In the case of the US it is somewhat unhelpful to look at the "United States" as a unit of measurement. There is ~10 year life expectancy difference between individual States and most of the risk factors mentioned are a function of State policy, not Federal. It also maps to large differences in population genetics across regions e.g. the famous observation that "the only person that lives longer than a Japanese woman is a Japanese woman in America" is doing a lot of work in Hawaii. There is a well-known inverse correlation between obesity and elevation which is doing work in the Mountain West.
While the lifestyle of many Americans leaves a lot to be desired, I do recognize that many parts of the US have weather/climate that is prohibitive for outdoor activity much of the year and these places tend to be fat. If you look at the life expectancies in parts of the US that are known for having human friendly weather and outdoor activity, they tend to be among the highest in the country with low obesity rates to match, but this is confounded by geography and genetics.
It is complicated. The causes are sufficiently diverse and regional that the solutions need to be local.
cherryteastain · 3h ago
If we're cherrypicking like that I'm sure you can find some Japanese prefecture or Swiss canton that has 10 years+ higher life expectancy than Hawaii's 79.9 years, the US state with the longest life expectancy.
jandrewrogers · 3h ago
Almost every US State is larger than Switzerland -- the entire country -- never mind a single canton. If you want to get that granular some State counties have life expectancies in the mid-90s.
alephnerd · 3h ago
I think a subnational analysis of Switzerland is a good metric for analyzing subnational development in similarly sized states like MA, Kansas, Minnesota, and Mississippi.
At a macro-level or even for larger states of the US like California or Texas, not really.
You absolutely should do the same spatial inequality analysis in Japan and Italy as well (in fact, this is the norm in Italy's policymaking space due to the documented north-south divide). Heck, this is called out in the Nature article as well if you read TFA.
The US (330m), Japan (120m), and Italy (60m) are all large countries, and in the US and Italy's case, extremely federalized with social service delivery responsibilities falling onto subnational governments.
And for large developed countries like the US, UK, France, Germany, Italy, Japan, etc their developmental indicators have largely converged at a macro-level (the difference in living standards between countries with a national HDI of 0.900, 0.920, and 0.940 are marginal), but spatial inequality continues to act as a persistent laggard.
Outliers matter. This is like statistics/EDA 101.
P.S. If you do EDA on Japan versus US from an HDI perspective, you find that the Southern Kanto region (ie. Greater Tokyo) tends to skew Japanese statistics - with a subnational HDI comparable to MA - but the rest of the subnational regions of Japan have HDIs comparable to Tennessee (0.890-0.900) or Florida (0.920-0.930).
What this highlights is that public service delivery is stronger in the Greater Tokyo region than the rest of Japan.
And this is unsurprisingly a major topic of discussion in Japanese policymaking as well, as the poorer regions have seen a massive youth flight to Tokyo.
Same with the less developed regions of the US as well.
When you do a similar spatial analysis of the US, you find the Deep South (MS, AL, AR, LA), Appalachia (WV, TN, KY), and MO continuing to lag. You also end up identifying rust belt states like MI and OH starting to lag.
The interest thing is, the Deep South and Appalachia didn't seem to lag in the early 1990s compared to the rest of the states, but remained stuck at 1990s levels while other states improved significantly in the 2000s and 2010s, and it was these states that regressed the most in the COVID years (2020-2022) [0]. My running theory is that these states were the kinds of states where low value single factory/industry towns (eg. Textiles) were most prominent, and were the worst hit by a mixture of NAFTA, China Shock, and the Great Recession.
This would also explain why GA, NC, and SC didn't see the same laggardness despite being comparable with the rest of the south in the 1990s - Atlanta, Charlotte, RTP, Greenville, and Columbia were industrialized enough in high value industries like automotive and power systems and had significant additional industries like Finance and Tech that allowed them to upskill and diversify.
> I do recognize that many parts of the US have weather/climate that is prohibitive for outdoor activity much of the year and these places tend to be fat.
Your comment doesn't make any sense. The South has terrible climate, suffocating heat and humidity much of the year. It is at the same latitude as North Africa. Why would anyone expect people to be outdoors in this environment? There is a reason they rely on air conditioning.
The populated parts of Alaska have mild climates similar to the Pacific Northwest, certainly more pleasant than the Midwest and not nearly as cold in winter. The high desert (e.g. Utah, Colorado) similarly has a pleasant low-humidity climate most of the year that is conducive to outdoor activity.
lapcat · 3h ago
> The South has terrible climate, suffocating heat and humidity much of the year.
I just have to laugh at this. Have you lived in the Midwest? We have suffocating heat and humidity too, in fact the past several days. In the winter, we have biting cold windchills. And guess what, we also rely on air conditioning!
Two other factors worth noting: exercise does not depend on the outdoors. There are gyms, etc. Moreover, obesity does not depend entirely on lack of exercise; diet is a major factor too. Indeed, many would argue that diet is the more important factor.
nostrademons · 1h ago
I'd interpreted GP's comment "parts of the US have weather/climate that is prohibitive for outdoor activity" as specifically referring to the South, much of which is extremely unpleasant and borderline uninhabitable without air conditioning.
I don't know much about the Midwest but I grew up in Massachusetts (one of those northern states with good health & life expectancy but a reputation for bad weather) and my sister lived in Houston for a decade (which has mediocre life expectancy and bad weather). In Massachusetts, the winters were cold and snowy, the summers are hot and humid, and you had about 3 weeks of good weather in the spring and 2 weeks in the fall, but you sucked it up and went outside anyway. The snow wasn't going to shovel itself. In Texas, you stay inside in your nice air conditioned home all the time, unless you're getting into your nice air conditioned car to drive to a nice air conditioned indoor place. Nobody goes outside.
I'm in California now, in a town that is both hilly and walkable, and a lot of the residents here live to 95. When you're climbing the equivalent of 200 stairs each time you drop your kid off at school, you get a lot of background exercise without really trying.
I'm fairly convinced that exercise or the lack thereof and relatedly the rate at which people go outside is a major predictor of health outcomes.
lapcat · 42m ago
> I'd interpreted GP's comment "parts of the US have weather/climate that is prohibitive for outdoor activity" as specifically referring to the South
To each their own, I guess, but I immediately thought of Midwest winters.
> borderline uninhabitable without air conditioning
The south was inhabited long before air conditioning was invented.
> In Massachusetts, the winters were cold and snowy, the summers are hot and humid, and you had about 3 weeks of good weather in the spring and 2 weeks in the fall
Minnesota is like that too, except the winters are colder and the summers hotter.
> you sucked it up and went outside anyway
Indeed, it's a choice. People exercise in all types of weather, hot and humid or cold and bitter.
> unless you're getting into your nice air conditioned car to drive to a nice air conditioned indoor place
Like the gym, for example?
> Nobody goes outside.
That's false, but in any case it's a choice.
> I'm fairly convinced that exercise or the lack thereof... is a major predictor of health outcomes.
Of course it is. But you completely ignored my statements about diet.
> and relatedly the rate at which people go outside
This is a different matter. Speaking personally, I almost always exercise indoors nowadays.
Arubis · 4h ago
Not to worry, we'll fix this on our end by ensuring that we no longer keep accurate track of anything science or health-adjacent. A few years out comparisons like this will be impossible and meaningless.
jimt1234 · 4h ago
Except for autism. ... Don't they wanna start tracking all autism treatments in the US for [reasons]? ¯\\_(ツ)_/¯
Arubis · 2h ago
I don't think the powers that be care if those numbers are accurate, so long as they can use them for control and intimidation.
jimt1234 · 3h ago
> One of the biggest drivers of those deadly conditions is obesity
That jumped out at me, because, unfortunately, it seems it's become unpopular, or even offensive, to claim there's a link between obesity and poor health/lower life expectancy. I've heard of doctors refusing to recommend weight loss to their patients for fear of being accused of "body shaming".
keiferski · 3h ago
Does this actually happen in real life, or only in online outrage anecdotes?
My guess is that doctors typically understand that the patient already knows they’re obese, and therefore tries to get them to do something, anything, that’ll help.
bananalychee · 2h ago
Alcoholics know that they drink, chain smokers know that they smoke... Obesity has an impact on longevity that is on the same order of magnitude as cigarette smoking. I would hope that it would come up during a checkup. If it doesn't, rationalize it however you want, but it's clearly because the doc decided it wasn't worth the risk of saying it out loud. In other countries it's not uncommon to be blunt about it with friends and family, let alone at the doctor's office, but in the US it's considered extremely rude. As a result, I know many people who have a skewed definition of obesity. To them a BMI of 30 is a tad overweight and obese starts maybe at 40. They're prescribed pills and CPAP machines and no one ever tells them they need to lose weight as long as their blood work looks decent. It's easy to neglect a health issue that no one wants to talk about.
reverendsteveii · 3h ago
IME the opposite is true. I myself and several friends have had doctors that refuse to treat something until a weight issue is addressed. In my case the treatment was for obstructive sleep apnea and losing weight as part of combined therapy w my CPAP has helped a lot. In at least one friend's case she had severe, constant belly pain and multiple doctors gave her the old "have you tried losing weight about it". It wasn't until one actually engaged with her symptoms that they found out she had an active infection in her abdomen and also several tumors on her ovaries. So, you know, a mixed bag. Sometimes they tell you to lose weight because being heavy directly correlates with the symptoms you're expressing, sometimes they tell you to lose weight because losing weight is vaguely correlated with positive health impacts overall and they've got 10 minutes per patient to make a diagnosis and develop a course of treatment.
That being said, I'm gonna file "doctors are afraid to tell patients they're obese because they'll be accused of body shaming" next to "they're putting litter boxes in the classrooms so the furries can poop in front of everyone" and "strangers are putting LSD in halloween candy to get kids hooked". It's 100% made up rage bait and the people who believe it believe it because they hear it all the time from their propaganda echo chambers.
veggieroll · 3h ago
This happened to me. I switched doctors.
keiferski · 3h ago
What happened to you? The doctor refused to diagnose you as obese, someone else, or…? Your comment is unclear.
veggieroll · 3h ago
I went to my doctor as someone overweight bordering on obese and asked for help. I told him my plan for losing weight. But, he told me I didn't need to lose weight, because being overweight isn't bad for your health. Eventually I lost 70 lbs and found a new doctor.
keiferski · 2h ago
Interesting, but good that you did switch doctors and had success!
veggieroll · 3h ago
Yes! Can confirm: I went to the doctor when I was very overweight (on the verge of obese BMI-wise) and he pulled this line. He was a nice guy. But, I couldn't get out of there fast enough. Why go to a doctor that won't even acknowledge one of the most important things you can do for your health?
reverendsteveii · 3h ago
What line? Your doctor told you that you were overweight but that he wouldn't recommend you do anything about it?
veggieroll · 3h ago
I went to my doctor as someone overweight bordering on obese and asked for help. I told him my plan for losing weight. But, he told me I didn't need to lose weight, because being overweight isn't bad for your health. Eventually I lost 70 lbs and found a new doctor.
reverendsteveii · 2h ago
Wow, that completely flies in the face of the experience I and everyone I know has with doctors all the time. IME it's much more likely that your weight will be blamed for any and all conditions that develop because losing weight is strongly correlated with improvements across the board in overweight and obese people and (and I think this is the key to why it's the first line of defense for so many disparate things) insurance companies all but mandate that "lifestyle changes" be tried as treatment before they will cover any other treatment option.
Riddle me this: were you trying to lose weight as a course of treatment for some other thing that was happening or were you trying to lose weight for its own sake? I'm wondering if the doctor actually thinks that being overweight is fine or if they were just saying you don't have any particular condition that being overweight would treat or relieve. I don't mean to call you out in particular, it's just that your experience is directly opposite to anything I've experienced or been told about as someone who was overweight and went to doctors about it and as someone whose entirely family has always been in healthcare in some way or another (a couple doctors, several nurses, I'm in med tech alongside a couple cousins and my dad runs a power plant but even he runs a power plant owned by a hospital system).
tptacek · 3h ago
The important bit of this article is the graph labeled "Varied Causes". Factor COVID-19 out, and everything but social causes (overdoses, traffic fatalities, homicide) is practically a rounding error. The one significant distinctive contributor is CVD, and CVD is extremely unevenly distributed in the United States; the northern states have CVD death rates akin to those of Europe, the southern states less so.
nostrademons · 3h ago
It's quite an achievement of modern medicine that the vast majority of early deaths in the U.S. now amount to various forms of "killing oneself", or occasionally "killing other people near you". Accidental, unpreventable acts of nature (or God, depending on your persuasion) have basically dropped out of the statistics.
I wonder how much of this is because of America's embrace of liberty. If you give people choices, some of them will inevitably make stupid choices.
tptacek · 2h ago
In particular, this points away from our health care system as a significant life expectancy causal factor. The biggest health-related contributor to life expectancy, by a long ways --- really, the only "big" one --- is CVD. But CVD deaths in Mississippi look nothing like CVD deaths in Connecticut, despite the same health care structure in both locales; Connecticut's CVD deaths look like Europe's, despite drastically different systems.
jandrewrogers · 3h ago
We probably shouldn't be including COVID at all in 2025 since it isn't relevant. That is like using all cause mortality models from 1944.
throw0101c · 3h ago
Pre-vaccines, COVID death rates were roughtly the same for Democrats and Republicans. Post-vaccine, Republican rates were higher than Ds:
Gun violence is responsible for nearly 2% of annual deaths in the US, I imagine that might skew the statistics slightly.
But yes, US poverty is much worse than poverty in other countries. But the flip side is also true - it's generally better being rich in America than in Canada, for example.
bestouff · 3h ago
Not even that, even rich people have better life expectancy elsewhere.
rwyinuse · 3h ago
I would bet that unhealthy eating habits and car-centric city design affect rich people as well. Use of sugar and fatty processed foods appears to be out of control in America compared to your average EU country.
marcusverus · 3h ago
US poverty is vastly overstated. The most common measures of poverty are based on census data, but the census excludes the vast majority of redistributions from its calculation of income. It even excludes cash programs like "refundable tax credits".
We spend $1.3 trillion dollars per year on medicaid, HUD, Food Stamps, and refundable "tax credits" like the earned income credit and child tax credit. That's $32,500 of spending for each of the 40 million Americans who live "in poverty" (before including state-run programs and private charities like churches and food banks), meaning our welfare spending per "poor indvidual is higher than the median income for an EU household.
America's poor are doing just fine.
bobxmax · 2h ago
Comparing spend is an odd way to look at poverty - why wouldn't you look at outcomes?
I'm not sure how many pockets of, say, the Netherlands, look like Gary, Indiana.
JPLeRouzic · 3h ago
> "US poverty is much worse than poverty in other countries"
You must be restricting your thinking to other Western countries, because there are a lot of areas on Earth that look like hell. At least no part of the US is in a constant state of war.
bobxmax · 2h ago
The post you're commenting on is comparing the US to other developed countries.
JPLeRouzic · 2h ago
Please, show me where it compares the US to other --developed-- countries.
bobxmax · 2h ago
The title: "The United States has lower life expectancy than most similarly wealthy nations"
msarrel · 4h ago
That's only if you include the entire population.
pieds · 4h ago
> Comparison data also showed that at every wealth level in the U.S., mortality rates were higher than those in the parts of Europe the researchers studied. The nation’s wealthiest Americans have shorter lifespans on average than the wealthiest Europeans; in some cases, the wealthiest Americans have survival rates on par with the poorest Europeans in western parts of Europe such as Germany, France and the Netherlands.
> Just as in other countries, chronic conditions like heart disease are major factors in how many years Americans remain alive but in poor health. But, the authors add, a high burden of mental health and behavioral conditions — which the WHO groups together, and include depression, anxiety and addictions to alcohol and drugs — are also weighing heavily on our health span, as well as curtailing life expectancy in the U.S.
> Underpinning both chronic diseases and what are sometimes called deaths or diseases of “despair,” such as addiction, is the prevalence of loneliness, stress and inequality in the U.S., Gurven says. “It’s hard to avoid that living in a highly unequal society is stressful and that takes a toll on our health in so many ways,” he says. That inequality affects not only access to health care, but can also be seen in how little opportunity there is for Americans in many parts of the country to get physical activity or healthy meals in their busy days, helping to fuel the obesity epidemic, which, in turn, curtails health span.
It seemed to me that you were attributing the lower life expectancy due to US' diversity compared to many wealthy nations. My point was: Canada is similarly diverse and yet its life expectancy is higher.
jimt1234 · 4h ago
I'm really not sure what this means. Yeah, the U.S. is a multicultural society, but so what? Are we supposed to focus only on the certain cultures and ignore others when we talk about health and life expectancy?
I think I've heard this argument before in the context of gun violence in the US - as in, the US wouldn't have a gun violence problem if we excluded cities like Chicago and Baltimore from gun violence research. Is this the same basic argument?
msgodel · 4h ago
It makes a lot of sense actually, a lot of this stuff comes down to what the smaller groups are doing. It's for the same reason no one cares about global gun violence statistics.
Talking about behavior patterns of US people like they're all part of a single nation stopped making sense long ago if it ever did.
Muromec · 3h ago
It"s a racist dog whistle, not an actual argument
marcusverus · 3h ago
Say Canadian Whites and American Whites both have mean lifespan of 81, and Canadian Blacks and American Blacks both have a mean lifespan of 71. Using that data and the fact that the US has 3X the proportion of blacks, you could calculate how much of Canada's higher life expectancy is due to demographics. It could explain the entire difference!
Alternatively, if Canadian Whites and Blacks live proportionally longer than American Whites and Blacks respectively, you would know that demographics could not explain the difference.
Hence the need for the disaggregated data.
nonameiguess · 3h ago
It matters in discussion forums like this involving ordinary people. There are two reasons we might care about statistics and trends like this.
One, you're a public health official or maybe even just a voter trying to weigh various policy options or assess the success of what has already been done. In this case, sure, you have to care about national averages and other measures of central tendency and ways to characterize distributions.
Two, you're an individual American trying to figure out how much you should worry about an early death. In this case, national averages or even per-culture averages seemingly mean next to nothing for you. I can't speak for all Americans, but I expect to outlive the average by quite a bit.
For gun violence, it's often travelers and visitors worried they're going to get shot if they come to the US, and we're trying to tell them that whether they really need to worry heavily depends on where they're visiting. Even if they're actually visiting Chicago or Baltimore, gunshot deaths in tourist districts are damn near unheard of, and besides which, the vast majority of people ever killed by guns at all are either killed by themselves or someone who knows them. There aren't a whole lot of random stranger attacks happening anywhere.
amelius · 4h ago
> To gauge US health, life expectancy — the average number of years a person is expected to live — is a good place to start.
Ok, but it is a lagging indicator. Hopefully there are faster ways to measure it.
scottLobster · 4h ago
The "Regional Differences" section is behind a paywall, but for an overview, here's a map of all-cause mortality in the US by county:
> The biggest difference in death rates has been in people aged 15–49 (see ‘Early deaths’). Among these younger people, the death rate has been falling much more slowly in the United States than in peer countries — and it spiked drastically owing to COVID-19. “More people die younger,” says Lynne Cotter, a senior health-policy researcher at KFF. And because young deaths erase more years of life than do older ones, they drag down overall life expectancy.
> Overall, chronic conditions — heart disease, cancer, stroke and respiratory disease — take up four out of five spots on the country’s list of biggest killers.
> As of 2022, about 42% of adults were considered obese in the United States, compared with 27% in the United Kingdom and 5.5% in Japan. Obesity increases the risks of developing diabetes, heart disease, cancer and many other conditions.
> Research supports Kennedy’s argument that ultra-processed foods might be partly to blame for poor health. Their consumption has been linked to increased risks of obesity and some other chronic diseases, and is relatively high in the United States. Such foods comprise an estimated 58% of US daily energy intake — similar to that in the United Kingdom, but greater than the 48% in Canada and 31% in France3.
> Deaths from substance misuse are explained mainly by overdoses of synthetic opioids such as fentanyl — part of the US opioid crisis. Many Americans are killed in traffic accidents, partly because they tend to spend proportionately more time driving, and in bigger cars, than people in many other nations.
It looks like obesity promotes chronic disease and the younger demographic is dragging the life expectancy down.
A higher concentration occurs in the south eastern quadrant of the US. This as I recall coincides with obesity rates.
What can I do personally? I guess eat less processed food, cook more at home, walk more, or engage in fun phisically active time. Even cleaning the house, yard care, home gardening, simple hikes, or walking while shopping can help. Chosing stairs over elevators, that kind of thing.
What can the government do to help? Maybe regulating sugar additives and plastic use in food containers? Limiting the use of seed oils in convenience foods, in favor of healthier options? Build back a strong middle class would go a long way towards preventing the other causes too. Drugs and gun deaths are linked to poverty. The closer the middle class is pushed to the poverty line the more those things increase. I suppose there's some merit to preventing the illegal import (smuggling?) of drugs like fentanyl, which in that case requires a harder stance on import from China. I dunno guys. I'm throwing darts at a wall here...
AstroBen · 3h ago
What can the government do? Some more ideas: I don't agree with regulating it but taxing sugar, heavy sweeteners, and fast food and invest it into a universal healthcare system. Invest in improving walk-ability and bike-ability in cities and stop subsidizing the meat and dairy industries
If you want to eat junk then fine but there's something going wrong if it's the cheapest, most convenient option available
Muromec · 3h ago
Those causes are all doctrine- motivated. Too much cars and not enoygh socialism is the thing kills you and doesnt kill Europeans that much.
slaw · 3h ago
> The United States has higher mortality than comparable rich countries in most age groups, the the biggest gap is those in their late teens or early adulthood.
> Five times more people died as a result of substance misuse in the United States in 2021 than the comparable country average.
US culture actively promotes alcohol use. Go to a college party and all their games revolve around drinking
mandevil · 3h ago
In 2019 per-capita alcohol consumption, the US came in 35th, behind most countries in Europe (1). Latvia, Czechia, Lithuania and Austria all consumed about 25% more pure alcohol per capita than the US did, by this measure. Latvia and Lithuania, in common with most fUSSR countries, have a lower life expectancy than the US, but Czechia and Austria both have higher life expectancy than the US, despite that notably higher per-capita consumption of pure alcohol. So I don't think that has much to do with it.
Probably less so than in most European countries. I'd suggest that more likely causes for this are:
- Poor diet
- Low levels of exercise due to car dependence
- Difficulty accessing healthcare
- General lack of safety net for the poor
BadCookie · 3h ago
I’m not sure if “difficulty accessing healthcare” captures the whole problem. Even if you live next door to a hospital, you still don’t know how much it will cost you if you check yourself in. Sure, there is some theoretical maximum out of pocket, but are you certain that the hospital is in network with your insurance? Are you sure that every provider you will see and every test or scan you have done will be treated as in network?
I once had a doctor order a test at a hospital that he assured me was in network. The hospital got pre-authorization from my insurance company for me to have the test done. I had the test done. My insurance company then denied me any benefit because they said afterward that I went out of network … and there are millions of stories like mine.
Not to mention that even if you manage to stay in network, lots of people cannot afford even the max out of pocket that creeps up faster than inflation every year.
I have had some family members decide that they will just accept that they are going to die in an emergency situation because “if it’s my time, it’s my time” and they don’t want their life savings to get vacuumed up by some hospital administrators. This is not merely theoretical… one person in my life is dead now who probably would have lived if he had felt comfortable seeking medical care.
soperj · 3h ago
You're saying the same thing.
BadCookie · 3h ago
“Difficulty accessing healthcare” brings to mind doctors and hospitals being too far away—a real concern for lots of rural Americans, especially the ones who cannot drive. Or perhaps doctors are nearby, but wait times are too long. This is also a real issue. I have seen wait times for primary care doctors creep up to 4+ months in my area.
So I just wanted to highlight that even if those problems don’t exist, you still have the scary unknown cost question that might be the largest impediment of all.
nicoburns · 2h ago
The thing I find most scary about the American health care system is people not going to the doctor (/hospital) (/calling an ambulance) because they're concerned about the cost. Often even if they have insurance. And I definitely think if you can't afford something then that counts as having difficulty accessing it.
tacticalturtle · 3h ago
We’re waaay down the list of per capita consumption, especially compared to Europe.
And anecdotally, any corporate event I’ve attended in the US is dry or 1 drink. Which is a pretty stark difference from when I’ve visited European colleagues.
mandevil · 3h ago
I recall reading that Gordon Ramsay's first NYC restaurant (Gordon Ramsay at The London) didn't meet its financial projections because, used to London social mores, he expected far more alcohol consumption at lunch and dinner (but especially lunch) than actually happened, and without the huge mark-ups from alcohol the food couldn't pay for itself.
snovymgodym · 2h ago
The social drinking and binge drinking culture of most European countries make the USA look like Saudi Arabia.
While the lifestyle of many Americans leaves a lot to be desired, I do recognize that many parts of the US have weather/climate that is prohibitive for outdoor activity much of the year and these places tend to be fat. If you look at the life expectancies in parts of the US that are known for having human friendly weather and outdoor activity, they tend to be among the highest in the country with low obesity rates to match, but this is confounded by geography and genetics.
It is complicated. The causes are sufficiently diverse and regional that the solutions need to be local.
At a macro-level or even for larger states of the US like California or Texas, not really.
The US (330m), Japan (120m), and Italy (60m) are all large countries, and in the US and Italy's case, extremely federalized with social service delivery responsibilities falling onto subnational governments.
And for large developed countries like the US, UK, France, Germany, Italy, Japan, etc their developmental indicators have largely converged at a macro-level (the difference in living standards between countries with a national HDI of 0.900, 0.920, and 0.940 are marginal), but spatial inequality continues to act as a persistent laggard.
Outliers matter. This is like statistics/EDA 101.
P.S. If you do EDA on Japan versus US from an HDI perspective, you find that the Southern Kanto region (ie. Greater Tokyo) tends to skew Japanese statistics - with a subnational HDI comparable to MA - but the rest of the subnational regions of Japan have HDIs comparable to Tennessee (0.890-0.900) or Florida (0.920-0.930).
What this highlights is that public service delivery is stronger in the Greater Tokyo region than the rest of Japan.
And this is unsurprisingly a major topic of discussion in Japanese policymaking as well, as the poorer regions have seen a massive youth flight to Tokyo.
Same with the less developed regions of the US as well.
When you do a similar spatial analysis of the US, you find the Deep South (MS, AL, AR, LA), Appalachia (WV, TN, KY), and MO continuing to lag. You also end up identifying rust belt states like MI and OH starting to lag.
The interest thing is, the Deep South and Appalachia didn't seem to lag in the early 1990s compared to the rest of the states, but remained stuck at 1990s levels while other states improved significantly in the 2000s and 2010s, and it was these states that regressed the most in the COVID years (2020-2022) [0]. My running theory is that these states were the kinds of states where low value single factory/industry towns (eg. Textiles) were most prominent, and were the worst hit by a mixture of NAFTA, China Shock, and the Great Recession.
This would also explain why GA, NC, and SC didn't see the same laggardness despite being comparable with the rest of the south in the 1990s - Atlanta, Charlotte, RTP, Greenville, and Columbia were industrialized enough in high value industries like automotive and power systems and had significant additional industries like Finance and Tech that allowed them to upskill and diversify.
[0] - https://globaldatalab.org/shdi/table/healthindex/USA/?levels...
This is completely untrue. In fact, most of the fattest states are in the south. A number of the fittest states are in the north, including Alaska, as well as Minnesota. https://www.forbes.com/sites/garystoller/2019/11/12/9-states...
The populated parts of Alaska have mild climates similar to the Pacific Northwest, certainly more pleasant than the Midwest and not nearly as cold in winter. The high desert (e.g. Utah, Colorado) similarly has a pleasant low-humidity climate most of the year that is conducive to outdoor activity.
I just have to laugh at this. Have you lived in the Midwest? We have suffocating heat and humidity too, in fact the past several days. In the winter, we have biting cold windchills. And guess what, we also rely on air conditioning!
Two other factors worth noting: exercise does not depend on the outdoors. There are gyms, etc. Moreover, obesity does not depend entirely on lack of exercise; diet is a major factor too. Indeed, many would argue that diet is the more important factor.
I don't know much about the Midwest but I grew up in Massachusetts (one of those northern states with good health & life expectancy but a reputation for bad weather) and my sister lived in Houston for a decade (which has mediocre life expectancy and bad weather). In Massachusetts, the winters were cold and snowy, the summers are hot and humid, and you had about 3 weeks of good weather in the spring and 2 weeks in the fall, but you sucked it up and went outside anyway. The snow wasn't going to shovel itself. In Texas, you stay inside in your nice air conditioned home all the time, unless you're getting into your nice air conditioned car to drive to a nice air conditioned indoor place. Nobody goes outside.
I'm in California now, in a town that is both hilly and walkable, and a lot of the residents here live to 95. When you're climbing the equivalent of 200 stairs each time you drop your kid off at school, you get a lot of background exercise without really trying.
I'm fairly convinced that exercise or the lack thereof and relatedly the rate at which people go outside is a major predictor of health outcomes.
To each their own, I guess, but I immediately thought of Midwest winters.
> borderline uninhabitable without air conditioning
The south was inhabited long before air conditioning was invented.
> In Massachusetts, the winters were cold and snowy, the summers are hot and humid, and you had about 3 weeks of good weather in the spring and 2 weeks in the fall
Minnesota is like that too, except the winters are colder and the summers hotter.
> you sucked it up and went outside anyway
Indeed, it's a choice. People exercise in all types of weather, hot and humid or cold and bitter.
> unless you're getting into your nice air conditioned car to drive to a nice air conditioned indoor place
Like the gym, for example?
> Nobody goes outside.
That's false, but in any case it's a choice.
> I'm fairly convinced that exercise or the lack thereof... is a major predictor of health outcomes.
Of course it is. But you completely ignored my statements about diet.
> and relatedly the rate at which people go outside
This is a different matter. Speaking personally, I almost always exercise indoors nowadays.
That jumped out at me, because, unfortunately, it seems it's become unpopular, or even offensive, to claim there's a link between obesity and poor health/lower life expectancy. I've heard of doctors refusing to recommend weight loss to their patients for fear of being accused of "body shaming".
My guess is that doctors typically understand that the patient already knows they’re obese, and therefore tries to get them to do something, anything, that’ll help.
That being said, I'm gonna file "doctors are afraid to tell patients they're obese because they'll be accused of body shaming" next to "they're putting litter boxes in the classrooms so the furries can poop in front of everyone" and "strangers are putting LSD in halloween candy to get kids hooked". It's 100% made up rage bait and the people who believe it believe it because they hear it all the time from their propaganda echo chambers.
Riddle me this: were you trying to lose weight as a course of treatment for some other thing that was happening or were you trying to lose weight for its own sake? I'm wondering if the doctor actually thinks that being overweight is fine or if they were just saying you don't have any particular condition that being overweight would treat or relieve. I don't mean to call you out in particular, it's just that your experience is directly opposite to anything I've experienced or been told about as someone who was overweight and went to doctors about it and as someone whose entirely family has always been in healthcare in some way or another (a couple doctors, several nurses, I'm in med tech alongside a couple cousins and my dad runs a power plant but even he runs a power plant owned by a hospital system).
I wonder how much of this is because of America's embrace of liberty. If you give people choices, some of them will inevitably make stupid choices.
* https://jamanetwork.com/journals/jamainternalmedicine/fullar...
* https://www.sciencedirect.com/science/article/pii/S259022962...
But yes, US poverty is much worse than poverty in other countries. But the flip side is also true - it's generally better being rich in America than in Canada, for example.
We spend $1.3 trillion dollars per year on medicaid, HUD, Food Stamps, and refundable "tax credits" like the earned income credit and child tax credit. That's $32,500 of spending for each of the 40 million Americans who live "in poverty" (before including state-run programs and private charities like churches and food banks), meaning our welfare spending per "poor indvidual is higher than the median income for an EU household.
America's poor are doing just fine.
I'm not sure how many pockets of, say, the Netherlands, look like Gary, Indiana.
You must be restricting your thinking to other Western countries, because there are a lot of areas on Earth that look like hell. At least no part of the US is in a constant state of war.
https://www.brown.edu/news/2025-04-02/wealth-mortality-gap
The US also have less healthy years.
> Just as in other countries, chronic conditions like heart disease are major factors in how many years Americans remain alive but in poor health. But, the authors add, a high burden of mental health and behavioral conditions — which the WHO groups together, and include depression, anxiety and addictions to alcohol and drugs — are also weighing heavily on our health span, as well as curtailing life expectancy in the U.S.
> Underpinning both chronic diseases and what are sometimes called deaths or diseases of “despair,” such as addiction, is the prevalence of loneliness, stress and inequality in the U.S., Gurven says. “It’s hard to avoid that living in a highly unequal society is stressful and that takes a toll on our health in so many ways,” he says. That inequality affects not only access to health care, but can also be seen in how little opportunity there is for Americans in many parts of the country to get physical activity or healthy meals in their busy days, helping to fuel the obesity epidemic, which, in turn, curtails health span.
https://www.yahoo.com/lifestyle/the-us-has-the-biggest-lifes...
No, that's not a fact.
https://en.wikipedia.org/wiki/Demographics_of_the_United_Sta...
https://en.wikipedia.org/wiki/Demographics_of_Canada?#Visibl...
I think I've heard this argument before in the context of gun violence in the US - as in, the US wouldn't have a gun violence problem if we excluded cities like Chicago and Baltimore from gun violence research. Is this the same basic argument?
Talking about behavior patterns of US people like they're all part of a single nation stopped making sense long ago if it ever did.
Alternatively, if Canadian Whites and Blacks live proportionally longer than American Whites and Blacks respectively, you would know that demographics could not explain the difference.
Hence the need for the disaggregated data.
One, you're a public health official or maybe even just a voter trying to weigh various policy options or assess the success of what has already been done. In this case, sure, you have to care about national averages and other measures of central tendency and ways to characterize distributions.
Two, you're an individual American trying to figure out how much you should worry about an early death. In this case, national averages or even per-culture averages seemingly mean next to nothing for you. I can't speak for all Americans, but I expect to outlive the average by quite a bit.
For gun violence, it's often travelers and visitors worried they're going to get shot if they come to the US, and we're trying to tell them that whether they really need to worry heavily depends on where they're visiting. Even if they're actually visiting Chicago or Baltimore, gunshot deaths in tourist districts are damn near unheard of, and besides which, the vast majority of people ever killed by guns at all are either killed by themselves or someone who knows them. There aren't a whole lot of random stranger attacks happening anywhere.
Ok, but it is a lagging indicator. Hopefully there are faster ways to measure it.
https://hdpulse.nimhd.nih.gov/data-portal/mortality/map?cod=...
> The biggest difference in death rates has been in people aged 15–49 (see ‘Early deaths’). Among these younger people, the death rate has been falling much more slowly in the United States than in peer countries — and it spiked drastically owing to COVID-19. “More people die younger,” says Lynne Cotter, a senior health-policy researcher at KFF. And because young deaths erase more years of life than do older ones, they drag down overall life expectancy.
> Overall, chronic conditions — heart disease, cancer, stroke and respiratory disease — take up four out of five spots on the country’s list of biggest killers.
> As of 2022, about 42% of adults were considered obese in the United States, compared with 27% in the United Kingdom and 5.5% in Japan. Obesity increases the risks of developing diabetes, heart disease, cancer and many other conditions.
> Research supports Kennedy’s argument that ultra-processed foods might be partly to blame for poor health. Their consumption has been linked to increased risks of obesity and some other chronic diseases, and is relatively high in the United States. Such foods comprise an estimated 58% of US daily energy intake — similar to that in the United Kingdom, but greater than the 48% in Canada and 31% in France3.
> Deaths from substance misuse are explained mainly by overdoses of synthetic opioids such as fentanyl — part of the US opioid crisis. Many Americans are killed in traffic accidents, partly because they tend to spend proportionately more time driving, and in bigger cars, than people in many other nations.
It looks like obesity promotes chronic disease and the younger demographic is dragging the life expectancy down.
Where?
https://hdpulse.nimhd.nih.gov/data-portal/mortality/map?cod=...
A higher concentration occurs in the south eastern quadrant of the US. This as I recall coincides with obesity rates.
What can I do personally? I guess eat less processed food, cook more at home, walk more, or engage in fun phisically active time. Even cleaning the house, yard care, home gardening, simple hikes, or walking while shopping can help. Chosing stairs over elevators, that kind of thing.
What can the government do to help? Maybe regulating sugar additives and plastic use in food containers? Limiting the use of seed oils in convenience foods, in favor of healthier options? Build back a strong middle class would go a long way towards preventing the other causes too. Drugs and gun deaths are linked to poverty. The closer the middle class is pushed to the poverty line the more those things increase. I suppose there's some merit to preventing the illegal import (smuggling?) of drugs like fentanyl, which in that case requires a harder stance on import from China. I dunno guys. I'm throwing darts at a wall here...
If you want to eat junk then fine but there's something going wrong if it's the cheapest, most convenient option available
> Five times more people died as a result of substance misuse in the United States in 2021 than the comparable country average.
1: https://www.cia.gov/the-world-factbook/field/alcohol-consump...
- Poor diet
- Low levels of exercise due to car dependence
- Difficulty accessing healthcare
- General lack of safety net for the poor
I once had a doctor order a test at a hospital that he assured me was in network. The hospital got pre-authorization from my insurance company for me to have the test done. I had the test done. My insurance company then denied me any benefit because they said afterward that I went out of network … and there are millions of stories like mine.
Not to mention that even if you manage to stay in network, lots of people cannot afford even the max out of pocket that creeps up faster than inflation every year.
I have had some family members decide that they will just accept that they are going to die in an emergency situation because “if it’s my time, it’s my time” and they don’t want their life savings to get vacuumed up by some hospital administrators. This is not merely theoretical… one person in my life is dead now who probably would have lived if he had felt comfortable seeking medical care.
So I just wanted to highlight that even if those problems don’t exist, you still have the scary unknown cost question that might be the largest impediment of all.
https://en.m.wikipedia.org/wiki/List_of_countries_by_alcohol...
And anecdotally, any corporate event I’ve attended in the US is dry or 1 drink. Which is a pretty stark difference from when I’ve visited European colleagues.