The average American has the same life expectancy as the worst part of England | Hacker News Reader

The average American has the same life expectancy as the worst part of England

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325 pointsgrecy371 comments

The original article points out that the primary difference between the US and the UK (as well as other peer countries) is that you're much more likely to die young in the US. A 5-year-old in the United States has a 4% chance of dying before age 40, whereas a 5-year-old in Australia, Austria, Canada, England and Wales, France, Germany, the Netherlands, Sweden, or Switzerland has ~1% chance of dying before age 40 (values appear to range from ~0.9% to ~1.25%). This suggests that the US's shorter lifespans aren't primarily caused by poorer healthcare outcomes, but rather social problems like drug overdoses, gun violence, and car accidents.

Woah!

Deaths by billion vehicle miles in UK - 5.2. In US - 12.5. (both have tens of thousands of KSI, but the US has over twice as many per cap. In fact, way, more KSI from car accidents than even gun related homicide in the US. I hadn't realized that!)

Deaths by gun related homicide in UK - 200. In US - 20000. (Both numbers pale in comparison to motor vehicle deaths, but there are a lot more in the US. Probably to be expected as there is stringent firearm control in the UK.)

Deaths by drug overdose and poisoning in UK - ~5000. In US - um, yeah, well over 120000 if you count the poisonings too as the UK does. (I'll just say, I think we found one of our major culprits in this one.)

I'm thinking overdoses is a major contributor. It's the only way to get to millions in less than 10 years. Car accidents, maybe, but honestly it's not that much compared to the number of young people who die every year. Ditto, with gun related homicide, which is even less than car accidents.

I know we may not want to talk about it, but I also noticed major numbers in suicides among young people. (More than vehicle accidents and gun related homicides combined in 2021.) Not sure if that's where the parent comment was going though? So I left that out. It could be a contributor though? The numbers are there, which is what you need to impact averages.

My takeaway? Suicides and drug overdoses. Not to be taken lightly.

Youth suicide has always been pretty bad in the US and it's getting worse https://www.pbs.org/newshour/health/youth-suicide-rates-are-...

That's from 2019, numbers for the last 3 years are a little harder get but like attempts went up but deaths went down at least in most places but in a couple places deaths shot up a lot?

https://www.nichd.nih.gov/newsroom/news/042722-COVID-adolesc...

https://www.nbcnews.com/news/us-news/youth-suicide-attempts-...

I was floored when I met some students from NYU who explained they've installed nets in the library because there have been so many suicides from people jumping.

Yikes.

Not exactly how I remember it.. but yeah. https://www.huffpost.com/entry/nyu-bobst-library-suicides-al...

NYU is also more vertical than most universities in the US. How many university buildings in the US are 12 floors or higher?

I don't care if the building 100 floors - the problem is not the height of the building. The problem is that young people in the US who are clearly privileged enough to attend a very prestigious university are driven to suicide.

Tall structures everywhere are suicide magnets because they are fairly accessible and the means of death is easy and (seems) fairly certain. It’s why you can’t build a large bridge with a pedestrian walkway without some kind of safety netting, and that’s globally.

Countries by suicides per 100,000 population:

US: 14.5 UK: 6.9 Germany: 8.3

The problem IS NOT tall structures. The problem is something about US society.

https://en.wikipedia.org/wiki/List_of_countries_by_suicide_r...

> the problem is not tall structures

https://www.skyscrapercenter.com/countries

The data shows that the USA has way more tall buildings than most of Europe, by more than an order of magnitude.

Disclaimer: I don’t agree they’re a leading cause, rather an accessory to a suicide premeditated by various health/societal factors.

I remember when the exact same thing was used to berate Apple for working with Foxconn.

Looking at the date of the article, they were almost contemporary.

Youth suicide in the US has been in the press a lot lately but it's not really one of those things that's really bad or getting worse. It's less frequent than it was years ago, and less frequent than in many OECD countries. That sets it apart from the overall picture which shows the US to be worse than all other advanced countries and rapidly getting worse.

For anyone else not hip with the lingo, KSI seemingly refers to 'Killed or Serious Injury'

> I hadn't realized that!

That's because the media only reports on unusual deaths.

For example, sometimes I'll see the emergency crews pulling a body out of Lake Washington. It never makes the news. Drowning deaths are too common.

Many drownings could have been prevented but it's still a relatively niche cause of death. Unintentional drowning is ten times less frequent than either of falling or motor vehicle crashes, which are about the same frequency. The main way that drownings could be prevented among adults is by enforcing alcohol rules, or having some in the first place, but that goes against the entire theme of American water recreation. Which is sort of the point of the article: dying unnecessarily is part of the culture of America.

> Many drownings could have been prevented but it's still a relatively niche cause of death.

I read somewhere that drownings were the 2nd leading cause of death for children. Cars were #1.

People drown mainly because they underestimate the risk of it.

I know parents who had their toddler drown. The grief and devastation of that never stops, decade after decade. They had camped near a river bank, and the kid wandered off into the water.

In the youngest age group, drowning beats cars even. https://wisqars.cdc.gov/data/lcd/drill-down?causeLabel=Unint...

Basically the #1 causes of unintentional death in age order are drowning (<5), cars (5-20) then drugs (20+).

> Deaths by billion vehicle miles in UK

UK driving test is difficult, and I suspect drunk driving is much lower because distances are lesser and public transport is better.

> suicides

Much easier when you have a gun around

And DUI is treated much more seriously in the UK, consequences are stricter (for example, no "oh you need a car to get to work so you can carry on driving but only too and from work" loophole) and there is greater social opprobrium to drink driving.

Yes, it's fairly common to go to prison for drink-driving here.

The problem with drug overdoses can be directly tied to the War on Drugs. The entire campaign criminalized addiction vs focusing on rehabilitation, it removed outlets from relief in many states and it has only made illicit drug quality significantly worse (versus removing access to them).

This is one of those metrics that really makes US federalism apparent and shows the drastic difference in outcomes from the two major parties. By reviewing the per state metrics[1], you can see that states that take a much lighter hand to drug criminalization and that offer state sponsored relief (California, for instance) have a much lower death rate to ones that take a heavy hand (southern states, New Mexico, etc).

1 - https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mor...

Your map tells no such story. In particular, California's low rate cannot be attributed to California's policies, as California's rate is matched by Utah, Idaho, Texas, Mississippi, Alabama, etc.

You say Southern States have a higher death rate, yet Mississippi (typically considered archetypical of the deep south) a lower per-capita drug overdose rate.

Texas, which is a state dominated by the party that does not rule California has an overdose rate about 75% that of California.

There's a lot more going on than your analysis would suggest.

Your drug and gun deaths are totals right? That makes the US look worse than it really is due to the large population difference. If that’s the case then you can divide the US number by about 5 to make it actually comparable (and still terrible).

The road deaths surprise me the most , as most American roads are big and straight and most British roads are small and squiggly!

I can guess a few reasons:

* Cars tend to be bigger i.e. more dangerous in the US

* Drink driving seems to be more acceptable in the USA.

* The driving test in the UK is much tougher than even the toughest us state

* Most of the US don't have mandatory annual vehicle inspections to check they're safe and roadworthy

Big and straight allows higher speeds and less need to pay attention. Lane width is a major contributor to the actual speed driven.

It's counterintuitive, but broad and straight roads are often more dangerous, as they invite faster driving.

Faster *inattentive* driving.

I'm always kind of surprised how terrified Americans visiting the UK are, when they see the kind of speeds people drive at here.

If you're coming here on holiday from the US and you're planning your route using Google Maps, double the time estimate. You won't like the speeds it expects you to drive at.

> roads are big and straight

To accommodate big cars.

Re: Vehicle miles. In the UK a license proves you are competent to drive. In the US a license proves you are not incompetent. The US driving test is set so that over 90% pass, deliberately. Because driving is seen as necessary.

Has that changed? Is the UK license standard as high as it once was?

> In fact, way, more KSI from car accidents than even gun related homicide in the US. I hadn't realized that!

Guns get an outsized portion of air time on most media. Especially crimes committed by legal weapons against white people. If all gun crimes were covered equally you would hears a lot more about gang violence and illegal weapons.

> Deaths by gun related homicide in UK - 200. In US - 20000. (Both numbers pale in comparison to motor vehicle deaths, but there are a lot more in the US. Probably to be expected as there is stringent firearm control in the UK.)

I'd be curious to see the difference between gun homicides and homicides. The UK has a huge knife crime problem.

> I'm thinking overdoses is a major contributor. It's the only way to get to millions in less than 10 years. Car accidents, maybe, but honestly it's not that much compared to the number of young people who die every year. Ditto, with gun related homicide, which is even less than car accidents.

Overdoses and drug related deaths. Drug addiction will shorten a person's lifespan by decades.

As you can see in his chart at [1] from the same thread, drugs, violence, and accidents only explain less than 1/3 of the difference, so the rest would be mainly various disease/lifestyle and care related issues (the overwhelmingly top causes of death in the US [2]). I think those graphs are a easy to misread, the long tail of somewhat poorer results is less dramatic than that younger gap, but actually includes much of the disparity. In [1], you can see that the last cause, cardiovascular, explains more of the difference than drugs, violence, and accidents combined.

[1] https://nitter.moomoo.me/pic/orig/media%2FFsjYUjhWcAEatMo.jp...

[2] "From 2020 to 2021, age-adjusted death rates increased for 8 of the 10 leading causes of death and decreased for 2. The rate increased 3.3% for heart disease (from 168.2 in 2020 to 173.8 in 2021), 1.7% for cancer (144.1 to 146.6), 22.5% for COVID-19 (85.0 to 104.1), 12.3% for unintentional injuries (57.6 to 64.7), 5.9% for stroke (38.8 to 41.1), 2.4% for diabetes (24.8 to 25.4), 9.0% for chronic liver disease and cirrhosis (13.3 to 14.5), and 7.1% for kidney disease (12.7 to 13.6)." https://www.cdc.gov/nchs/products/databriefs/db456.htm

> In [1], you can see that the last cause, cardiovascular, explains more of the difference than drugs, violence, and accidents combined.

This is for overall life expectancy, not 5 to 40 death rates though. I would expect cardio-metabolic disease is a significant driver of "early" deaths (say before 65) in those over 40 in the US compared to other developed countries.

The point is, despite the twitter/article author's (perhaps sensationalist) claims, the numbers don't support the extreme emphasis on the 5-40 age group. The difference in life expectancy, which is what we are talking about, mainly (~2/3) comes from health and healthcare issues, and is in fact spread out throughout Americans' lives, from about 0-79 years of age.

You’d expect correctly; there is non-trivial number of people dying from those diseases between 40 and 65 in the USA, and the number is only increasing.

In the USA and Canada, the probability of death from these diseases is roughly 1 in 3.

As I recall, other developed countries are kind of catching up. Malignant neoplasms and cardiovascular disease are becoming the typical causes of death in the majority of cases in most countries, generally followed by accidental injuries and suicide.

The good news is that if you don’t kill yourself, you exercise, and you eat well, you can likely avoid or significantly delay these events. Accidental injury though, that’s hard to control for.

That's a fair point; I was simply trying to paraphrase the FT article in pointing out the importance of "social factors" (including diet/obesity/etc. leading to cardiovascular disease) in explaining US life expectancy and picked the three examples they used. I hadn't seen the chart you linked.

I still think drugs, guns, and accidents are worth specifically highlighting even if they aren't the single biggest driver of this disparity in life expectancy. I'd wager that most people are aware of America's obesity epidemic, but they might not realize the extent to which these three (big) factors make the US unlike it's peers. I certainly didn't.

They are definitely important issues that I have been aware of for some time, just due to where I have lived over the years. However the author went a bit too far and lost sight of the forest for the trees.

One thing that isn't clear to me (and didn't seem to be addressed in any of the charts) is the percentage of the life expectancy disparity that is explained by the "likelihood of dying before age 40" disparity. To me, this is the key statistic that the author is missing because the original article isn't really about causes - which are only tangentially mentioned.

It doesn't matter that most people die of cancer or heart diseases, as these are old people and these are also prevalent in other countries. When someone dies at 25 from a drug overdose, however, age expectancy is greatly reduced as more expected years are shaved off. The US has WAY more of those than other developed nations.

There is literally a graph I linked, and several other in his twitter thread, that show you are not correct. The difference is caused by deaths in all age groups, throughout every age bracket until about 79. Obviously infant mortality rates in the US, which are higher than elsewhere mainly due to poor prenatal care, have the biggest impact on a per-person basis. But we can see that it does not add up to explaining away 74% of all deaths in the US as insignificant (CDC link indicates top 10 causes make up 75% of all deaths), simply because even though the difference is greater in younger age groups, the absolute number of deaths is still too low to completely change the statistics. It certainly has a measurable impact. About 1/3 of the difference, as I said.

I'm sorry but you are the one who doesn't get it. Your data does not show the most important point which is the difference in deaths in people between 5 and 40 years old. In this age range, we are already past the child mortality issue you mention and we are before the other causes of death that are prevalent later. Also, we for this analysis you have to focus on the major differences across countries, not similarities. It doesn't matter that something is causing most deaths, as long as there is another factor, such as drug overdoses, which explains the differences.

You claim this is the most important point, I am saying it is important, but not the most important point. The charts show the difference already, show that this difference is largely related to medical / health reasons (as I said above, cardiovascular alone accounts for more of the difference than all those reasons combined), and don't support your conclusion.

We are talking past each other. You are claiming that cardiovascular diseases and other factors are more important to the US having a lower life expectancy than all these other countries. But not in the age range that is the main thrust of the thread we are in, 5 to 40 years old. The first graph you posted is a bunch of counterfactuals on the aggregate life expectancy, suggesting that the overall impact of these early deaths are almost as significant as cardiovascular diseases, which is astonishing.

I think you are confused about this because you also brought up child mortality. Yes, child mortality is also much higher in the US than other developed countries. But we knew that. The article is focusing on less discussed yet very impactful factors which disproportionally impact young people in the US.

Even the person who started this HN context has agreed I made a good point about these premature deaths not being primarily (their words) from the age range / causes in question, so I am not sure why we need to continue.

You are trying to make the conversation about something it is not, and have changed their point to my point (from primary to important but not primary) to then say I am being unreasonable because I don't understand their point, which is in fact mine. There is no reason I should accept to be shut into your box. Read the twitter thread, and this comment thread again, and it is clear you are the one trying to force the conversation to be about one very specific thing while refusing that it is legitimate to place it into a larger context - the overall causes of lower US life expectancy.

The only reason I care is I don't want a bunch of people running around with the false idea in their head that we just need to deal with the important social issues of our younger generations, and we have solved the bulk of the problem. They are certainly important, even critical issues, but that is not true.

How am I supposed to read your first image? It appears to me that heart related issues, all else constant, have less an effect (2.2 for men) than all the other issues mentioned (2.3-3.3).

When removed, it reduces the actual 3.6 difference to 2.2, the greatest reduction. Lower numbers are indicate bigger effects in those charts.

Yes, there has been a huge increase in the number of accidental fentanyl poisonings. I think this is now the leading cause of accidental death among young people, surpassing even vehicle crashes. Mexican drug cartels have been manufacturing counterfeit prescription painkillers and replacing active ingredients with fentanyl. They have bad quality control and sometimes just put in too much. Fentanyl is so potent that there is only a tiny difference between a recreational dose and a lethal dose, even for opioid addicts who have built up a tolerance.

https://peterattiamd.com/anthonyhipolito/

That's why punishing Big Pharma for making opioid pills has the perverse effect of causing more opioid deaths due to no quality control on the illegal versions.

I mean one could use the money from settlements to you know .... Help?

> but rather social problems like drug overdoses, gun violence, and car accidents.

I think you could make a reasonable argument that much of these actually are healthcare problems. But either way, investment in looking after people is the solution, what that looks like is probably more controversial.

I don't think you have enough information to say this?

Certainly that Americans die young, but that could be because American healthcare does worse for people between 5 and 40.

Eg. You'd prefer to be in a car crash in Canada, because it's more likely that the healthcare will take better care of you

I'm not a doctor so I don't know the answer but could poorer lifestyle choices in mothers/to-be cause an increase in infant mortality?

"1 in 25 Americans being born will not make it to their 40th birthday."

Wow. Actually impressed with the analysis backing this up. If you read the entire thread, he actually covers nearly every correlating factor I could think of.

And it's pretty clearly drugs, guns, suicide, and cars. (The cardio health one doesn't seem as strong).

The one that is crazy to me is the uptick in driving fatalities. Cars are an order of magnitude safer than they used to be and we were trending towards 0. An entire generation has to be that much more reckless than before to make that kind of a dent.

It’s not necessarily recklessness.

Cars in the US have gotten much larger and heavier in recent years.

A Ford F150 might be safe to drive, but it’s not safer for pedestrians and other road users than the smaller cars we used to have.

I bet phone usage is also a factor.

Keep in mind that while we had cell phones for a while, it’s only within the past 10 years that the whole “distraction economy” became a thing, so while people may have used phones to communicate back in the day, nowadays they might be using the phones even more just to attend to those distractions.

With T9 you could send a text with your one hand in your pocket. Try that with an iPhone...

Text-to-speech is available on the iPhone, is it not?

And it probably has the same accuracy as the spellcheck on the T9, unless you meant to talk about the ducking ponyman in your text.

The phone usage thing also affects European countries though. Large cars becoming more common is an issue more unique to the US.

That's a good point, although the phone usage could have a multiplier effect and cause proportionally more trouble in the US due to the bigger cars and more-car-oriented environment.

Plus, modern US trucks are as big (if not as heavy) as WW2 tanks. Photos taken from the infamous DailyMail, but they look correct to me, that is [1] and [2]

[1] https://i.dailymail.co.uk/1s/2021/07/25/21/45875073-9823577-...

[2] https://i.dailymail.co.uk/1s/2021/07/25/21/45876985-9823577-...

> if not as heavy

A difference in mass of around 15x, I believe.

In some states you can register a tank to drive on the street!

A Ford F150 is most dangerous to small pedestrians (i.e. your kids or the kids of those you visit) in the driveway which you can't see over your hood due to its size.

Cars are getting so big that people can’t drive them. An indescribably sad statistic: In the US, a parent drives over and kills their kid in the driveway every other day [1].

All the guns also cause -a bunch of— some small kids to kill their siblings every year.

[1] https://www.nbcnews.com/news/amp/rcna52109

>All the guns also cause a bunch of small kids to kill their siblings every year.

No they don't, unless you're going to quibble about what a bunch is. Numbers that seem to show lots of deaths to "kids" pretty much always include age ranges old enough to include gang members.

I’ll admit I didn’t look up those numbers but I read about these things way too regularly.

But that’s of course not the main thing about guns and kids in the US like everyone knows.

Statistically speaking, suicide is the #1 cause of gun death in the US, gang activity is #2.

School shootings are far down the list. They get a lot of attention but don't account for a large proportion of deaths.

Of course, that any of these deaths occur is tragic, which is why the most sensible solution is repeal of the Second Amendment and implementation of a nationwide, federal license requirement to purchase or own a firearm. 120-day grace period. License each gun, turn them in, or go to jail.

Let the gangs resort to cutting each other like Japanese gangs.

That doesn't require a repeal of the second amendment. That just requires a willingness to interpret the full text of the amendment, instead of focusing only on the last four words.

School shootings are far down the list as far as fatalities go. But that's a poor way to measure the impact of school shootings. The trauma inflicted by each of these events goes way beyond the number of children killed. Everyone who has heard actual gunshots in their own school building feels life-changing trauma.

When a kid in the US says "I'm scared to go to school," you can't tell them they have nothing to be scared of. You can tell them "It's not likely to happen at your school today." That's small comfort.

The full text of the amendment is pretty clear that "a well-regulated militia" depends upon "the right of the people to keep and bear arms", it does not limit that right. In order to train farmers and craftsmen into an effective reserve fighting force, they have to have weapons of their own they can practice with. Times have changed, obviously, and civil society no longer depends on citizen firearm ownership. You can put together a Supreme Court to overturn Heller and other decisions on this issue, but constitutional scholars are likely to consider it rickety jurisprudence.

Repealing the 2nd would be a full-throated declaration that wielding weaponry is a privilege, not a right.

We should probably repeal and replace the First Amendment while we're at it, and tie up some loose ends like Citizens United and the inability of U.S. governments to criminally punish hate speech.

Remember, the Constitution was crafted by men of their time, and they explicitly stated it was not a suicide pact and that future generations were fully allowed to amend it should they find the desire. We can probably find a compromise that greatly reduces gun violence, if only compromise could be made.

> We should probably repeal and replace the First Amendment while we're at it, and tie up some loose ends like Citizens United and the inability of U.S. governments to criminally punish hate speech.

I am not a gun nut, and have little interest in owning/shooting guns. I've done it, and found it boring. But my defense of the 2nd Amendment is based on the domino theory that if the 2nd can be ignored, there goes the First and every other "inconvenient" right enshrined in the Constitution. The First is the most important of all those Rights.

Thanks for illustrating I am right that the First would be put on the chopping block right after the Second.

There's still freedom of speech in countries with stricter gun laws. Also in my country prostitution and abortions are legal. So stricter gun laws don't always lead to other restrictions.

The difference is the 2nd Amendment is not a law, it's in the Constitution. The Constitution ain't worth nothing if it is not respected.

I don't care about gun rights. I do care about the Constitution, and I very much care about the First Amendment.

The Constitution is not set in stone - it can be amended. If the Constitution is amended in a legal way then how is it disrespectful?

So long as it’s respected until/unless amended, I’m entirely in agreement.

Yup - passing laws that straight up ignore the Constitution would set a really bad precedent.

That's what I'm getting at. If we take the Constitution seriously, but want to enact real gun law reform, amending the Constitution is the solution.

Repealing am amendment isn't ignoring it. It's the opposite.

You could clarify that you mean the rights stated in the amendments of course.

The while we're at it, let's get rid of the rest of the Bill of Rights, is terrifying.

There are countries freer than the USA where the government reserves the right to severely restrict speech and even criminalize some forms of political speech, if it serves the public interest. If you express Nazi views in Germany, for instance, you go to jail. Guess what -- Germany hasn't had to deal with a Nazi problem significant enough to turn into a real political movement in nearly 80 years. The USA, by contrast, had a near miss with Hitler 2 actually occupying the White House.

Sorry, but the first amendment, as currently formulated, really needs to go. It should be replaced with a formulation of freedom expression that better balances individual freedom with the public interest according to modern political standards.

In fact, given the problems with corruption in the American system and first-past-the-post voting leading to money-driven, rather than truly democratic, politics, the entire constitution probably needs to be rethought. No less of an American political thinker than Justice Ginsburg has opined that the US constitution is no longer, in the current era, a model for good governance. This should happen in a civilized fashion with a convention and ratification much like the current constitution replaced the Articles of Confederation, but it nonetheless needs to happen.

> There are countries freer than the USA where the government reserves the right to severely restrict speech and even criminalize some forms of political speech

No, there aren't.

> the first amendment, as currently formulated, really needs to go

That's the first thing the Nazis did, as well as Mussolini, and every other repressive government. Without free speech, the rest of your rights go down the drain.

If Ginsburg advocated getting rid of free speech, I'd like to see a cite from you about that.

When Ginsburg was interviewed on Al-Hayat TV in 2012 about where the new Egyptian government should look for inspiration, she cited the South African constitution, the Canadian Charter of Rights and Freedoms, and the European Council on Human Rights positively and said "I would not look to the U.S. Constitution" as a model for establishing a new state:

https://africasacountry.com/2012/02/ruthbaderginsburg/

On the matter of free speech, note that the South African and Canadian constitutions, and the ECHR, all protect freedom of expression exclude hate speech as protected speech. It is VERY much in line with modern statecraft to do so, and the doctrinaire approach of the First Amendment (only established in 1969, by the way, before which the USA implemented speech restrictions not dissimilar from those seen elsewhere) is the outlier here. Also note that getting rid of the First Amendment is not getting rid of freedom of expression.

Granted, her position was not even as radical as mine, which is that we must rethink the constitution from the ground up and implement a new form of government more resistant to corruption, again drawing from examples of more modern statecraft -- a multiparty parliamentary system, for instance. All she was saying was that new governments should look elsewhere for a template.

Ginsburg's views that the U.S. constitution is the supreme law of the land, and must be hewed closely to and not played fast and loose with for as long as it is active, were congruent with mine.

Since the second amendment doesn’t specify what arms I have the right to bear does that mean I should be allowed to wander down to my local gun store to pick up a surface to air missile so that I can shoot down an airliner? Of course not, that would be insane. So why not put similar limits on automatic weapons that can mow down an auditorium full of kids?

Automatic weapons that can mow down an auditorium are already illegal without a special license.

What's needed is a ban on semiauto rifles and pistols in civilian hands without a license. While we're doing that, may as well restrict all firearms.

> gang activity is #2

What is that based on? The only people I hear even talk much about 'gangs' is conservative propgandists trying to demonize black and brown people and cities. I'm not saying no gangs exist, but they aren't really an issue (unless you define 'gang' as any association of >1 person

> the most sensible solution is repeal of the Second Amendment and implementation of a nationwide, federal license requirement to purchase or own a firearm. 120-day grace period. License each gun, turn them in, or go to jail.

It's a politicized judiciary. For centuries, nobody interpreted the 2nd Amendment the way the conservative judges do now, but when the Federalist Society intentionally politicized the judiciary, this is what happened.

> I'm not saying no gangs exist, but they aren't really an issue

Sounds like you've never been poor in urban areas?

I've spent a lot of time in those areas. Have you?

For one thing, talking about them like they are all the same betrays that you haven't. They are as different as any other neighborhoods.

> I'm not saying no gangs exist, but they aren't really an issue (unless you define 'gang' as any association of >1 person

Not too far off. The federal definition is 3+. Gangs aren’t necessarily big.

This is delusional. I am a brown person, I grew up in these areas. Gangs exist. They are a scourge on the areas they blight. Please do not vote

Maybe where you lived, but not in so many other places.

NY tried that forced registration trick. Look up the compliance rates for it sometime.

You'll read about those but not suicides and that is a greater problem.

Numbers that seem to show lots of deaths to "kids" pretty much always include age ranges old enough to include gang members.

So what if they were? It's pretty damn sad for a person young enough to be considered a child to die from gun violence regardless of who they were! A sad societal failure on top of our failure to set them up with life circumstances that made them unlikely to fall in with a gang.

It matters because it’s ineffective to pursue the wrong root causes.

Agreed. We should implement policies that prevent guns from getting into the hands of children, regardless of whether they're gang members or not.

Sarcasm noted. Hopefully you understand a multi-pronged approach is needed.

I'm not being sarcastic.

A multi-pronged approach that involves reducing the amount of guns in American is a surefire way to reduce access to guns by children, both in gangs and out.

Sarcasm might’ve been the wrong word. I meant to say I see you reusing whatever words I write to disagree with them.

That'll be very very difficult. Even very restrictive weapon ownership countries like Netherlands and Sweden have a big violent gang problem. And a policy as strict as they have is just totally unthinkable in the political reality of the US.

So a policy stricter than the US can have isn't enough to solve this problem. That's why it's better to aim at reducing accidental underage gun deaths which is much more achievable.

It's so bizarre that America is the only country in the world that seems to face these kinds of problems.

As a Canadian who grew up in a household with a dozen firearms, I never once touched those firearms, and hardly ever saw them until I was taken to the range by my father and taught how to use them.

It wasn’t a problem for rural American kids to have access to guns in the 1950s. My dad routinely hunted small game before class.

America is the only first world country to border South and Central America, which is the region of the world with a homicide rate orders of magnitude above any other. It is no surprise violence spills over due to proximity.

I'm very interested in this border between South America and the US. most maps seem to be hiding it.

also, fun fact, when your government spends a hundred years assisting coups of democratic or socialist governments, those counties are going to have a lot of political instability.

> America is the only first world country to border South and Central America

The United States has one border with a central America country (Mexico). Please show on the map where it has a border with any south American country?

Are you seriously blaming the US's horrible society on all the latam countries they deliberately destabilized?

France have a border with South American countries, and is facing illegal incursion from Brazilian gangs in it's territory (and an army guy died for it last year if I remember correctly), still the gun violence in Guyana is pretty low (lower than Marseille). Not an excuse.

Sweden’s murder rate is less than a fifth of the murder rate in the United States.

It seems like their policies do go a big way to solve the problem, as infeasible as they appear to be for the USA.

You can't compare murder rates in the US with Sweden.

They have a real welfare system, diminishing social inequalities and with that the feeding ground for crime.

we can do both

Sounds like a great idea…

…but it’s also worth pointing out that murder rates are also a lot lower than the US in other developed countries that don’t have Scandinavian levels of welfare transfers.

The other developed countries still have much lower income differences between rich and poor than the US though. I think this is a bigger contributor to US crime levels than its gun policy.

Also, I don't understand the focus on murder rates. Compare all violent crime at least.

Don’t know about Sweden but the Netherlands does not have a “big violent gang problem”.

It has a problem with a few small and very violent gangs that occasionally gun down people in broad daylight, in the middle of the street, completely disregarding the safety of the people around them, which is bad but nothing like the gang problems in the US or Latin America.

> Cars are getting so big that people can’t drive them.

While controversial because car companies in the US intentionally chose to market large SUVs to the public, there is some evidence that smaller vehicles are safer and that auto manufacturers have doubled down on unsafe vehicles. Why this is the case, isn’t exactly known, but one of the theories is that bad drivers will get behind bigger cars and take more risks.

I’ve driven both large SUVs and smaller subcompacts, and I can talk at length on the pros and cons. However, as a driver, I can tell you that smaller cars are often bullied by larger cars, and this gives weight to the idea that people driving larger vehicles take larger risks, resulting in greater danger to the driver and to other cars and pedestrians.

There’s also the mistaken perception by older generations that smaller cars are inherently more dangerous; this was once true, and everyone can point to disastrously unsafe compact cars in the 1970s and 1980s. But due to modern technology and safety enhancements, this probably hasn’t been true for the last two decades or more. This older, erroneous belief continues to underlie why people choose larger vehicles today.

These Stupid Trucks are Literally Killing Us

https://www.youtube.com/watch?v=jN7mSXMruEo&t=1858s

Risk compensation

Smaller cars are more dangerous in a multi-car accident.

Most accidents only involve a single car.

There is less control in larger vehicles.

Everyone thinks they are a better driver than they are and the only way they'll end up in an accident is if someone else hits them.

Add all this up and many want to drive larger cars.

> Smaller cars are more dangerous in a multi-car accident.

Smaller cars bear more of the risk in a multi-car accident from the more dangerous larger cars. The smaller cars themselves are safer.

It's like saying t-shirts are less safe than guns because they won't stop bullets.

It's a negative spiral. More people get bigger cars now because well there are more bigger cars on the road now. That and the convenience of an SUV is unbeatable for people with families - like baby seats or ease of getting in and out and so on. When I bought my car almost a decade ago, it felt reasonably sized. Now it looks puny on the road.

True. But language is important. We don't have to help them victim blame.

No victim blaming. Smaller cars are more dangerous given an accident is already occurring between multiple cars.

Choosing a car to be in an accident, a bigger car is a solid choice. Of course, that skips over being in an accident at all. It also skips over any concern for others -- but so many people view that hypothetical accident as clearly the other person's fault, so may as well go with the big car.

> Smaller cars are more dangerous given an accident is already occurring between multiple cars.

Again, you're victim blaming here. The small car is not causing the danger. T-shirts are not more dangerous than guns just because someone firing a gun randomly into a crowd is less likely to get hurt than someone in the crowd wearing a t-shirt.

Still not victim blaming, go back and read the whole thing again.

Which car is safer if you're choosing a car to be in? big or small? The bigger is safer and the smaller is more dangerous (to be in), in a multi-car accident.

My whole post was on the rationalization of the choice of size of car. Language matters, as you say. It is about people not choosing the smaller car and not being the victim due to driving a smaller car.

Yes, the escalation of size causes problems in aggregate, but not the point of what I wrote.

The small car is safer to be in. The person with the small car is causing less danger.

You are participating in the victim blaming and the arms race by conflating the externalisation of risk with safety. And there is no need to aggregate to see the effect. It is present in every individual case.

The person in the big car is not being safer, they are being more dangerous and more selfish. Just because they perceive that their selfishness is exceeding the added danger (something not borne out by the stats) does not justify it. Acknowledging the framing of the auto industry is making the problem worse.

All being equal, no it’s not. However, SUVs get their “safety” by killing the drivers of smaller vehicles. Two SUVs colliding is more dangerous for both than, say, two Ford Fiestas colliding.

And that’s to say nothing of what happens when the person being hit is a pedestrian or cyclist.

Perceived convenience for people with families. Actual convenience is a joke because they’re horrifically impractical compared to an estate (station wagon in the USA).

Minivans are in many ways more practical than SUV for families just as many seats easier access back row of seat tons of leg room better millage. and while suvs perform better in head on collisions van are safer in most other as the suvs are more top heavy and likely to tip. Vans just have a stigma as the soccer mom vehicle despite all those soccer moms having moved to suvs to get away from it.

>Everyone thinks they are a better driver than they are and the only way they'll end up in an accident is if someone else hits them.

I hear this a lot and wonder how true it is because I personally think i am a horrible driver and can't wait until actually safe fully self driving cars take away my need to drive. on the other had a drive a small car and want a smaller one despite sharing the roads with behemoth raised 4x4 pickups that seem to be inexplicably popular.

Self driving cars are never coming in a form that would allow you to absolve yourself of responsibility for driving

"Never" is a long time.

Given the explanations I've been given for why demonstration videos of general purpose vision-based robots are still often sped up x4 or more (despite Tesla and Spot), I have to assume it's at least a few years away yet, but that's not never.

The human will always be responsible. There is no way the manufacturers are going to accept liability in case their self driving car has an accident.

I remember hearing something different. Seems like Mercedes is moving in that direction.

https://insideevs.com/news/575160/mercedes-accepts-legal-res...

Interesting. I’ll be happy to eat my hat in a couple of years, but I don’t think this will be generalised.

Even if so, they may be forced to do so for the right to market the vehicle as self driving.

I would favour this.

Even if legally you're not culpable, you're still responsible for choosing to use a death machine in an environment where it can cause harm to others.

Are you arguing against human drivers there, or against cars in general?

Against personal cars in cities

> I’ve driven both large SUVs and smaller subcompacts, and I can talk at length on the pros and cons.

One thing I find genuinely surprising is that the Renault Zoes we have as pool cars at work have got far bigger blind spots and far worse visibility than my 25-year-old Range Rover.

And, in turn, although that Range Rover is described as an SUV (it's not especially sporty, it's a top-heavy three tonne army truck with nicer seats), it's the same length and width as most "normal" family saloons. It's got a much smaller footprint on the road than some large 5-seaters like a Tesla Model S.

It's because of modern safety regulations. A, B and C pillars are all thicker, so are doors. Windows don't go as low to improve crash outcomes.

Yes!

My ‘60s Triumph 2000 had amazing visibility. If I’d rolled I’d have died for sure, but I’d have seen the thing that killed me.

I've noticed that certain types of large vehicles attract drivers (or create false confidence) in bad driving and aggressive driving habits.

It is appears that the driver of the large SUV or pickup believes they have right of way over smaller cars, pedestrians and cyclists.

A "get out of my way" attitude.

I love small cars, not to mention cycling and walking.

It concerns me that the shift of cars parked at the parking lot has dramatically changed over the past 20 years.

Walking from the car to the shop is like carpark gauntlet, you need to be increasingly ready to dodge giant vehicles reversing with disregard to their surroundings.

Surveys have found that people driving large SUVs and trucks like them for reasons including, it makes them feel powerful, and it makes them feel important. These were high on the list, even.

> car companies in the US intentionally chose to market large SUVs to the public,

This didn't happen in a vacuum. Poorly written fuel efficiency regulations incentivized automakers to do this.

My unscientific pet theory is that poorly built/zoned neighborhoods and cities, designed as if every human needs to drive a giant car at all times, are to blame more

Neighborhoods are built slower than cars are, and the increase in car size has outpaced construction. Sure we should fix our neighborhoods, but they're not the main reason behind increasing car sizes.

They weren't "poorly written" as much as "lawmakers accepted bribes to add exemptions for semis"

Bigger vehicles by volume are safer, as there is more space for crumple zones. Bigger vehicles by mass are more dangerous, as there is more momentum and kinetic energy involved in a collision.

I think bigger vehicles often have the disadvantage of having a more rigid chassis.

Bigger vehicles by volume are taller vehicles, they impact pedestrians closer to the vital organs in the upper torso and head. Pedestrians are also more likely to be swallowed / run over by cars with higher ride heights.

> Pedestrians are also more likely to be swallowed / run over by cars with higher ride heights.

It would be very interesting to see more studies on this. Where I am, the car of choice is a lifted truck that I don’t think has been accounted for with regards to pedestrian safety.

Americans spend a lot of time in their vehicles. Big vehicles are simply more comfortable and practical on a daily basis, at least outside of a few dense cities. If you're going to be stuck in traffic then might as well have some space to stretch out instead of being squeezed into a compact car. Safety is less of a concern for most buyers.

You can argue that this is irrational based on handling or fuel economy or whatever. But for better or worse buyers prefer size and comfort.

I’m around 195cm. There is plenty of space. I can fit very comfortably into most vehicles (passenger planes excluded). Outside of leg and elbow room, what can you even do with that extra space when stuck in a traffic jam?

You may leave less room for rear seat, adult passengers if you drive a compact car.

It's still manageable, and fine for occasional trips, but I wouldn't choose that car to drive 4 adults daily.

...I wouldn't choose that car to drive 4 adults daily.

Is this a typical thing that cars do? I'm not sure if I've seen 4 adults in a car in the last month.

Before the plague forced pervasive WFH, this was every Friday when a bunch of us would pick somewhere for lunch and all pile into the fewest cars needed.

A long time ago I worked in an office like that. I usually biked to commute, so when we had one more person going than cars going to lunch, I just biked to the restaurant as well. Otherwise, I rode in someone's car. Still, none of the drivers did this "daily". Neither this nor sibling comment describe a "daily" situation. If you need a big sedan once a month and big SUV twice a year, just rent at those times and drive something more practical the rest of the year.

Tall teenagers would also count. It's not something I'd notice, so I have no idea how common it is.

I do it occasionally for hiking trips and similar with friends. Someone doing this every weekend might want more comfort.

In Germany, the car tax includes the type of car and is adapted based on the accident rate for this type. Basically, you know ahead of time that you will pay more if you buy a car type that is often driven by reckless drivers.

> Cars are getting so big that people can’t drive them

and likewise, people are getting so big they can't drive their cars...

in Texas, police officers in some municipalities have requested that their vehicles be modified to elevate the steering wheel...they literally cannot jam their stomachs between the seat and the wheel, and if they push the seat back far enough they cannot reach the pedals

It's amazing that only legislation has been able to add trivially inexpensive backup cameras to cars.

I don't know why every car doesn't have around-the-car view cameras right now. New teslas have all the cameras, but don't show the view!

That goes double for trucks of all types - even though they are professionally driven.

I drive a Ford Focus, my neighbor drives a new F150. Our parking spots are next to each other, this is what is looks like:

https://www.carsized.com/en/cars/compare/ford-focus-2022-5-d...

I laugh every time I walk to my car because I don't want to cry.

I never understood why people feel like they need something the size of a Ford Transit just to potter to the shops and back.

Fine if that's what you happen to have lying around, but why would you choose something like that? It's totally impractical.

I imagine it is not always possible to distinguish between a car accident and a suicide.

> the uptick in driving fatalities [...] An entire generation has to be that much more reckless

Smartphones.

Which are omnipresent all over the world but I don't believe the uptick in traffic fatalities is (at least in Australia they were considerably lower in 2020-21 due to covid lockdowns. Mind you we also have very strict laws and stiff fines for mobile phone usage while in control of a vehicle, even if it's idling in traffic or, yes, in a drive-thru lane - technically it's illegal to use your phone to pay in that scenario, unless you switch the engine off first).

(Just checked, and while there was a slight increase in 2022, road fatalities are still very much trending downward in Aus. Fairly sure we have similar levels of mobile phone usage. We've also seen a surge in average car size, though the sort of massive pickup trucks that seem common in the US are thankfully relatively rare here, despite the popularity of "utes")

In the US cars likely kill more people through lack of exercise than through accidents. The UK has small compact towns and cities with street layouts designed in the horse and buggy days that force people to get out of their car and walk around the shops - there are very very few if any drive-thru businesses and only the big newer supermarkets have dedicated parking lots.

Something happened during the initial stages of the pandemic. People lost their absolute minds and aggressive and reckless driving got way, way worst than I've ever seen.

Hell, about an hour ago a cop tailgated me while I was going 15 over the limit, wove through traffic to cut me off, run a red light, then damn near ran another driver off the road. No lights, no emergency, just an asshole. This is the behavior you have to expect from all drivers now.

At least two or three times a week I have a close call that would wreck my car or seriously hurt someone, and I pretty much only drive up and down the one road between my house and the office, it's a 5 mile drive.

There's something very deeply wrong in American society, and I don't see things improving any time soon.

I thought people in the US drove like insane idiots long before the pandemic. Weaving in and out of lanes, excessive speeding, road rage over the slightest inconvenience and, the dumbest one to me because it is virtually effortless, failure to use turn signals. It's very easy to drive safely but a good chunk of divers seem to outright refuse.

Having said that, the data backs you up. 7% increase in per capita road fatalities in 2020. Then a 10.5% increase on top of that in 2021!

Driving like idiots compounded by lack of traffic enforcement as police budgets and staffing decline. I just moved away from a pretty decently sized city, and the police there didn't do any traffic enforcement at all. Not enough manpower to cover traffic and crime.

it's not that they don't have the resources, it's that police would rather racially profile people and only perform a traffic stop if they think they can illegally force a search to find or plant drugs.

No, police are very explicitly choosing to not enforce traffic laws.

> failure to use turn signals

Why signal your intentions to your opponent like a chump? They'll just use that information against you to block you from changing lanes, or to duck into a parking lot row ahead of you in a crowded parking lot and steal that empty spot. /s

I've found that drivers vary tremendously in the US. The best average drivers I've been around were in the California Bay Area. Oregon drivers are generally out of it (left lane freeway camping always started the moment I crossed from CA into OR), and only moderately angry. Arizona had wildly incompetent "snow birds" in the winter and insanely aggressive road raging locals in the summer. I've heard that Boston and New Jersey are like Mad Max with potholes.

>There's something very deeply wrong in American society, and I don't see things improving any time soon.

Any hypothesis as to what it is? I think it is a lack of community. We've become transactional and virtual/online communities are not sufficient.

In terms of driving I think it got a lot worse during the pandemic because with the lack of daily commuter traffic allowed people to drive faster and hence more recklessly.

The encouragement of hate, outrage, prejudice, and mis- and disinformation. It's pretty transparent - we see the expected outcomes.

this is how a high-trust society devolve into a low trust society. It's quite alarming, and it seems to me, that nothing is being done to reverse it.

By the time the "regular" people feel it (ala, the rich people), the problem may be irreversible.

What are you doing about it? Let's start now.

> By the time the "regular" people feel it (ala, the rich people), the problem may be irreversible.

I think they definitely feel it. You can see it here on HN. You can see it everyone resigning, in the vogue of despairing and not caring.

All day long, every day, the news media attempts to gin up more wars. They foster ignorance, fear, and hatred. Foreign leaders who haven't been in the news for years are made the primary focus overnight, just because that's where we're supposed to bomb next. Not all of us can even imagine why we should fight people in other hemispheres who've never done anything to us, so our fear and hatred lands closer to home. That's a big reason we have such tyrannical prison sentences.

If we didn't have a gigantic military that spends over a trillion dollars a year on the purchase of armaments, our armaments manufacturers would have less money to make our news media insane.

I've noticed the post pandemic crazy driving anecdotally as well and it's alarming. Lots more tailgating, lane changing where they almost clip you and driving really fast while passing on the right.

I think defensive driving is becoming more important as well and I worry far more about driving at night, as people get more erratic, than I used to.

I’ve noticed this trend as well around my neighborhood since the pandemic.

>Something happened during the initial stages of the pandemic. People lost their absolute minds and aggressive and reckless driving got way, way worst than I've ever seen.

That's easy enough. People who were socially minded stayed home; people with an individualistic attitude ignored recommendations. You hear similar stories from people working in customer service - the average quality of the person they had to deal with plummeted.

What's a bit peculiar is that, according to you, road culture has not recovered.

>Cars are an order of magnitude safer than they used to be and we were trending towards 0. An entire generation has to be that much more reckless than before to make that kind of a dent.

Jevons Paradox perhaps; you make the cars safer, so people feel more empowered to drive recklessly.

Re: car fatalities, one word: phones.

Phones exist everywhere. Why would Americans be more affected?

> Phones exist everywhere. Why would Americans be more affected?

Because with advent of SUVs you can't actually see most of the things that you normally would see through your car window. Because SUVs are bigger people believe they are safer, they are deathtraps on wheels for everyone involved. Also because they are bigger drivers believe they can bully everyone else on the street or just don't pay any attention to what is going outside.

Right so not the phones then

>"1 in 25 Americans being born will not make it to their 40th birthday." >(The cardio health one doesn't seem as strong).

Here's a bit of an anecdote, but I bet my family isn't alone in this type of story... my cousin died from cardiac arrest at age 45. Keeping the story here brief - he was a high-income business owner who got into a tough spot in his marriage and business, found himself without health insurance when he had a medical episode. Knew something was wrong and would likely bankrupt him - and we think that's why he didn't follow up with his doctor and was dead two weeks later. Congenital issue, could have been easily resolved - but without health insurance it was probably a death sentence either physically or financially.

Now, this was just as the ACA was coming into play - but I'd argue it's moot. The ACA was well-intentioned, but has not actually improved the insurance or care situation for the majority of Americans. I need a surgery at present that won't be covered by my insurance to any meaningful degree, and being in rural America my care options are limited. So I'll live with regular pain because the system doesn't work. And I hear stories like this in my social circles weekly.

That's really tragic to hear. In your case doesn't the ACA limit your out of pocket max?

Only for marketplace plans. For plans purchased through employers the sky is the limit.

> For plans purchased through employers the sky is the limit

Almost everyone with insurance has a maximum out of pocket limit now. It's possible to have a grandfathered employer health plan, but they'd have to have been running it since 2010 without substantial changes since then, including in benefits or cost increases. There are very few employer health insurance plans that would have met that criteria, and even fewer who tried to.

They also have to directly inform you that you're on a grandfathered plan, so it should not be a mystery to those who somehow are.

> Almost everyone with insurance has a maximum out of pocket limit now.

"maximum out of pocket" does not mean what any normal person would interpret it to mean. More than one year I have had to pay way more than the "maximum out of pocket".

The insurance company gets to decide unilaterally how much of what you pay out of pocket is credited toward their tally of what you supposedly paid out of pocket. In several years I've paid a lot more out of pocket than what the insurance statement credits me for having paid.

Why? Can you give me an example here, particularly as it relates to a medically necessary surgery or procedure? Or does it come down to difference in interpretation of what is medically necessary?

I don't have a specific example handy, it's been a few years.

How it works is that blue shield (with employers I've typically always had blue shield in California) sends a statement saying your doctor visit cost $XXXX, blue shield will pay $YYY and this will credit $ZZZ towards your annual out of pocket total.

But $XXXX - $YYY > $ZZZ, so what I actually had to pay to the doctor was more than blue shield credits me for having paid. So at the end of the year what I've actually had to pay has been well above the so-called "out of pocket maximum".

It doesn't happen most years (to me), but has happened on multiple years.

Based on the providers contract with Blue Shield, you should not be liable for anything beyond what they consider to be your out of pocket cost. If they requested more, you could have just refused to pay it, and get your insurance involved if they pushed back.

For covered care anyway.

Labs that don't have a clear medical justification are probably easy to end up paying for out of pocket without getting the amount counted against the out of pocket insurance limit.

Would expect that to be clearly delineated on the bills though.

JFYI, the ACA did have a large impact on the health insurance coverage through expanding medicaid. The percentage uninsured was halved from 18.4% to 9.1-9.8% (in states which expanded medicaid. In nonexpansion states, the uninsured percentage went from 22.7% to 17.1-19%).

I hear you about the health care situation though. Health insurance is definitely not the same thing as health care.

https://aspe.hhs.gov/sites/default/files/migrated_legacy_fil...

It doesn't even have to involve death.

My buddy separated his shoulder snowboarding when he was 22, but had no health insurance because he was working at the ski resort for something like $6/hr (US Ski Resorts are legally allowed to pay below minimum wage... go figure).

So he never went to the Doctor, because he couldn't afford it. He's 41 now, and that shoulder impacts almost every day of his life.

I never understand why you guys put up with this. The French are burning Paris to the ground because their retirement age got put up 2 years. But America puts up with the most outrageous hardship with barely a whimper.

> I never understand why you guys put up with this

Oh, I'm not American, and actually I was there as a 22 year old Australian and was horrified. The idea that people in a Developed country didn't have access to a doctor was shocking - I'd never seen that before, and simply didn't understand. I thought everyone could just go to the doctor when they needed to.

Drivers in the US just seem incredibly aggressive to me. I remember crossing some street in downtown Pittsburgh, and a car coming towards me. The guy was clearly seeing me, and accelerating instead of slowing down. I jumped forwards and survived.

I find American drivers are chill compared to Germans.

I haven't been nearly killed by a German driver yet, and on purpose, and German drivers had many more opportunities to do so than American ones. But yeah, my impressions are of course only anecdotal, but then again, 100% verified from my perspective.

Autobahn-driving can definitely be nerve-wracking if you're not used to it, being flashed to change lanes when you're already doing over 150 k/h is quite disconcerting to say the least! But there is at least a system to it, and on regular roads Germans seem to drive pretty sensibly.

American people seem aggressive in general, and I say that as one. I didn't realize how bad it was until I finally went on a vacation overseas. I don't know if it's something in the water or what.

Ive lived around the country and the driving culture varies significantly from region to region. East Coast cities are the worst, whereas I find Seattle, where I live now, very east going. Having moved from the east coast, it shocked me to see drivers just stop for pedestrians, even outside of marked off crosswalks. Try that in NY and you’re dead.

I saw the same thing in Europe, southern Italy was very chaotic roads compared to Northern Italy.

In Seattle all unmarked intersections are crosswalks & pedestrians waiting to cross have right of way.

Italians can't drive.

Every other nation in Europe manages to keep the car between the white lines, Italians can't even manage it when parking.

As a counterpoint I’m an Australian living in the Bay Area and drivers here are more considerate than back home. In law abiding Melbourne where I grew up, drivers will happy run you over if you’re jay walking because they supposedly have right of way.

I guess driving fatalities are up because of texting and driving.

> An entire generation has to be that much more reckless than before to make that kind of a dent

Or maybe they are driving more dangerous vehicles (e.g. bigger and heavier)?

It’s the phones. I have to drive my kids regularly 45 minutes to school on a highway with very high accident rates. It is people staring at their phones approaching dangerous parts of the road with lots of sudden stops and interchanges.

A sudden secondary effect - legal pot is leading to many more stoned drivers where I live (NJ).

Phones are not unique to US, though. They don't explain the gap.

> Cars are an order of magnitude safer than they used to be and we were trending towards 0.

This isn’t true for the US, cars are actually more dangerous due to the prevalence of SUVs that skirt safety regulations by being sold as light trucks.

Sure there will be lots of hypotheses for why this is the case. In my experience, though, you can almost ignore longevity and just look at these sociological differences that make the quality of life better for the English:

1. You could easily argue that frequenting a pub shortens your lifespan, but I just loved "pub culture" when I visited colleagues in England. It's a great antidote to loneliness.

2. You can argue all you want that the NHS has loads of problems, but even some rich people in the US, when faced with serious medical issues, their first thought is "will this bankrupt me" or "will I get hit with a giant unexpected medical bill"? Our healthcare system in the US is simply indefensible.

3. Cities and towns in England are just much more walkable, "congenial" in general, e.g. row houses instead of separate, fenced off suburban houses with yards in the US.

In the US rich people can get worse healthcare because doctors have incentive to provide unnecessary operations and medications due to

A) legal liability

B) marketing of treatments and medications to the public means patients demand them. Patients shop doctors until they find one that gives them what they want.

C) money incentive.

For example, US opioid epidemic stems from legal opioid prescriptions.

Here are the counterfactuals: https://twitter.com/jburnmurdoch/status/1641799922583326720/... drugs, traffic, diet, guns.

It seems pretty likely that the US healthcare decisions at the federal level are to blame. This data suggests it isn't the access to healthcare that is to blame as much as the governance of the entire system is forcing bad outcomes. The effect here is too widespread to be "pub culture".

I could see city planning being a contributor. But the effect is so extreme the place to start is deliberate policy. It would be hard for that to be the case without high-level standardisation on terrible ideas. The US does link healthcare and employment so that might be the root cause; it is a stupid link.

Nailed it. The tying of healthcare to one's job is its primary problem in the USA. This idiotic relationship arose because of incompetent legislation during WWII that was never fixed. The government applied wage caps, but failed to anticipate employers' substitution of "benefits" for wages. So companies sweetened the pot with health insurance to work around wage caps, and the government neglected to close that loophole. Huge and disastrous mistake.

Today, millions of Americans are deluded into thinking that their "employer-provided" insurance is free. Because the true cost is buried in pay-stub line items that nobody looks at (if it's even required to be there; I don't know), it's huge.

This "system" serves corporations, not people. Big companies get a workforce replete with people chained to dead-end jobs by their healthcare; insurance companies get fat, fat payouts; and small businesses and individuals get screwed.

My best friend runs a small business in the USA that actually makes things in a factory and employs people. Why the hell should be be an insurance broker as well? And if you're self-employed... Obamacare is the only thing saving your ass. And if your income isn't in the sweet spot, it's not really affordable either.

So we are really screwed hard. You'll never get Republicans to defy their corporate owners and lobbyists to reform this shitshow, nor will you get their base to comprehend that they're being ripped off and demand such reform.

Employer-funded insurance should be taxed out of existence and replaced by employer-provided CHILD CARE. Now that's something that keeps people out of the workforce and actually makes sense for an employer to provide.

That last paragraph... why should employers go from being a health insurance broker to a child care broker?

Because it requires physical facilities and it benefits from proximity to one's workplace. I don't necessarily think this is appropriate either, but it's the only tiny grain of hope for getting "conservatives" to go along with it. You have to make it an issue of, hey, if you're so desperate to pump out babies, you have to give people a way to do so and still work.

"...if you're so desperate to pump out babies, you have to give people a way to do so and still work."

Yeah, I don't think they feel that way.

I don't think they believe in "the sanctity of life," either. ¯\_(ツ)_/¯

> It seems pretty likely that the US healthcare decisions at the federal level are to blame. This data suggests it isn't the access to healthcare that is to blame as much as the governance of the entire system is forcing bad outcomes.

What is your basis for that? Does it vary by state - I'm pretty sure states that invest less in health get much worse outcomes. And how can people without health insurance somehow get sufficient healthcare?

I've been in communities where many people lack health insurance (and note the bubble HN is in, where those people are seldom here to speak for themselves - for most people, it's like I visited a foreign country). I remember one person, after a car accident with many broken bones, spending 13 hours in an ER, in extreme pain, waiting to be seen. One older parent described to me removing maggots they found on their diabetic adult child's legs.

> I could see city planning being a contributor

Based on what? A dislike of city planning?

Obviously the US does not provide healthcare to its citizens, unlike every other wealthy country. You don't need much creative, insightful thinking to find the problem here. Citizens want it, the Democrats want it, almost every other major political party in the developed world supports it afaik. Like climate change, gun control and safety, and more, only the GOP opposes it; that's the problem.

This is a fundamental misunderstanding of how the political structure of the US works. The individual States are responsible for regulating healthcare, the Federal government has little jurisdiction as a Constitutional matter.

There are many single-party States that nonetheless have broken healthcare systems. You can’t legitimately blame the intransigence of any political party in those States, they control their own outcomes. I live in a single-party State (Democrat) and the systemic incompetence and corruption in healthcare is evident without any Republicans in sight.

Americans have very little contact with Federal law. The legal environment they live in is set by the States, by design. If you don’t like the laws where you live, or the competency with which they are executed, that is on the State.

Why would healthcare policy affect the life expectancy of young adults but not comparably those in middle age or the elderly?

Yeah but the country's cursed with stormy weather and it's always cold.

Ad 2. - freelancers/contractors have the same problem as regular employees in the US, no? E.g. one gets long covid, can't work for 12 months, runs out of money, then loses any medical insurance due to inability to pay anyway?

I saw this other life-expectancy-related story a a while ago, and there are probably COVID-related reasons, but I’m surprised this hasn’t got more publicity:

> China's life expectancy is now higher than that of the US [1].

Here’s a slightly deeper dive into this story [2].

[1] https://qz.com/china-life-expectancy-exceeds-us-1849483265

[2] https://www.newsweek.com/china-us-life-expectancy-birth-2021...

Anyone in the US (or just anyone really) considering visiting Blackpool to see what is driving this equivalence from our end - don't.

Historically, it was a pleasant seaside resort town. The rise of cheap flights combined with a decades long neglect of northern England has meant that all of these Victorian era holiday destinations have fallen to ruin, with Blackpool falling the farthest.

Left alone, it would just have been a shabby, run-down place - but to make matters worse, the cheap guest houses and B&Bs became the ideal place for drug addicts to live, or homeless people to be shoved out of the way. Blackpool hangs off the bottom of the rest of the UK districts in terms of life expectancy because of the normal health downsides of poverty, combined with the extra problems associated with excessive levels of drug and alcohol abuse.

Actually, turning cheek and looking away is the opposite of what such parts of society need.

The issue is common to other seaside towns in the UK although the figures suggest that Blackpool has a larger concentration of the low cost accommodation you mention.

Christ Jesus, the USA are on average as good as Merthyr Tydfil, the epicenter of Welsh coal mining, which Maggie Thatcher destroyed. It's bad, but no one anticipated it to be that bad.

I'm not surprised at all. If you compare individual US states to other countries, some parts of the US south have worse healthcare systems than third-world nations. The US is by far the worst health country in the OECD.

At the same time US government spends the most in the world on socialized healthcare.

Of course they do. Just look at how that entire system is set up. It’s very clearly a for profit driven industry first and foremost and a healthcare system in a very distant second place.

The US government spends the most in the world on subsidizing corporations for healthcare. There is nothing "socialized" about it. The public in general gets very little of that benefit. And that holds true even if you include Medicare.

I meant only Medicare and Medicaid. The US government spends on Medicare and Medicare more then any other country on healthcare.

Don't forget the VA, but this stat always shocks people. I don't think people's brains can even hold on to it. It's important to use italics: The US government spends more on healthcare per capita than all socialized systems. The difference between life and death in the US isn't about paying lower taxes, it's purely rent-seeking; i.e. we pay once for healthcare, and we pay once again to the landlords of healthcare, directly out of our pockets.

That's really only because healthcare is so absolutely insanely more expensive here.

You'd have to normalize those numbers. It doesn't mean the same thing if the US spends a billion dollars on 1 million procedures when a more civilized society can do those same million procedures for 300 million.

Between Medicare, Medicaid, and the VA, there are more Americans with socialized healthcare than Britons in the NHS.

Also - Medicare is for the elderly, Medicaid for the poor and indigent, and the VA for current and former servicemen, neither of the three groups are good risks. You'd expect higher than average costs even in a well-run system.

There are also hundreds of thousands more Americans going bankrupt from healthcare costs.

If Medi-* actually worked properly that wouldn't be happening.

Per capita based on those eligible? Because if so, that's not surprising, given individuals from those groups are more likely to need expensive healthcare (esp. the elderly). Whereas for countries with universal healthcare, most recipients are not likely to need to expensive treatment. If it's per capita based on total population then I agree it's crazy.

I don't think it's really about healthcare. It's about everything else in life, that makes people obese or driven into a life of drugs (meth, etc.). Healthcare doesn't really save you from that.

If you choose to look at drugs from a healthcare perspective, you'll find countries that have had some success....

It's not so much about the quality of healthcare as it is the price.

You could have the best hospital for free — if you are sedentary, eat poorly, and engage in risky behavior, you will die sooner.

Its actually worse, imagine all that with no social safety net, no functioning medical system. Here our medical and educational systems are so destroyed that not even the wealthy have a good outcome, wealth just enables their kids to get into addiction earlier than poor kids.

Yeah, well, as long as I can sling code for 100K+ a year in this fine country, it’s not my problem what happens thousands of miles away over in Mississippi.

—HN

Live fast, die young. What's the issue?

Why don't they just e̶a̶t̶ ̶c̶a̶k̶e̶ learn to code?

Do you understand the irony of saying this when we're literally on a thread discussing and caring about the problem that is obviously more affecting the demographics that are non-HN'ers?

No. I don’t understand the love people have for molesting the word “irony”.

That was a meta-comment about what 99/100 threads about “why is Europe poor” or “why do schoolchildren have to practice mass shooting drills” are about (i.e. classic Europe/America culture war fodder); people talking about their precious FAANG jobs and how they couldn’t mine data for 200K annually in their native Moldova. Well, sure, people are dying of preventable disease but, y’know why are they making such bad choices? People should just apply themselves (like me) and learn to code.

Then of course people disagree with them. But the locus of the conversation is still about the upward mobility opportunities of tech nerds.

Then out of those thousands of comments there are “other side of the tracks” observations (I mean stats) about how those who didn’t apply themselves are doing.

You do realize some people on this message board live in Louisiana and Mississippi

Okay Mr. periodless.

Could have fooled me since we’re apparently just talking statistics, not relaying personal experiences.

Obesity. Americans are so obese that they don’t even recognise anymore that they are fat when they are fat. Every time US based tech people come to the UK or Europe for conferences it’s incredibly eye opening what they think is healthy and how they see themselves. Plenty of folks who think they eat and drink healthy and are in a good body condition and all I can see is a big wobbly man with barely any hair on their head drinking diet cokes like water. They think eating Mexican tacos is healthy and eating a big KFC is unhealthy. In comparison to here, we think eating home cooked food is healthy and eating a greasy cheesy Mexican taco is unhealthy fast food and a KFC is just plain disgusting.

I was with you until the hair on the head part. Do you know of any established link between balding and other factors? Is it more prevalent on either side of the pond?

Stress and poor diet increase hair loss, most visible in the recent increases in Asian baldness rates: https://www.cnn.com/style/article/asia-men-hair-loss-bald-sc...

It would be interesting to see a proper study of baldness by country and age over time as I'd imagine much can be put to genetics, but diet and sleep rates etc might increase the speed of hairloss, resulting in decreasing age of bald men, rather then an increasing rate.

Of course they don’t. They’re relaying first-person anectdotes. Why would specifically that be sourced with statistics?

I think you’re really overselling the UK here. 26% of adults are obese with child obesity rising. Every high street is also full of every fast food chain one can think of.

https://commonslibrary.parliament.uk/research-briefings/sn03...

The US is difficult to compare with other developed countries because it essentially has (1) affluent core regions and (2) poor peripheral regions. The US is essentially bimodal.

The core regions resemble the developed world, with similar levels of education, wealth, and political perspectives.

The peripheral regions are much worse off. Entire states, such as West Virginia, are peripheral. Think low wealth, low life expectancies, and entirely different politics from the rest of the developed world.

If you average values from both regions, you won’t really be characterizing either of them. The value will be too low for everyone in the core, and it will be too high for everyone in the periphery.

So when comparing the US to other countries, you’ll get a much more accurate picture by providing separate summary statistics for the core and periphery.

This is true, but it's more fractal than that. You go to the most affluent, in your words "core" region like San Francisco, and you still find it to be bimodal: high wealth, high education, clean and tidy on one side, and medieval conditions just two streets away. Also, I suspect general health levels are lower even in the affluent parts compared to the rest of the developed world due to wide-spread obesity.

I see why it’s more confortable to see it your way. But somehow it seems to prove the point of the OP: individualism. Even if one sees the US as two different countries cohabitating, this data forces to consider the US as a whole, and maybe it’s healthy as a country.

Oh I’m sure you could find a (1) high-income workers and higher (wink wink) and (2) the unwashed, hinterland masses comparison between countries if you wanted. But then one asks what kind of point you would be proving with that.

This seems unsurprising given the drastic differences in typical diet and exercise levels, and the availability of healthcare.

Eh, we Brits are no models of good diet and exercise. According to [1] while Americans have the highest obesity rates among major countries, Brits have the third-highest obesity rates.

[1] https://metro.co.uk/2018/03/21/british-people-fat-no-denying...

While that's true, the difference may still be enough to explain the 2-4 year difference in life expectancy that is shown on the chart.

American breakfast cereal is probably a good example of the problem. In the UK, don't you have to buy stuff like Cinnamon Toast Crunch from speciality outlets? I was under the impression much of what passes for breakfast in the US is considered confectionary across the way.

Cinnamon Toast Crunch is 30% sugar: https://www.cinnamontoastcrunch.com/products/cinnamon-toast-...

But something like Frosties, a popular cereal in the UK, is 37%: https://www.kelloggs.co.uk/en_GB/products/frosties.html

So although breakfast in general might be an example, that particular cereal doesn't seem too different.

I don't know if it makes much difference, but observe that the British cereal has a red mark for high sugar content on the box. It will be shelved near other cereals with green marks.

The American one has a similar label, except it's not coloured.

My parents bought Frosties as a very rare treat. My American cousins seemed to always have sugary cereals.

As a Danish person I was chocked by the amount of fat people I saw in the US.

I know the non-fat healthy Americans on HN and reddit don't like this being brought up and would rather blame "the system". But even the Danish healthcare system would collapse if we were as fat as you.

Particularly extreme obesity. America is the only country where I see people who can't fit through doors, or people who are so big my entire family could fit in their T-shirt and still have our heads sticking out.

By contrast in the European countries I've lived in, a fat person is just someone who looks pregnant when they're not. Pot belly, chubby arms, but doesn't really have problems walking.

We've had decades of systematic removal of protections and healthcare for people. There is zero political interest in improving things (and even when there is some, it's opposed brutally.)

Both parties are responsible for dismantling the infrastructure to care for the humans who live here in favor of profit seeking. Republicans perhaps only slightly more so, but this is the obvious "finding out" result of the "fuck around" period we've had since the 70s.

Interestingly, within the US people who live on islands like Hawaii and Puerto Rico seem to have longer life spans. This is true even taking race and gender into account.

The title here is kind of misleading (need to report @dang, I think?). The tweet talks about healthy life expectancy, which is different from life expectancy overall:

> the average American now has the same healthy life expectancy (years lived in good health) as someone in Blackpool, the town with England’s lowest life expectancy (by far)

For comparison, healthy life expectancy in the UK [1] in 2020: 62.8 years.

Some of these charts don't make sense.

[1] https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

The numbers, and explanations, are both fascinating and despairing.

But, as an outsider (AU) looking in, they're not at all surprising.

Getting most of my information about the USA from what might be called (there) as left-leaning (but elsewhere as centrist) -- or witty aphorisms like 'Russia's about to find out why we don't have health care' (wrt weapons shipment to Ukraine), or the despairingly persistently applicable '"No Way to Prevent This", Says Only Nation Where This Regularly Happens' satirical headline -- this all seemed to be a generally well-acknowledged consequence of the society there?

To informed USA citizens, are these figures genuinely unexpected?

Or alternatively, is it the figures for the rest of the world that are the unexpected revelation here?

off the top of my head/out of my ass:

i don’t go to the doctor

i don’t work out

i eat poorly (the american diet is poison but addictive/hard to avoid)

i don’t go outside (too busy inside working/addicted to a dollar)

then add mass shootings

then add drunk driving/texting and driving

cancer

etc

As an affluent tech industry Australian living in the US (Bay Area) I’d say there’s very little practical difference in my standard of living here compared to back home. It’s more the poorer parts of society here where the figures quoted in the article apply and that feels just as removed from my life here as it does to you sitting in Australia. The US is a big place.

This is what pains me the most about the US. Out of sight and out of mind but these poorer parts of society represent xx millions of fellow humans. If you could have similar standard of living in Australia where the poorer parts of society perhaps have more accessible healthcare and better social safety nets, then why the hell can't we do that in the US!? (I know the answers to that question, but it just makes me sad and angry).

Tweetspam, without even a link to the original thread: https://twitter.com/jburnmurdoch/status/1641799627128143873?...

I wish there could be a real discussion about this, not just the usual baseball stat geek comparers deflecting. Because in the end, this shows a failure of democracy. If everyone is worser off, is that society still a democracy, even if it has all the rituals and proudly proclaims itself so. And the answer is no. The dead do not care about virtual curves flying high about there miserable corpses. And those still living, have every right to rage against such a system and destroy it.

UK gov is working to bring us down to the US level.

Really not surprised TBH.

Last week, I traveled to L.A. for the first time in ~ 15 years and I was very shocked to see how much everything there has degraded.

This is of course anecdotal evidence and very likely biased by my faulty memory, but still ...

The combo of the number of homeless people under West LA freeway overpasses, the quasi-perpetual gridlock even on surface roads, the dereliction of infrastructures (roads, buildings, even private single family houses in middle-class neighborhoods), the number of boarded shops in downtown Santa-Monica, and worst of all, I felt that the local where noticeably "grimmer" than I remembered them ... all of it was fairly shocking.

Really not the sweet SoCal I remembered from the nineties and aughties, and old friends I met with who stuck around confirmed that my feeling was not wrong - in spite of the boiled-frog effect of living there throughout, they felt exactly the same.

The Financial Times column from where it comes from:

https://enterprise-sharing.ft.com/error-pages/expired-link?c...

Thanks, but the link has "expired".

Better link: https://www.ft.com/content/653bbb26-8a22-4db3-b43d-c34a0b774...

here's a twitter thread with a lot more diagrams. https://twitter.com/jburnmurdoch/status/1641799627128143873

It would be quite interesting to see with the x-axis unnormalised and; at the moment the equivalent American percentiles are probably materially richer than their UK counterparts, so the effect is larger than shown in real terms.

Oops, that was the next tweet: https://twitter.com/jburnmurdoch/status/1641799667942866944?...

The solution to this is known by everyone, including those who will fain ignorance. Implement universal healthcare (including mental health), regulate guns (insurance, registration, training, buybacks, red flag laws) including banning weapons of war, build public transportation and transition away from car-mandatory living in all but the most rural areas, and push for democratically-controlled unions and worker co-ops. The second tier would be around children, namely we should reinstate the child tax credit, make university free, and provide childcare. We need to have a conversation around maternal mortality as well, because that is too darn high in the US (one theory is that we are too doctor-controlled and they will be more likely to induce or perform a c-section).

This may seem like a grabbag of policies, but it's because (as it is mentioned in the Twitter thread), there are a grabbag of failures: lack of healthcare, forced dependency on cars, and deaths of despair, which are very closely tied to our crushing work culture (especially for blue collar folks). The neoliberal capitalism alienates people from their labor and their fellow worker, and makes widely available drugs, alcohol, and ultra-processed foods to numb the pain after a long shift. We've created a machine that's very good at crushing people up to turn them into money for people who will never be able to spend what they have already (cf. the Sacklers and the opioid epidemic or Bezos and workers urinating in bottles).

America has so much potential. I still have great hope we can come together. Right now, it's like the Onion wrote: "'No Way to Prevent This', Says Only Nation Where This Regularly Happens". We have to stop pretending we don't know the solution. The jig is up. I feel like we're in the movie Fury. Everyone knows Germany is doomed, but more people have to die because of Hitler's ego and the cowardice of everyone around him. We've let the psychopaths run things for too long. We have to take our power back.

I happen to generally agree with you on the policies, but comments like this make it much more difficult. It’s intellectually shameful to assert up front that anyone who disagrees with your prescription for society must be just pretending. And then to go on to rant about “psychopaths” and “doom” and “taking our power back”. You contribute nothing here.

Sorry, this was overly harsh, I was grouchy (I shouldn't post pre-coffee), too late to edit/delete now.

I chose my words carefully (though clearly not my spelling):

- CEOs/wealthy folks are more likely to be psychopaths vs. the average population (https://www.cnbc.com/2019/04/08/the-science-behind-why-so-ma...) - Power disables empathy (https://www.psychologytoday.com/us/blog/social-empathy/20190...) - Normal Americans have basically zero power - all decisions are made by the elites/special interest groups (https://scholar.princeton.edu/sites/default/files/mgilens/fi...)

Add in a personal attack, and the common right-wing trope of "I wanted to agree with you but you said it wrong so now I must punish you," and, baby, you got a conservative stew going.

nitpick: it is "feign ignorance" or "fain be ignorant", not a mix of the two

Alternatively said, "fain" is a mostly archaic way of saying "gladly". Whereas "feign" is more common and means "to give a false impression". More details: https://www.grammarphobia.com/blog/2013/10/fain-feign.html

America is a much larger country with a much larger difference in outcome between different people.

A person in South Carolina will have a different life from someone in say Santa Barbara, California.

The US life expectancy has taken a nose dive in the last couple of years which other countries have not experienced.

> America is a much larger country with a much larger difference in outcome between different people.

Chart us against the entire OECD, then. The results are stark.

https://ourworldindata.org/us-life-expectancy-low

All I'm saying is pooling the entire United States into a single data point is fairly useless. We need to know which demographics are the ones bringing down the average the most in order to make moves that will improve this metric the most.

It’s not useless because we are comparing countries. By breaking up a country you are basically changing the question to get a more favorable answer.

Everybody gets that richer states get better LE.

But you're governed by one federal government, so this point isn't so relevant.

If America had a government and voting populace that actually cared about each other and weren't afraid to have universal free healthcare, we wouldn't see the problems that exist within the data?

America is a pretty fake place.

Shall we disallow comparisons between the USA and individual European countries as well since they're governed by the EU?

West Virginia's problems are West Virginia's problems and have no effect on anyone living a perfectly wonderful life in California.

California’s taxes pay for West Virginia problems.

https://apnews.com/article/north-america-business-local-taxe...

No doubt there's a real underlying problem here. The abuse of comparison doesn't help anything though. I'd guess (but it's a guess) that average american life expectancy is going down because of some demographics who have it really bad (opioid users eg). That's an acute problem that has no meaning when averaged with everything else. Quoting averages makes it seem like there's some sort of broad malaise as opposed to specific issues for specific groups.

I think the Oxycontin/Purdue scam is pretty typical of how corruptions that were once targeted by the government to intentionally victimize minorities in ways not large enough to wash away other gains in overall life expectancy have spread to a difficulty in limiting industries victimizing larger more diverse groups in ways that undermine the stats the US was protecting.

Also, we have really expensive healthcare, so preventative medicine and recovery type treatment is not done nearly as much as other countries I suspect. You'd think something would change after the massive cracks in the system revealed to everybody by COVID, but it didn't.

If you have read the article you know it talks about how comparisons across income percentiles yield reductions in US life expectancy across every income level. It's not an isolated issue.

Obesity play a role in this. I wish the study can consider the body weight too.

Sure. But is that a cause or an effect?

Pretty sure dying early doesn't make you fat.

Americans are fatter because their food is toxic and their car centric lifestyle is sedentary and unhealthy

I think they meant is it the cause of dying early or an effect of whatever is killing Americans.

That part is easy. But did being fat lead to health problems (that then also kill you), or did health problems lead to being fat (which then also kills you)?

And that is before we get into the entire bit where the data shows that most of the difference comes from lives lost at mid age (betwqeen ages 5 and 40), which is younger than the range where "being fat" typically catches up to you.

I would suggest that poor diet and a sedentary lifestyle lead to both people being fat and to health issues. FWIW, it's been a common pattern for friends of mine who visit the US for even short periods of say 2 weeks to put on small but noticable amounts of weight.

> visit the US for even short periods of say 2 weeks to put on small but noticable amounts of weight

As a European who lives in USA and visits back frequently: can confirm.

In Europe I fight to keep weight on, in USA I fight to keep weight off. Despite counting calories, working out like a maniac[1], and predominantly eating clean. Pre-packaged highly processed foods are like a 1x/month thing, takeout happens max 2x/week, and eating out once or twice per week.

And yet, USA wants to make me fat while EU feels like I can barely eat enough to maintain weight.

[1] my usual week is 7 workouts split between cardio and hiit. Right now I'm in marathon training so going to hit 107km of running this week.

it did https://twitter.com/jburnmurdoch/status/1641799922583326720 it's not nearly the only thing.

and as the npr article from a couple days ago and this point out https://twitter.com/jburnmurdoch/status/1641799742228144130 https://twitter.com/jburnmurdoch/status/1641799722418556931

the gap is there at all ages.

I had to click through to find what the worst part of England was, and ended up on an FT article about Blackpool and the causes of and reasons behind its decline. Very sad but very interesting.

Overall an excellent and correct thread. However I do have to take issue with his choice to equate comparing diverse and non-diverse areas to "adjusting for race". That is not what that is.

What corrective actions can be taken by the average American?

Eat less, mostly fresh and home-cooked, avoid sugary drinks, exercise more, avoid toxic materials, drugs, excessive stress, sleep well, don't smoke, have a good circle of friends and family, stay safe :)

Average life expectancy for a man in the US is still higher than a man in Scotland. Doesn't that make all the claims in this series of tweets imply the opposite of what they were trying to prove? Why doesn't the gun ban and the NHS and all that help people in Scotland if it would do so much good here in the US?

Lying with statistics is very easy, there is a book about it: https://amazon.com/How-Lie-Statistics-Darrell-Huff/dp/039331...

> Average life expectancy for a man in the US is still higher than a man in Scotland

A quick check says this is not true, with the US being at 74 and Scotland at 76. I don't know which sources are correct though, but maybe you can post yours since I didn't find that anywhere.

that's okay, the english are working on it!

Blackpool catching strays on this one

This is incredibly drastic data.

Is it? The difference is in 2-4 year range for most of the chart. Is 2-4 years of life expectancy drastic? I didn't read it as such, but I'm not really sure how to assess how big that difference is, honestly...

2-4y of life expectancy is typically an even greater discrepancy is morbidity. So if you die 3y earlier and are 'morbid'/ have life affecting illness for another 2y - you've basically halved the average enjoyable period of retirement for most people. I'd say that's quite drastic.

The average American has one testicle and one boob. What if u take out the 15% black population? The health care for the black community is just horrendous.

If you had read the about halfway into the article, you'd have read that the author has controlled for race, and that black people in the US had an improvement in health outcomes. One group that was hit hard? Working class white people.

each dot represents metro area representing 100k.

I wonder how this would look if you separate the data by race and average weight?

The article breaks it down; disparity is consistent across age, race, gender, income…

Curious how you isolate for race between two separate continents ?

Both USA and UK have a sizeable subpopulations of people of European, African and Asian descent, large enough to have reasonably reliable statistics on them.

I kinda expect it's just not possible for two main reasons:

- the concept of "race" ("ethnicity" would be a better word?) will vary depending on culture, and the intial split of populations + 2 centuries should be enough to bring significant divergences. When you say "asians" I'd fully expect the composition of that group to be a lot different on each sides of the pond.

- I don't expect the UK to have widely available etchnically separated data. They do check the repartition on census, but would they refer to that on death stats ? I could be wrong but that seems complicated on many aspects.

Article? I only see one chart? It doesn't mention anything about race and weight.

https://threadreaderapp.com/thread/1641799627128143873.html

^ Thread and link to article.

If you break it down by weight this becomes uninteresting. Weight is a health outcome. "People who are less healthy die sooner" no kidding.

It is not an accident. It is a plan.

blackpool is the jersey shore of england?

Is Jersey Shore full of bright orange people in cheap "fast fashion" clothing trying to pretend they're on roughly ten times as much money as they really make, who make a big show of ordering "expensive" vodka and flash their platinum credit card around as they chop their 30 quid bag of coke?

Then having thoroughly spoiled the weekend for everyone else, they'll pile into their idiotic loud car that they can't really afford the payments on, and fuck off back to their idiotic trashy house that they can't really afford the payments on?

Then yes, it is.

That was disturbingly on point.

Nice :)

why, yes

The british version of the tv show is geordie shore set in Newcastle, but the culture in most northern british coastal towns is the same. Essex however, is probably the most accurate comparison considering it has the pretty much the same culture but its close proximity to London mirrors Jersey’s proximity to New York.

Race/age correction please...

You want USA to look worse? If so, by all means, emphasize our racial disparities.

What's worse is that the article breaks it down by race, gender, income etc etc.

Clearly HN user Yeknoda never bothered to read it.

Spoiler Alert:

The disparity persists across all races, ages, and incomes.

Comparing the whole of the United States to England isn't as informative as one would think, given the wide variety of racial and cultural groups in the United States.

Comparing health outcomes of white Americans of Anglo descent to health outcomes in England would be much more informative. Even more informative would be data that look at white people (and other groups such as Chinese, Indians, etc.) in the US on a county-by-county basis.

The truth is that there are certain groups in the United States whose outcomes are much worse on many statistical bases, and those groups skew the data dramatically downwards. Black people in the US, for example, commit a majority of murders every year [1], despite being only about 13% of the population - almost 4x what the rate would be, if they committed murder at the same rate as white people.

Other disparities are present as well, which mean that there are many communities in the United States where you will live a life just as long and healthy, or even longer and healthier, than in European countries. For example, this article [2] shows a county-by-county breakdown, and many counties in America where life expectancy is over 80.

[1] https://www.wsj.com/articles/jason-riley-the-other-ferguson-... [2] https://www.deseret.com/utah/2020/3/13/21177268/utah-citizen...

You might enjoy this post by Matthew Yglesias which explores some of why this might be happening: https://www.slowboring.com/p/tackling-americas-weirdly-short...

Edit: Absolutely love the downvote for this

As fucked up as death is, I wonder if a lower life expectancy isn't the worst thing in the world.

To some extent in the West, but especially in Asia, we're really starting to see the demographic issues that come with people living for too long.

Aging populations, plummeting birthrates, redirection of public resources away from children and families...

Maybe we shouldn't be trying as hard as we are to drag on life into the late 80s and beyond.

You haven’t understood the article.

The decline in life expectancy in the US is not being driven by more rapid decline in the aging population but by young people dying earlier exerting influence over the entire curve.

I can assure you that the burden of age related conditions will continue to grow but that again is because the largest generation humans have ever produced is aging out. And on the most part they’re more functional and able later into their senescence than ever before thanks to hip replacements and laser eye surgery and all the rest.

I don't think you understand the comment.

If the life expectancy drops, there are fewer elderly to care for.

If people don't make it to 70, you don't have to care for 70+ year Olds. It is a fair thought experiment to explore.

Depending on what your priorities are, it could be optimal for everyone to die before retirement age.

its not like people are just healthy and then when they hit 70, poof!

obese people will have health issues from early adulthood onward

healthcare isn't the answer - the doctor says "lose weight", and people ignore it or make excuses and are even more obese at their next checkup

Sure, but the problem is that there is not enough of a young population to support the older population. So if the life expectancy drops because younger people are dying more, that just makes the inbalance even worse, with the population being even more top heavy.

As a thought experiment, if you killed everyone when they turned 70,that wouldn't worsen the imbalance, it would help it. It is more of a question of the type of death, and the onset of disease.

There are broad classes of life extending Healthcare that you could remove with minimal impact on worker productivity, but still reduce life expectancy. Simpler yet, you could just deny oncology or cardiovascular treatment for anyone over 65. Life expectancy would plummet with no impact on workers.

I'm not saying I agree with this approach, but rather saying that someone who points this out is not misunderstanding the topic.

Furthermore, like it or not, this type of cost benefit analysis is baked into the treatment analysis of every country on the planet with socialized medicine.

If you're going to be utilitarian - if people don't get to 70 they're losing years/decades of productive life.

Those who die young don't contribute much.

Which is also a fair thought experiment to explore.

And that's not getting into equally fair thoughts about morality and humanity.

Sure, but that is basically the question the OP was raising.

>I wonder if a lower life expectancy isn't the worst thing in the world....Maybe we shouldn't be trying as hard as we are to drag on life into the late 80s and beyond.

I think it is a reasonable and interesting question. If we could extend life to 200, but with the quality and cost of someone in their 80's, would that be socially desirable? Personally desirable?

What if you have to work 10X harder or more hours between 20 and 65 to support an elderly population 10X larger.

>Depending on priorities, it could be optimal

what possible priorities... sounds like the humanity extincting AGI has already gotten free /s

If civilization needs to adopt such measures it must be in deep crisis.

Ignoring the sarcasm, hey there's a fascinating question. It asked what our society's priorities are.

These aren't new questions or unique. Any country on the planet could extend lifespan if it wanted to spend more money. The question is who pays or what services do you cut. Would you cut schools to extend lifespan 5 years? Maybe everyone lives in tiny little boxes but people live to 90.

An American Healthcare System there is low hanging fruit where you could improve outcomes for a low cost. That said, how far do you take it?

No, yeah. Suppose I am arguing for a light touch. Assuming one were at the levers of power (of the state apparatus, of the corporation, etc). That humility is lacking, for even the very wise cannot see all ends. It is a conservative point of view, what's the rush anyway. The next generation may have better data.

I actually think there is something to this. The oldest people tend to be holding tons in wealth and assets, making things like houses unaffordable. People working longer before retirement means that job openings and promotions are repressed for younger people. All of these things mean younger people don’t hit the societal milestones at the times they’re meant to hit them which causes anxiety, depression, hopelessness. These things increase the likelihood of drug use, criminality and suicide.

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