Saturday, November 10, 2007

Where would you rather be sick?

The Carpe Diem blog has an interesting table, reproduced above, that corrects life expectancy data for differences in the rates of premature death from non-health-related injury, such as homicide and car accidents. The resulting number reflects health-related mortality. Notice that the United States has the longest standardized life expectancy.
I have not studied the details behind the construction of these numbers, but they are asking a sensible question. If our goal is to evaluate health systems, we should correct for international differences in outcomes that arise from other causes.
Homicide and accidents are only the beginning of the story, however. For example, I would also correct for differences in obesity, which are largely a function of lifestyle and can have significant health effects. Here, from OECD data presented in the O'Neil study, are the percentages of the male population with a body-mass index of 30 or more (female obesity rates are similar):
Japan 2.8
France 9.8
Germany 14.4
Canada 17.0
U.K. 22.7
U.S. 31.1
Given how overweight we Americans are compared with citizens of other countries, it is amazing that we live as long as we do. If we further standardized life expectancy by body-mass index, the U.S. lead in health outcomes would likely grow even larger.