic before vaccines and then the pandemic with vaccines. That was true worldwide.
In 2020, every country experienced devastating losses in life expectancy because of the pandemic. Within the U.S., however, we saw differences across states in the magnitude of those losses. We were doing research in real time using a method called excess deaths, which compares how many additional deaths occurred relative to what was expected.
Even before vaccines became available in 2021, we were seeing differences in excess death rates across states that seemed to reflect how aggressive states were in implementing pandemic control policies — things like the duration of early lockdowns, mask mandates, and social distancing. Because the response became politicized early on, you could largely predict a state’s COVID policies based on the governor’s party affiliation. We saw a clear partisan divide: red states experienced higher excess death rates.
Things became even more dramatic in 2021. In many countries, life expectancy began to rebound as vaccination coverage increased and mortality rates recovered. In the United States, by contrast, life expectancy continued to decline, and a lot of that was driven by states that did not do a great job with vaccination.
LP: You’ll hear people skeptical of vaccines claiming that excess deaths were actually caused by the vaccination: it’s the vaccines that made people sick. How do you counter that?
SW: Yes, such people would point out, well, in 2021, Biden is in office and he’s rolling out these vaccines — and look what happened to our death rates. So people just look at those facts and that seems to support their claim that it’s the vaccines that were killing us.
But it’s sort of like saying that the barn is on fire and the fire department’s come to put out the fire and you’re not letting them use any water. Then you blame the fire department for the barn burning down. The reason why our death rates kept climbing is because we were not vaccinating the population adequately.
You can see it very clearly in the data that the states that did a better job of vaccinating their population experienced much lower excess death rates than those that were more lax about it. Based on the research, there’s no question that those policy choices cost lives. I worry a lot about the next pandemic — because there will be one – and we may not have learned that lesson.
When the next public health crisis comes along, politicians in certain states may decide not to follow public health advice.
LP: Or politicians at the federal level.
SW: Yes.
LP: Given the state of federal health policy under the current Trump administration, do you see any real guardrails that prevent state-by-state life expectancy from diverging even further? Is longevity now largely a political choice made in state capitals?
SW: Yes, it is. And things are going to get worse. The trends that I’ve been studying all these years — I’ve always said that unless there’s a dramatic change in public policy, it’s going to continue to worsen.
What’s happened over the past year is not only is a failure to embrace the policies that would help address the U.S. health disadvantage, it’s moving in the opposite direction – the exact opposite of what you’d want to do to make America healthy again. I think what we’re going to end up seeing, unfortunately, is an acceleration of this trend.
LP: What about cities? Do they still have meaningful ways to protect public health, or has state preemption — where states block what local governments are allowed to do — reduced cities’ ability to act? Any promising developments at the city level?
SW: I view this as sort of like an upside down pyramid. There was a period where federal policy was making transformational changes in our health conditions, like the establishment of Medicare and Medicaid. Things like that that were historic and game changers. Now it’s flipped. Very little is happening in Washington that’s going to improve health – and a lot is actually going to threaten it.
There’s a real opportunity for states to make a difference, but it’s at the community level that you see some really cool stuff happen and very creative and bold strategies that improve population health. It’s true that if you’re in a state where you have a governor or a legislature that wants to use preemption to override what the local government is trying to do, that puts a brake on things. But it definitely doesn’t shut it down.
New York City is an example, but there are other localities that have used collective impact initiatives and a variety of other strategies to really make multi-sector changes in the community that have improved health outcomes, reduced health inequities.
One of my favorite examples is San Diego. There’s an initiative that’s been going on in San Diego now for about 15 years called Live Well San Diego, which is a collective impact initiative that involves hundreds of different entities within San Diego County across sectors. So we’re talking about government agencies, but also the Chamber of Commerce, the schools, the military bases, the supermarket chains. They all are members of this collective impact initiative. You walk into their offices and they have the same emblem on their wall. They are all sharing the same data dashboard.
They have a set of objectives that they’ve identified, and the data dashboard tracks their progress. Each of those entities, those sectors, whether it’s housing, retail, restaurants, what have you, are implementing their part of the plan to try to reduce obesity, reduce violence, and so forth. Those are exciting developments.
There are other examples along those lines.
LP: Some localities are sharing what’s working with others, like New York’s Abortion Access Hub, which has a hotline and referral system that connects people across the U.S. to providers and telehealth services. It’s an effort to fill in the gaps on restrictive federal policies. And I think it’s worth saying plainly: lack of access to abortion and reproductive care does not bode well for longevity. How concerned are you about women’s health in the current political paradigm?
SW: When it comes to women’s health, the policy rollbacks — not just in reproductive health, but across other areas of women’s health — along with reduced investment in early childhood development, are deeply concerning. It raises real worries about the long-term, cohort-level effects this will have on women’s health over time. People like me, a generation or two from now, will likely be publishing papers looking back at what happened to the cohort that lived through the Trump administration. Because it’s going to unfold.
LP: What might you expect to see in terms of impact on health outcomes and longevity for that cohort?
SW: I think you’re going to see that the cohort coming up now — children who are being born and growing up today — will face more challenges across their lives. From a life-course perspective, they’re unfortunately more likely to experience greater adversity, including poorer adolescent health, higher stress levels, mental health challenges, and disease processes that begin earlier in life.
I think that we’re going to see an increase in chronic disease and substance abuse related morbidity and mortality in this generation if we don’t move in a different direction.
*Stay tuned for Part 2 of INET’s discussion with Steven H. Woolf.
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If anything one should read at least the last question and answer. Think of it. “Children being born and growing up today will face more challenges across their lives”. This i think is quite probably true thought it is probably too soon to have an idea on how those challenges will manifest. Add to socio-economical factors climate change disruptions and the cocktail might be explosive. Progressive ideas and policies were abandoned long ago. Maybe the US is acting here in some senses as our “canary in the mine” for extreme neoliberal to libertarian policies effects on human welfare.
The comparison between New York and Oklahoma and how these states have diverged since 1990 would require, IMO, a little bit more of attention and explanation. Though here Woolf says that the main difference was at State level choices (things that NY did and OK didn’t), it might be argued the opposite: Federal “inaction” since 1990 had different effects in NY and OK given their socio-economical and geographical differences. Let’s say, OK was more vulnerable to US policies than NY. May be a combination of both factors resulted in such wide divergence.
> The comparison between New York and Oklahoma and how these states have diverged since 1990 would require, IMO, a little bit more of attention and explanation.
Indeed. The only specific example given was New York’s tobacco control policies, which implies Oklahoma did not have such policies. But Oklahoma does! In fact it took one of the most pro-public health turns of any state during the tobacco litigation of the 1990s, constitutionally dedicating all tobacco settlement revenue to a public health trust (google “Oklahoma TSET”), letting anti-tobacco crusaders loose in public schools, and raising cigarette taxes dramatically. That part gave off big “blue states make better choices vibes” without showing any receipts.
In fact I think it much more likely that New York’s improvement relative to other states stems primarily from demographics. I’d need really compelling evidence otherwise, not handwaving.
I don’t know about Oklahoma, but NY does not exempt soda or candy from sales tax, but food is exempt. So that also makes a bit of a price difference.
Oklahoma has a significantly high population of Native Americans, just under 15%, second only to Alaska. The Ponca people live around the oil refineries in Ponca City, for example. Their life span, due to continued exposure to pollutants, as well as to forced relocation, discrimination and resulting substance abuse, and other factors resulting from over two centuries of attempted erasure, is lower than the white population.
We’re all Ponca now.
One unexamined difference in the populations of NY and OK is this:
NY’s native American population is about 1.4% of the total NY population, OK’s native American population is about 13.4% of the total OK population.
If you know anything about the poverty levels in the native populations in the US and about the way the native American populations have been treated by the US Fed govt then you would not be surprised by the difference in health outcomes between NY and OK. Nearly half of the state is governed by tribal jurisdictions.
https://ichef.bbci.co.uk/news/640/cpsprodpb/14840/production/_113323048_tribal_areas_oklahoma640-nc.png
State laws generally do not apply to tribal reservations. Federal law does apply.
@flora at 8:04 am
Good point. Averages hide many things. There is also the issue of race. A US anthropologist friend told me a few years ago that if you looked only at the white population in the US the health numbers were comparable to other countries.
I realise that race is also a marker of social class and income. Not adjusting for these factors makes the observations in the study less interesting. Inequality is noted but not used in the break-down of the results. The very lowest classes in the US live in appalling circumstances as has been described many times. One thing I remember in particular is the one million (if I remember correctly) people living with open sewers.
Lambert used to refer to this kind of thing as the ”go die” feature of neoliberalism. It is not a misguided policy outcome. It is deliberate.
My 12 year old daughter (6th grade) often says to me that everyone in her class is tired and/or anxious. When I was in 6th grade (I’m 54, solid Gen x) I never even thought about anxiety.
You probably had a home push button phone, social media was playing pong with your neighbor and you had the free time to think for yourself.
100%
And my mom would disconnect the phone after school when she saw I was tired and needed a nap. You could disconnect.
Progressive ideas and policies were abandoned long ago. Maybe the US is acting here in some senses as our “canary in the mine” for extreme neoliberal to libertarian policies effects on human welfare.
Ignacio: Yes. Given the scandal here in Italy from the discovery that ICE is supposedly being sent by U.S. authorities to protect the U.S. bigwigs and athletes at the Olympics, and considering some of the antics of the current governing coalition — which seems to get some of its tactics from reading TwiXts from Trump, Rubio, and Steve Bannon — I, too, have a sense that the Imperial Center is a kind of canary.
Which worries me. Because the U S of A is actively exporting its distemper.
Parramore and Woolf discuss a remarkable number of factors that have all gone wrong. Having read the article, I wonder what advice USanians should follow. How does one renovate a house in which all the systems are on the fritz? Here in Italy, which sometimes resists the U.S. mess and sometimes imports U.S. messes, there is some three thousand years of recorded history and a remarkable cultural continuity. USanians have been sold an endless number of novelties, from Crisco to keto diets to neoliberalism to iPhone 95. What remains of the social fabric?
PS; Gini quotient: I suggest that USanians become more familiar with it.
PPS: Gunz. Mentioned repeatedly in the article. Just as the original U.S. constitution made a fatal mistake about slavery, it is indeed likely that the Tragic Second Amendment has turned into a liability. No amount of yammering about gunz-as-tools or gunz-as-recreation (a croquet mallet that kills) is going to cover up the slaughter.
Keeping it simple, New York had less mask shaming, and the min wage in oklahoma is a pathetic $7.25/hr
That’s the federal min wage, isn’t it, not Oklahoma’s?
On the general decline here, in the 1960s I was working in a New York State epidemiology research unit. We were already seeing infant mortality fall behind our global peers as well as such things as wealth inequality ratios.
Look, let’s face it. Our political structure is obsolete and dangerous, and it’s supported by equally dangerous cultural values. The resistance to Trump is largely robust and local while the state and federal resistance is tepid.
New York is a much richer state than Oklahoma. Median income in NY is $86,830 — in OK, $65,310, per the St. Louis Fed: https://fred.stlouisfed.org/release/tables?eid=259515&rid=249. But politics and race are obviously huge factors as well.
Grasping at the root, effectively US culture prioritizes profit over humanity. And, as in all things human, philosophy and belief ultimately underlie action and behavior. Our actual beliefs are found in what we do. Whatever American’s may feel they believe, profit still takes priority over humanity. Or, in contrast to the urging of Emmanuel Kant, people are routinely treated as the means rather than the end. I suggest that this philosophical root underlies American’s existential values, at least to a greater extent than in most other cultures, and shapes its behavior at every level. It has naturally become and is becoming even more structural as well.
On the other hand, human values can be fostered, encouraged, and strengthened. If there is a wish and will to.
Soo.. Going for a melanoma check for my face on Thursday, but found out yesterday there’s a tumor wrapping a kidney. The CT scan: ‘A CT Scan in [my town] costs $1,486 on average’. Our 100k population town has a Level 3 trauma center, but is not capable of handling the surgery, so it’s up to Indy for that. Cost for removal likely won’t be less than $15k. I’m assuming at this time no metastasis because… well, because.
I got Medicare last summer. Our income was too high for subsidized insurance, but not enough to afford what’s been offered on the market. We’ve had actual insurance for less than 10% of the last thirty years. We would be f’d and f’d again if I hadn’t got lucky enough to get old. I’m sixty-five, and most of the men in my cohort that I’ve known are already gone.
The care I’ve had so far has been good. The last time I went to a doctor was 2020, and the ethos seems strong here.
OMG I am so so sorry!!!
Thank you, Yves. I have Medicare and a second kidney, and no pain, so I’m doing okay. Janet knows more than me (45-year RN) and is not so, shall I say, sanguine. But things are moving quickly on this front.
On the other, I haven’t had a primary care physician, which has caused some administrative problems. I have a ‘bridge appointment’ today to solve some of those, since I won’t be able to see the physician for about six months.
>> Social epidemiology and medical research show that only about 10–20% of our health outcomes are shaped by health care.
Amongst my cohort, loss of work and greater isolation strongly correlates. Larger communities fractured. I have too many fingers to count the number of people I engage with on larger issues. This place, NC, has been a sanctuary for both expression and reality-testing, and I am profoundly grateful for that.
Sorry to hear the lousy news. Sympathies and our best to you snd J.
Stick around (please). The show ain’t over yet.
Sending many good thoughts to you and Janet.
And deficient as Medicare is, it is still a blessing for so many of us. Thank goodness for it. I haven’t had to use it for much so far, but I know the day is coming. I am so thankful you got old. Now go make good use of it, and get older!
Sorry to hear of your bad health. Sending good vibes to you…
Sending you very best wishes for a good outcome and recovery.
Good luck, Steve!
Sorry to read of your health and I hope that everything turns out well for you. I remember when young old men would say doctors were nothing but pill pushers. I stayed away from them until I went on Medicare. Now what was once a year has become twice. My mother had a sticker on her refrigerator that read Old Age Is Not For Sissies. I never realized what determination it takes to, as Chief Dan George put it, “Endeavor to persevere.”
After my father had a stroke many years ago he would always have me list the entries in the obituaries when I read him the newspaper. Occasionally there would be an acquaintance but not that often. He was in his mid-seventies at that time and wanted to see who had won the race. I suspect I too have out-lived my elementary school companions (soon to be 73) but it is hard to know. When my twin brother died he did not want an obituary ran. It seems they are not as common for my generation.
Cancer is a roller coaster ride, up and down with each scan and blood test. That was good timing with the Medicare. I’ve relied exclusively on it and grants the hospital staff have helped me with. I feel like I’ve had first rate care despite my poverty, and I’m sure you can get the same in Indy.
The half-dozen oncologists I’ve encountered through this see themselves as warriors against the Big C, and they’re inclined to fight with all the tools at their disposal, and those are considerable. Just remember that most of these treatments come as close as possible to killing you as possible without crossing that line. I wound up on that line 3 times that I know of. If you feel like you’re gong under the waves during treatment, especially chemo, get to the hospital. Time might be critical.
But those warriors against cancer can work wonders. I take another ride on the roller coaster this month with a semi-annual CT and tests for cancer antigens and cancer cells in the blood, but two of the independent tumors I started with have made no showing for a year now. I’m coming off the prostate treatment this month with the plan to play whack-a-mole until I can’t.
One of the beauties of this is that the cancer patient’s life is no longer in his own hands. You go with the flow, wu wei if you will, a good learning experience in a culture that pretends humans can ever be in control.
One thing you can count on is good support from the NC community. I know that’s been a big positive for me.
I am quite astonished that Stephen Woolf claims unequivocally that differing death rates in 1921 were caused by the differing vaccination rates. In the abstract of the study he refers to it says: “his study found that states with Republican governors and larger Republican majorities in legislatures experienced higher death rates during the COVID-19 pandemic-and in preceding years-but these associations often lost statistical significance after adjusting for the average income and health status of state populations and for the policy orientations of the states. Future research may help clarify whether the higher death rates in these states result from policy choices or have other explanations, such as the tendency of voters with lower incomes or poorer health to elect Republican candidates.”
Furthermore it is simply not true that vaccination “had a huge impact. If you compare 2020 and 2021, you’re essentially comparing the pandemic before vaccines and then the pandemic with vaccines. That was true worldwide. ” Here a comparative study of morality rates in Europe by the Office of National Statistics of the UK. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/comparisonsofallcausemortalitybetweeneuropeancountriesandregions/28december2019toweekending1july2022#relative-cumulative-age-standardised-mortality-rates
In some countries there was indeed a spike in early 2020 but in others there wasn´t. They spiked around the time of the roll out the vaccine in the winter of 2020/2021. In yet other countries like Sweden there was no remarkable change in age adjusted mortality neither in 2020 nor in subsequent years.
I do not understand your claim. As much as many were harmed by the Covid vaccines (including your humble blogger), they were still beneficial on a population level. The big fail was the refusal to collect good information on vaccine injuries so patients could make informed decisions about risks.
It would have been vastly better if the public had been willing to mask and insist on good ventilation. But that is not what happened.
And I don’t understand your comment about Sweden. This study contradicts your claiim: https://www.sciencedirect.com/science/article/pii/S0264410X25001677
I have read the French study. It is highly questionable if not junk. They examined the mortality of approximately 28.7 million adults aged 18 to 59 depending on their COVID-19 vaccination status. Cause-specific death rates were analysed over a period of up to four years. The study found significantly lower mortality in the vaccinated group – not only for COVID-19 deaths, but also for other diseases and external causes of death such as traffic accidents or drowning. It is noteworthy that the reported reductions for the various causes of death are of a similar magnitude, predominantly in the range of about 20 to 30 percent. How can that be? There must be undeclared confounders.
It reminds me of an ONS study where they likewise compared vaccinated and unvaccinated in the UK. It was a very detailed study. Strangely enough the mortality of the unvaccinated shot up as soon as they started to vaccinated. Norman Fenton, a professor of mathematics at Queen college London found the explanation: people were only counted as vaccinated TWO WEEKS after having received the first shot. I suspect there’s something similar going on with the French study. What exactly is unknown as the raw data hasn´t been published.
About Sweden: age stratified all cause mortality was among the lowest in Europe. And that although the country had one of the highest vaccination rates. So it is definately not an exhibition case for the antivaxxers.
Generally speaking the problem is the influence of Pharma money. It would have been easy to select a cohort and compare unvaxxed vs vaxxed. You don´t need a big data base. You need two carefully selected groups of people. 200 000 people would be quite enough in the case of France.
I am sorry but all cause mortality is REGULARLY used as a clinical endpoint. You can’t dismiss it the way you do. Your posture analytically invalid. You are discrediting yourself by making this the basis of your dismissal.
I am not dismissing all cause mortality. Not at all. I totally agree that it is the one measure that can´t be faked. Whatever else you might say about the ONS its statistics are among the best there are. You need to read the fine print though…
The problem with the French study is 1. there’s no raw data and 2. it is completely implausible that there is such a huge difference in mortality regarding things like drowning, cancer, traffic accidents et al.
Finally my point about Steven Woolf is that he claims that there’s a world wide reduction of all cause mortality after the introduction of the vaccine. And that is simply not true. The ONS data clearly show that in about half of European countries the peak of all cause mortality was in 2021.
Huh? The vaccines were introduced in the US in early 2021. Distribution was limited in the first month or two to medical professionals. So how does this contradict the idea that the fall in all cause mortality was after the intro of the vaccines in 2021? The pace at which the population got vaccinated presumably varied by country.
The Pfizer vaccine was rolled out all across the EU from the end of 2020 and by June 2021 at least 50% of the population had received at least one shot. Here a link: https://www.bbc.com/news/explainers-52380823
Nevertheless half of EU countries had higher age adjusted all cause mortality in 2021 than in 2020. The latter is established by the above cited article by the Office of National Statistics of the UK.
Furthermore the ONS article didn´t include Germany. In Germany there are the numbers by the German office for Statistics Destatis. In 2020 all cause age adjusted mortality was negative i.e. below expected. In 2021 and 2022 it was considerably higher than expected. This is well known among German actuaries and has caused quite a bit of controversy as to the cause. Here please a link to deeper look at German all cause mortality: https://royalsocietypublishing.org/rsos/article/10/8/221551/92451/Reports-of-deaths-are-an-exaggeration-all-cause
One reason for doubting that the vaccines were the cause of the higher mortality is the Swedish counter example. In fact Sweden had overall (2020 – 2022) one of the lowest mortality rates in Europe.
Hypothesis: people already at risk for a heart attack get vaccinated for covid. This triggers a heart attack some of them within 2 weeks (before being counted as vaccinated). This then reduces the odds of having a heart attack and/or being alive when they would appear in the “vaccinated” bucket of the observations which helps that arm of the experiment appear artificially healthy.
I have no idea if this is correct. The recent studies do show such a large benefit that its tough to see any single bias changing the effect. But I also have a hard time trusting any studies done by big pharmacy and our compromised regulators. The fact that you were never counted as vaccinated until 2 weeks after was always a giant red flag that screams data manipulation
The anecdata from IM Doc is that the myocarditis is overwhelmingly among extremely fit adult men and teens who may be only moderately athletic. This is the reverse of your hypothesis. It seems that they have been pushing their cardio performance limits and the vax overtaxes them.
I have reservations about the vaccines but I have no doubt they reduced mortality and injury from Covid.
I do not see, however, any biological rationale for the vaccines reducing nearly every component of all cause mortality (as opposed to reducing the aggregate all cause mortality, which measure enables comparison between groups in an observational population study by including all factors to minimise artefacts from group construction).
Without a biological theory of action, such a reduction, if not an artefact, is correlation and not causation – and suggests an unseen confounding factor at work. For example, the two week cutoff in the UK study to count as vaccinated. Or simply vaccinated people are more risk averse and drown less….
Swedish mortality went up in 2020. It evened out and eventually went the other way in the years after, but the spike in 2020 was very clear.
In the spring of 2021 vaccination started and vaccination was rolled out first for the elders, which in practice meant that the oldest cohorts got vaccinated between two waves. At this point testing was free, easily available and promoted so there’s a good relationship between spread and positive test results. Policies were the same across the waves. The waves were roughly the same in cases, but the first was much larger in deaths. I would call it a natural experiment.
Vaccination rates were high, without making it mandatory or downplaying risks. There was nurses and an ambulance standing by and it was really clear that you sit and wait until you are in the clear.
Part is social cohesion, but a big part is that if you are unlucky in the draw the state will provide, which it has a track record of. Still sucks if you are unlucky but so does COVID, so that tilts the expectation value.
Maybe what should be noted is the effect of stress in American’s lives, especially workplace stress. I have to admit that the source of what I am seeing is YouTube videos so is anecdotal but it is consistent. American workers that go to live and work in foreign countries have to be told to dial it down a bit as they come from high pressure situations. One young girl who came to Oz started work at 6 am. Problem was her place of work did not open til 8:30 so she sat getting stuff done on her laptop while she was waiting. She had to be told to cease and desist. Regardless, the reports of stress in the American workplace has got to have a serious effect on the health of those workers and must age people prematurely. And this isn’t even including the effects of mental health. So I find it strange that stress is barely mentioned at all.
This is at least true in my case. When I went to live and work in Ireland in October 2000, I hadn’t made any friends yet that were close enough to be invited to anyone’s house for Christmas, so I told my boss I’d use the time that the company closed down (gasp! The whole WEEK of Christmas!) to re-arrange the test lab. At first he very kindly said no, that I should enjoy the time off. After a lengthy back and forth he finally had to INSIST.
Now, I’ve just retired from work here in Eugene Oregon, and I am already feeling the difference. Stress of course hasn’t completely left but. . . I am sleeping better, I am more relaxed (I have a lot of trouble relaxing my face, head, and neck muscles, which is now improving), my digestion is better.
I miss that slower pace, and we talk a lot about moving back, but Ireland isn’t doing better as a whole than we are here, so here we stay. Ireland has unfortunately imported too much America.
Eugene is a great place to slow down. I completed my nursing degree in Eugene and given I am just a few hours South, I go “home” in the Summers. Stay the course; retired at a pace that supports your “new way in the world”. All the best🌅
“Social epidemiology and medical research show that only about 10–20% of our health outcomes are shaped by health care.”
and then points out that NY has better health outcomes than Oklahoma, which, to me, seems largely due to access to affordable (by population) health care. Air pollution is much higher in NY.
To my guess, it might be true for some health issues and not others. If you have cancer, arguing access to health insurance and thus health care is 10-20% of the five-year outcome seems ludicrous on face value.
The air in NYC, which is where the air is bad, is not bad by global standards. Try coming to Asia.
In addition, in NYC people walk a lot. In fact, if you are mobility-challenged, the city is difficult. You see few obese people compared to the rest of the US. And in terms of fitness benefits, the most important gradient is getting out of the sedentary category, which walking achieves. More is better up to a point, but the biggest bennies are in going from sedentary to not sedentary.
If you think care is affordable in NYC, you are smoking something strong. Many doctors refuse to take Medicare patients.
So I would say that more than offsets your air pollution issue.
I should have clarified affordability (and accessibility) as relative to income. But fair point about sedentary lifestyle (and maybe access to ethnic foods?) – especially since (I think from a recent links) that most Americans do zero exercise (esp. in the deep south) outside work. Accessibility, as in distance / time to a trauma center, thanks to the evisceration of rural hospitals, imposes a time-to-care “inaccessibility” even with insurance
Re: American life expectancy
From the interview:
LP: You talk about five key factors that help explain why Americans are less healthy than people in many other countries. Can you walk us through them?
The interviewee replies, “Yes.” There’s a subliminal message here. Can you spot it? That’s right—the word “walk”. WALKING. Maybe more Americans should try it, get out of their Ford F-350s and all the drive-thru’s, and improve their lives and life expectancies.