Our Undue Focus on Long Life

Americans are living longer but not necessarily better.
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Earlier this week data published in the Journal of the American Medical Association indicated that the life expectancy of people in the United States has increased over the past two decades by three years, to 78.2. This means that the average American today enjoys an extra 1,100 days of life. However, the news is not all good. For example, the U.S. still lags behind most of the world's other rich nations on a number of health indices, including rates of heart disease, lung cancer, and diabetes. Moreover, during the same period, the U.S. ranking in healthy life expectancy fell from 14th to 26th. As one news outlet put it, "although we are living longer, we are not living better."

The statistics surrounding life expectancy are important, and in general it is highly desirable that we find ways to prevent needless deaths. No one wants to die before their time, particularly if we are paying this price for something so trivial as an extra daily nut fudge sundae. On the other hand, the idea of "living better" deserves serious examination. What do we mean when we say that someone is living well or living poorly?

Especially galling is the fact that much poorer countries, including Chile, Portugal, and Slovenia, are actually doing better in terms of their citizens' mortality rates.

It is tempting to compare metrics on waistlines, blood glucose levels, or relative risk of developing cancer, in part because we love the competitive spirit behind such rankings. We love to think, for example, that the U.S. leads the world in number of patent applications, justifying our claim to be the most innovative nation on earth (in fact, we're number 3). Likewise, we take great comfort in the notion that the U.S. has the highest per capita income in the world (actually, we're somewhere between number 5 and 10). Many of our national pastimes are competitive sports with clear winners and losers, and we carry our love of competition right through to the hospital and into the cemetery.

So telling us that our ranking in preventing premature deaths has fallen from 14th to 26th really gets under our skin. We want to be number one, or at least moving up in the rankings. Regardless any absolute increase in life expectancy, we are inevitably disturbed to discover that we are falling further behind. Especially galling is the fact that much poorer countries, including Chile, Portugal, and Slovenia, are actually doing better in terms of their citizens' mortality rates. And some Americans, such as those living in Appalachia, are actually no healthier than Bangladeshis.

What could be the reason? One possibility is that we are not spending enough money on health and healthcare. But this is a difficult argument to sustain, in part because the U.S. pays out far more than any other nation on earth, outspending our nearest competitors by more than 50 percent. If the way to obtain health is to spend money on healthcare, then the U.S. should rank as the number one healthiest country on earth by a substantial margin. But we don't. This suggests that health is not a commodity that can be purchased like automobiles or gallons of gasoline.

And this is certainly true. While there are some broad positive correlations between economic standard of living and health status, it is clearly not the case that wealth causes health. In fact, some very wealthy people have died quite young. Consider Christina Onassis, reputed to be the wealthiest woman in the world, who died at age 37. By contrast, some very poor people have lied to a ripe old age. For example, Mother Teresa, who took a vow of poverty as a young woman and lived without a dollar to her name throughout most of her life, lived to be 87.

To some of us, it seems initially something of an affront to be told that there are things we cannot purchase. Yet a moment's reflection shows this necessarily to be the case. An obvious example is time. Even the richest person on earth cannot buy an extra year, hour, or even second. To be sure, a rich person has an advantage in obtaining the best medical care and might be first in line for an organ transplant if needed, but again, health is not simply a matter of purchasing power. Rich, poor, and everyone in between soon come to the same end, from which no investment portfolio can protect us.

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Richard Gunderman, MD, PhD, is a contributing writer for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman's most recent book is X-Ray Vision.

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