One possible partial explanation for this is the same reason why the Bill Gates Foundation wasted a bunch of money fostering small high schools. Smaller high schools were some of the best performing schools...but also some of the worst [0].
The answer is just that small counties have high variance. By chance some small counties will be a lot higher or lower than the national average.
I would be interested in seeing a Cox Proportional Hazards Model would show if the remaining changes are related to pollution, meth, economics, etc.
Sample-size-based variance is a nice nit to pick, but it doesn't really seem to match the data presented in the article. Outcomes are strongly correlated in adjacent counties across the map, which is not predicted by sample-size (which would produce uncorrelated noise, in inverse proportion to population density). On the other hand, there is substantial correlation between the given geographic distribution of life expectancy changes and geographic distribution of wealth, as observed in the article.
Yes, this is correct. Especially with how extreme the values are within the clusters (like in Kentucky), there is almost no chance they occurred by sample-size variance.
Sample-size variance might explain some of those little counties with blips out in OK, MS, and TN though. As an aside, the color scheme on the map makes any decrease look substantially more massive.
I wish we had a map which was recentered on the national average growth of life expectancy as well.
The largest life expectancy increase is in New York county, which has a population of 1.6 million, comparable to whole smallish countries - no, this is not explained by high variance in small counties.
But even the small counties have populations in the several hundreds or thousands, right? Outliers that die at 33 or 103 affect the average little when you have a population of 2,000.
Intuitively what you say makes sense. However, I just ran a simulation in R based on census data (actual county sizes from [1]) and the result is that you do get by-county age differences of up to ~17 years just by chance. These bigger differences do not occur often but the assumptions I made in the simulation are fairly conservative and the true random variation could easily be bigger. So 20 years does not seem absurd.
Running the simulation repeatedly yields maximal differences between counties between 16 and 19 years.
EDIT: False alarm. I incorrectly assumed that census data sets uses unique identifiers for counties and that introduced a bug in the simulation. After correcting it, the simulation shows that random variation indeed explains only very small differences in life expectancy of about one year. Corrected simulation code below:
I think a big problem (and you highlight an outcome here) is that focussing on geo political units like county boundaries which have a huge variance in both area and population is always going to be a troublesome background on which to pin statistics.
One idea might be to distort the map so each county has a size proportional to its population - quite tricky around metropolitan areas! There might be a way to aggregate adjacent counties in some way.
Depending on the raw data granularity it might be best to dispense with political boundaries and say plot based on some form of population to area measure that smears things somewhat. That would probably be fair but wont please anyone with an axe to grind (ie everyone).
You should see the statistical contortions carried out here (UK) for similar bollocks. North/South divide? - where is the middle of the UK? Who knows? Does it include Scotland, Northern Ireland and Wales? Where exactly are the Midlands? Is Wiltshire in the South West or the South? Anyway you get the idea.
You end up spending more time explaining outliers and oddities than you do focussing on the real issues (whatever they are) with these kind of maps unless they are very, very carefully and rigorously put together. A fair and rigorous map will probably please no-one 8)
Oh and another thought - if your post (sorry) zip codes are involved in the raw data then as a previous article on HN showed they don't always map very well to the boundaries they purport to cover.
You also should use an actuarial table, because deaths become much more common with age shrinking the deviation significantly. However even one year variation shows there is something significant going on.
It would be interesting to know the standard deviation for counties less than say, 10,000 people, as well as the for counties larger than 10,000 people.
You'd think that, but the US has about 724 deaths per 100,000. In a county with fewer than 10,000 people that leaves only about 72 deaths per year. Loving County in Texas has 112 residents. "35 counties have a population under 1,000; 307 counties have a population under 5,000; 709 counties have a population under 10,000" [0].
I haven't read the paper, so I don't know their exact methodology but if they just took a snapshot in 1980 and then in 2014 a county of 10,000 would only be looking at about 145 deaths total. That's small enough that it's pretty possible for outliers to have a big impact. In a county of 1,000 there are only 7 deaths a year, so if you only look at two years that's a total of 14 deaths. It doesn't take a lot to jostle the numbers when you don't have many observations.
In any case, this isn't the main contributor here, as pointed out elsewhere. But it is a good thing to be aware of whenever county level statistics are provided.
It seems they are being smart about using counties:
"All analyses were carried out at the county level. Counties were combined as needed to create stable units of analysis over the period 1980 to 2014, reducing the number of areas analyzed from 3142 to 3110 (eTable 1 in the Supplement). For simplicity, these units are referred to as “counties” throughout."
They also use https://en.wikipedia.org/wiki/Small_area_estimation which seems like a way to deal with the counties with small sizes.
And from what I can tell they are using hierarchical models that should have some regularizing effect from larger populations.
Not only county-to-county. My friend did his PhD dissertation on how (at least in Rochester, NY), life expectancy varies by decades between zip codes. His research focused on urban Food Deserts and studied how the lack of access to healthy food nearby restricted diets to that available in convenience stores (chips, soda, etc). I wish I had access to his dissertation, but he just defended a month ago and cannot find it in any publications right now.
> His research focused on urban Food Deserts and studied how the lack of access to healthy food nearby restricted diets to that available in convenience stores (chips, soda, etc).
I hear this often but always wonder which way the causation arrow flows.
Do "food deserts" cause unhealthy eating? Or do groups of consumers that prefer unhealthy eating create "food deserts" with their purchasing decisions?
In the past 10 years or so, the notion that unhealthy eating and food deserts are related has been refuted in multiple articles and studies. Here are links to some of the more popular ones.
It does seem fairly obvious that it is lifestyle choice and like-minded cultural group bubbles as opposed to not having anything but garbage to eat nearby.
I'm not sure it has to be quite that binary. Certain areas of cities may be unattractive to better markets for a variety of reasons. However, I had the same thought you had. I'm not sure dropping a Whole Foods into an area with poor food options today is going to be a panacea that suddenly makes everyone eat healthy home-cooked meals. For example, this piece [1] presents a fairly mixed picture on whether new shopping options improve outcomes.
Whole Foods is absurdly expensive, though. Even after I became an engineer I didn't understand why I should pay like 3 bucks a pound for broccoli when I can get it for a buck a pound at the local Mexican/Chinese Shop (99 Ranch or ma and pa).
That's a better question: does dropping a cheap ethnic produce market into a neighbourhood that didn't have any cheap produce nearby before improve health outcomes?
Eating habits are cultural. People used to eating mostly cereal and bread throughout the day aren't suddenly going to start vegetables because vegetables drop in price and become more readily available and appealing for consumption. Humans are creatures of habit and social momentum.
What if in their neighborhood there are new restaurants with cheap, plant-based foods too? And if packaged food with refined sugars (cereals) and unhealthy oils got more expensive at the same time?
Humans can change their diets. It would help to be subsidizing healthy foods instead of refined sugars.
hey, I get all my organic ice cream and craft spirits from there.
You can buy junk food from almost any market, but WF is great because you can assume that everything they have is of reasonable quality, that their meat + fish is reasonably more sustainable / quality-controlled than elsewhere, that their produce is reasonably fresh, etc. It's more about saving time from not having to research every apple farm and figure out their distribution networks when I just want an apple. Also, their return policy is super generous ("I bought this brand and I actually don't like it" = money back), their lines move quickly (sometimes Safeway is a 30min wait), they're rarely sold out of things, and they have some higher-end products which are hard to find elsewhere (I like some fancy cheeses and cured meats). They have some of the same stuff at other places, sometimes for less money, but it's never more convenient or a one-stop-shop.
I've heard of a couple studies that say that the unhealthy eating is a result of consumers in the area not having either the time and/or the money to make better decisions. If you're working 2 jobs you may find yourself less able to make healthy decisions. In my more self-imposed case, I know that I wasn't able to eat healthy while pursuing an EE/physics degree while working an engineering internship. I was either sleeping or working and there was rarely time to prepare my own food or even go to the grocery store to get the ingredients.
This is not a scientific answer, but my perspective is that healthy food is more expensive, therefore purveyors of healthy food tend to avoid poor areas. It's not so much the consumer's "choice" to buy these products, but their inability to purchase or lack of knowledge that fresh foods may extend their lives.
Edit: Another issue affecting these consumers is that they may not have as much time to cook as a family with 2 parents working 1 job each.
Healthy food isn't very expensive if you're smart about it (it requires a bit of education and understanding nutrition). I live off of rice, beans, spinach, pita bread, whole grain pasta, peanut butter and the cheapest veggies I can find. I spend about 20$CAD a week on groceries.
Where's the steak? =) The day someone defines what "healthy food" actually is, or what subsets of food will suffice, will be the day people realize it can be had for as much or less than the unhealthy options.
Avoiding processed foods, limiting carb intake, and eating plenty of fruits and vegetables is a good rule of thumb. Also, make sure to stay hydrated to reduce false feelings of hunger.
When I was in college and couldnt afford steaks or other expensive forms of protein, I got them from eggs, one of the most well rounded sources of protein for the pricr
Yeah, but define "empty calorie". Like, I eat pretty low-carb (mostly because I feel better, not out of any ideological thing). Heavy on lean meats and green vegetables, while I avoid pastas, root vegetables, breads, etc.--I think a potato is the closest thing to an empty calorie you'll find this side of a sugar cube, but reasonable people can and do disagree.
Potatoes on their own aren't empty calories. [1] One medium potato is ~150 calories but full of potassium, vit c, and other nutrients. It's when you fry them or drench them in cheese and bacon bits and sour cream or mash them with loads of butter that they become unhealthful.
An empty calorie is one that provides little to no nutritional value other than the calorie itself. In my mind the most common empty calories come from sugars, some flours, and some oils.
Completely disagree: I eat a high-fat (~70% of calories from fat) and lots of protein diet (I'm about 12% bodyfat).
Bacon* and cheese and sour cream are the healthy parts of that meal, the potato is the "empty" thing by far, and the thing that will provide the highest glycemic load of those ingredients, spiking insulin.
(note that I have no idea what bacon bits are, or if they're even pork meat)
That's a fair cop. Potatoes are merely in the ballpark. (GI spikes for nutrients much more easily gotten from things that won't make me feel like crap? Either way, gimme.)
It's most likely a confluence of those, and other factors. My default inclination is to look to systemic effects first, though. So, in this case, whatever the specific balance between the confounding factors may be, my bet is that it's weighted towards "food deserts" creating the unhealthy habits, rather than being their consequence. People don't generally have a lot of choice but to eat what's available to them, and the overwhelming majority of what's available in these places is packaged and processed beyond recognition.
I grew up on the Great Plains, in the largest conurbation for hundreds of miles in any direction. I was literally surrounded by farm and ranchland. That area is classified as a food desert — a phenomenon I'm shockingly confronted with every time I fly home to visit the folks. Based on the conversations I've had with folks living there about this stuff, they (broadly) aren't even aware there are alternatives, or those alternatives are outright mocked. (Imagine growing up as a vegetarian when you have multiple relatives who ranch...)
I spend half of my time in a food desert and half my time in a hippie foodie mecca.
I think the answer is both. Rural areas lack the population to keep fresh food entrepreneurs from locating their businesses there.
At the same time, rural food culture tends to be shit outside of garden season - people think that potato chips and brownie mix are somehow valid ingredients in a recipe. They swap these "recipes" with their friends and look at you funny if you skip the bun and double up the veggies on your burger.
Well, based on his other activities helping lead an organization called Food Link (http://foodlinkny.org/), there is very high demand for healthful food in those areas. So while I would agree with you when taken without that context, he's been working hard for years towards proving the causation using multiple avenues.
And its not just causation. There are often unaccounted variables that are driving both the cause and effect and observing that decorrelates the cause and effect completely. There is some fascinating research going on on this in the field of economics. Matt Taddy, University of Chicago, Microsoft Research is doing some interesting research on this very kind of problem.
I also wonder about this. Most places restrict the number of liquor licenses, but I would imagine don't restrict the number of grocery stores. Large and small Asian markets seem to exist in a wide spectrum of neighborhoods.
Hm that is really interesting. I can definitely believe that effect.
I've bought groceries from the same few places for 7 years or more. It seems obvious that people buy food 90% of the time from the 5-10 places closest to them geographically. I live in a good area and they have good food.
But if my choices were all cheap soda and snacks like I see in other places, I imagine that would have a very concrete effect on my health. A few extra calories or a few more food adulterants every meal, every day, for 7 years or 20 years really adds up.
It seems extremely unlikely that there's no consequence of the food choices of your nearby grocery, so I'm glad that someone is measuring that effect.
The city I live in is supposedly a food desert but there are 6 grocery stores in the zip code that supposedly has none. They are huge chains like Kroger but they have everything you could imagine.
But even when I'm at Kroger or Meijer, people have carts full of frozen food, sugary drinks and snacks, etc. No fresh produce, no staples, etc.
I would imagine that it's not just convenience stores. I frequently ponder the fact that the grocery store closest to me is a marque of a US conglomerate (I live in Canada) that manages to have "low prices" by just treating Canadian stores as part of its US logistics chain—almost all of its products are shipped here from the US, rather than locally produced under US brands. And that includes things like baked goods and produce.
Thus, everything perishable in that store is either much "older" than you'd expect (i.e. it will go bad very soon after you buy it), or is pounded with preservatives—the bread, bagels, muffins, etc. all sort of have this uniquely-bad "springy yet doughy" texture: the sort of texture that I associate with Wonderbread.
Within the same distance there are local bakeries, produce markets, butcher shops, etc. that sell good stuff. But I don't doubt for a moment that certain families ignore those and go straight for the "everything shipped from far away" supermarket for all their shopping—and are having different health outcomes because of that.
>local bakeries, produce markets, butcher shops, etc.
That's probably where I would go to shop. Waiting for my local farm stand to open for the summer. And there's a nice local butcher down the road. But these are not cheap alternatives to my local grocery store (which actually has fairly decent produce, meat, bread from in-house bakery, etc.) I enjoy going to farmers' markets but they're not cheap places to buy food for the most part.
Fascinating, thanks for sharing. The points made in the article seem obvious, but doesn't offer much in terms of a suggested solution (conscientiously redraw zip codes). Do you know of any effort to have a more accurate "health boundary" region designation?
A major problem in any demographics research is data coding. For health-related demographics, HIPPA starts playing in.
Because mailing address is almost always provided in a healthcare setting, ZIP Code data are present in records. Similarly for coronor or death reports. Other alternatives, say, census block number, exist, but would have to be coded into the data. If you're already working with ZIP rollup data, you simply cannot recode for finer-grained analysis.
The most obvious data target would be the ZIP+4 encoding, though here in a provider context you'd likely run into HIPPA concerns (I've not worked in the field for some years). For death reports, that's obviated, so access to county death records at household detail would be an option, but you'd need to acquire data across all (or some sampling of) the 3,144 counties in the US.
Some of that data may be available in electronic form, but I'd suspect some level of fieldwork might still be required.
The optimal solution is likely a huge set of overlapping boundaries each accounting for different things.
Like if easy access to fresh groceries matters, the boundaries for that will not line up with the water system boundary (there could be some interesting correlations between the areas, but a good analysis would have to split out the boundaries to account for each effect).
I met someone working for the city of Oakland who was researching similar things here. She pointed out that life expectancy in the 'flats' of Oakland was 7 years lower than in the 'hills' of Oakland. That geographical boundary mostly separates the wealthy from the poor (though areas of the 'flats' are rapidly gentrifying). There are also other factors, such as proximity to pollution from highways and the ports, crime rates, etc.
>Not only county-to-county. My friend did his PhD dissertation on how (at least in Rochester, NY), life expectancy varies by decades between zip codes.
Amazing. Perhaps life expectancy even varies between households or...dare I say it...individual people?
A very similar article by many of the same authors was reported in JAMA in Dec 2016.
From JAMA Arch Int Med article from today, p. E6:
"...At the same time, 74% of the variation was explained by behavioral and metabolic risk factors alone, while one marginally more variation was explained by socioeconomic and race/ethnicity factors, behavioral and metabolic risk factors, and health care factors combined."
From the WaPo article:
"Mokdad said countries such as Australia are far ahead of the United States in delivering preventive care and trying to curb such harmful behaviors as smoking. “Smoking, physical inactivity, obesity, high blood pressure — these are preventable risk factors,” Mokdad said."
In NYC, and not just Manhattan, New Yorkers are doing better because of a number of interventions initiated in 2001, when Mayor Bloomberg and Dr. Tom Frieden took over as Mayor and Health Commissioner.
Adult smoking is 14% in NYC, 24% in Louisiana. Raising the cost of tobacco contributes more than half the effect of getting smokers to quit and to stop teens from ever starting.
NYS tobacco tax is $4.35 per pack and the city is an additional $1.50. Cigarette sell for at least $12 per pack here.
The tax is $1.08 in Louisiana.
Mokdad mentions Australia, where the tobacco tax is $14 per pack plus an additional $2 sales tax.
The ACA made a huge mistake in not raising the about $1 US Federal tax to a much higher number for the 13 billion packs smoked each year.
Raising the Federal tax by $4 would raise at least $30 billion each year for helping those with high risk preexisting conditions.
"Mokdad mentions Australia, where the tobacco tax is $14 per pack plus an additional $2 sales tax."
There is something else going on as well. The young (Australians) don't see smoking as ^cool^. In fact the path to smoking is the path to being a social pariah. You can't smoke in pubs, clubs, taxis, trains, trams, in or around public buildings.
> Raising the cost of tobacco contributes more than half the effect of getting smokers to quit and to stop teens from ever starting.
Yes, though it's also created a thriving black market for cigarettes, often trafficked from other states or otherwise sold without paying end-consumer taxes[0].
Separately, it's worth noting that the age for purchasing tobacco in NYC is 21, as opposed to 18 in most other places.
Furthermore, it's also just really damn hard to smoke in NYC. It's been banned in restaurants and bars for fifteen years, long before that was commonplace in other places. More and more buildings are smoke-free, which makes it less and less convenient for people to maintain a smoking habit.
[0] The cost of having an illegal market isn't always monetary. For example, Eric Garner was killed after an encounter in which police approached him because they claimed he was selling untaxed cigarettes: https://en.wikipedia.org/wiki/Death_of_Eric_Garner
I didn't notice until very recently when I saw a sign on a cash register (I don't smoke). Good for us. It's also very hard to smoke here, many places have lots of rules about where you can do it (not indoors, really far from doors, etc). I'm kind of surprised that people still bother.
That said, when riding a bike around, it's very apparent that many people smoke weed in their cars now. You can smell it for about a block or two behind their vehicle.
No kidding! I was just thinking about this last night on my 34 mi bike ride in the rural bits surrounding Athens, Georgia. It seems like every third car that passes me emits the scent of weed in some way.
> "it's also just really damn hard to smoke in NYC."
Yes, it is :-)
Also banned in the parks. The age increase to 21 is a relatively recent change, the adult rate had been 14% and the teen rate 7% prior to that change.
Taxes, banning smoking in public places, hard-hitting anti-smoking ads spending $1 to $2 per capita are the main reasons for decline, all policy. Clinical intervention is also important, but have less effect than the policy.
I find it much easier to smoke here than when I lived in Seattle, where everything is smoke free there; vape culture is also much bigger on the West coast. I actually haven't noticed being in a smoke free apartment in NYC, yet.
But certainly right about the black market. Go to any bodega enough for them to remember your face and you'll get the under the counter 7-8 dollar packs imported from Virginia.
This map seems correlated with socieconomic status and all the health implications that go along with that. And it looks similar again to Republican voting districts. It's Sarah Palin's "Real America", so to speak.
One thing the Democrats would do well to focus on is the fact that there's a large portion of the country that is sick, where the statistics look more like an underdeveloped country. Those of us who live in the major cities would do well to empathize with this other part of the country and their malaise, even if for our own sake of having a more sane and less partisan government.
Democrat or not, those in the "other part of the country" are the ones voting against themselves, i.e. for politicians who oppose subsidized healthcare, who oppose workplace benefits such as paternity, maternity, and sick leave, those who oppose healthy food for public school students (and public schools in general...)
Those living in major cities have empathized with those in areas that consistently vote for "smaller" government, by not voting for the same policies and politicians that are causing them harm.
The belief in smaller government and general distrust of it in some such areas (but not all) is, IMO, often because paternalistic urban policies don't effectively meet rural needs. Which is taken as proof that government can't solve their problems.
The politics of benefits in such areas are also frequently driven by a perception of affordability -- it's all very nice to have paternity, maternity, sick leave, etc., but when the perception in the community is that there are few jobs, and what jobs there are can barely afford to pay people's wages to begin with, of course it's going to be accompanied by a belief that forcing the provision of benefits is just going to destroy jobs and not help anybody.
I think it's important to take some sort of needs hierarchy into perspective - when daily living is tenuous and stressful, I think many of the benefits the "too stupid to know what's good for them other parters" don't seem to be moved by are addressing the wrong steps of their needs hierarchy, or fail to take into account the financial and environmental realities of their day-to-day lives.
Just as housing has turned out to be an important first step in combating homelessness (as opposed to medication, employment, etc.), I would not be surprised if there were different first steps needed to support people in poorer, more rural, areas than what are perceived within them as very white-collar benefits.
If the rural areas are doing poorly, it's always tempting to blame the cities, or the "urban elite", or whatever. Yet the rural areas quite often dominate state politics. If their own representatives are acting paternal, it's hard to see how it's the cities fault.
Providing help to rural areas remains quite popular across the board. There is a long history subsidizing rural agriculture, infrastructure and utilities. It's proven difficult to eliminate the poverty despite that.
State politics are often little more than a reaction to national politics crossed with support for moneyed interests like car dealerships and some grandstanding/boot-licking race-to the bottom job policies. National politics really sets the tone, context, and priorities people are aware of, especially so in an era when most reporting and commentary is national in scope and local information is often via word of mouth and social media.
I do think it's true that in many rural-dominant states you can't blame a state-level urban elite, and that's not really what I intended to suggest in my comment (though I do think in "blue" states there very much is such a dynamic, witness Jefferson, rural sheriffs flatly stating they won't enforce various state laws, etc.). Frankly, I don't think blaming an urban elite at a national level makes sense either, as I don't believe what I referred to is at all intentional.
That said, I think the examples you list of things subsidized may also be examples of things that are likewise slightly misplaced priorities in terms of the larger picture. For example, I'd imagine (though I don't specifically know that) agriculture subsidies mostly go to large enterprise farming operations and have little trickle-down effect to many every-day rural people. Likewise, subsidizing rural infrastructure seems like it may be necessary regardless of any significant benefit, though it's once again highly speculative on my part (for example, I'd guess fire-fighting services require significant external subsidies in some areas, but also don't have tremendous effect on the day-to-day life experiences of average "locals").
My previous statement is also why I think the election of Trump may be an important milestone in solving some of their problems: namely I think (hope) he may be a gateway to the realization in certain quarters that what were presumed to be their problems and solutions actually aren't, leading to a significantly reformulated and broadly unified national consensus. (Yeah, probably a pipe dream...)
There was much more involved in the election than healthcare alone. There were cultural concerns(people in big cities worry about very different things than the rest of the country), economic concerns(outsourcing and illegal immigration have brought down wages for the lower and middle classes) and even democratic concerns(the DNC suppressed Sanders from being the Democratic candidate). Those are all legitimate concerns, and on top of that you've got to consider gerrymandering and the emotional aspect of voting that isn't rational. Trump recognized a large part of the country that wasn't acknowledged by Hillary, and that boosted the Republican party as a whole.
Your post is weakened by including some popular tropes which are unsupported by the evidence.
The DNC didn't suppress Bernie – he has a great run for someone who wasn't even a member of the party but he was going against the best known name in the party who wasn't the outgoing president.
Similarly, Hillary had the same message – and a far more detailed plan to get there – but a variety of factors (Comey, propaganda, a 3 decade smear campaign, the media obsession with keeping the email story on the front page despite lack of an actual story, etc.) led more Democrats to stay home than Republicans. Both candidates had a small amount of crossover votes but by and large more registered Republicans showed up to vote.
The DNC did suppress Sanders and showed massive bias towards Clinton, the email leaks showed it. Clinton's campaign got debate questions early. They got preferential treatment in the media. Then when Debbie Wasserman Schultz, the DNC chair at the time, was kicked out because the collusion became public knowledge, the Clinton campaign _immediately_ hired her. If there wasn't massive collusion, then there was at very least an image problem, which Clinton did nothing to help by hiring the very person forced to resign.
Also, the message sent by the two were not identical at all. Sure, if you tallied them all up and compared them by existence they would be very similar, but the difference was in the focus. Sanders' campaign focused on socioeconomic inequality which would have resonated more in rural America, while Clinton's campaign focused more on social issues, which matters more in the urban centers where the economy is less of an issue.
> the ones voting ... for politicians who oppose subsidized healthcare
It's more complex than that, because those same voters are pressuring their elected representatives to retain healthcare subsidies and similar benefits.
I couldn't help but notice that the top three counties (Summit, Pitkin, and Eagle counties in CO) are largely empty space with some of the country's best ski resorts. I suspect that the life expectancy there may largely be driven by fit retirees who move there.
Not merely ski resorts, but specifically Aspen (in Pitkin County) and Vail (in Eagle County). These are not merely fit retirees, but the richest retirees in the world.
Further, there is a bit of selection bias here in that the town of Aspen is at 8000 feet of elevation. You need to have a decent baseline of physical fortitude just to step off the plane there as an older person...
Finally, for what it is worth, day to day life in Aspen (even outside of the ski season) is extremely active and everything about the town promotes that activity.
I personally don't think there is anything actionable or interesting[1] about Aspen and Vail having high life expectancies - they are completely non-representative of any piece of the real world.
[1] Well, other than fitness and activity increasing your lifespan, but we all know that already.
Having lived in Aspen for a while (no longer) I do have to say: everyone that lives there is extremely fit compared to say... the Bay Area.
Not just the rich people - the average person (who is more likely a retail/food service worker) is just more active - going on several 1000ft hikes in spring & summer weekly, or long bike rides, etc.
It's very very easy to be healthy there: I got fitter, skinnier, and healthier in the 8 months I was there.
I really wish that journalists would learn some 3rd grade maths before writing anything with numbers in it. How does the life expectancy vary by "more than 20 years" when the difference between the counties with the highest (85) and lowest (67) life expectancies is 18 years?
You should be more diligent if you're going to be so snarky... 85 wasn't the highest life expectancy. WaPo noted three adjacent counties with very high life expectancy and captioned the graphic, "Summit, Pitkin, and Eagle Counties, each at more than 85 years."
Their actual values were 86.83 years, 86.52 and 85.94 years. Oglala Lakota County had a life expectancy of 66.81. Lo and behold, 86.83 - 66.81 is more than 20 years.
From the source article:
> Counties were combined as needed to create stable units of analysis over the period 1980 to 2014, reducing the number of areas analyzed from 3142 to 3110. In 2014, life expectancy at birth for both sexes combined was 79.1 (95% uncertainty interval [UI], 79.0-79.1) years overall, but differed by 20.1 (95% UI, 19.1-21.3) years between the counties with the lowest and highest life expectancy.
Is there any reason this isn't just selection bias? Young, healthy, people with good careers travel to big cities. The rest stay behind. Do we have data to compare those who stuck around vs those who grew up there but moved away?
Rural upstate NY. Always checking out the obits. There were some weeks there when no one broke 62. Seems to stabilized, but more rural than Appalachia. The winters are brutal, MDs are hard to find.
Truth. Here in Ithaca the health care is pretty good, but quality falls quickly after 15 minutes drive in any direction.
Not to mention that, aside from college towns and the canal cities, most of upstate NY hasn't been economically prosperous for generations. It takes a toll on folks.
Heck I bet within a 5 mile radius it varies. Just go to east palo alto and then go to "not east" palo alto. The reasons I think are pretty obvious and almost certainly correlated with how affluent your neighbors are. Money basically solves all problems when it comes to wealth related problems like access to good schools and healthcare. Even though in theory healthcare and education should not be so strongly coupled to money.
The "life expectancy of a county" is not a trivial thing to define if you ask me. Is it how long children born now in a county can expect to live, no matter where they live or die, does it only depend on people who die in the county, or is it somehow weighted by the time people live in the county? Maybe there's a standard definition, but my guess is that most people don't know.
Conventional life expectancy measures are calculated based on the death rates at each age of the residents in that place. Therefore the death rates of people at 80+ or 90+ years may be affected by their lifestyles 30-50 years ago, so it's not always an accurate measure of how long you would expect a child just born to survive in that place.
AFAIK it's not weighted by the time people live in that place. Perhaps areas with lots of affluent retirees will have distorted life expectancy rates that may not be reflective of people who are born and spend their lives in that area.
Thanks for that explanation. So if a county has, say, a lot of hospices (and people change their residency when they go there, not sure how that works in the US), that will affect the expectancy negatively, saying nothing about how living in that county affects longevity.
>“We are falling behind our competitors in health. That is going to impact our productivity; that’s going to take away our competitive edge when it comes to the economy,” Mokdad said. “What we’re doing right now is not working. We have to regroup.”
What's the logic behind this? Out of curiosity. It's a morbid thing I hesitate to say, but from a purely utilitarian view isn't it better for a country— from a macro perspective— if people die as close as possible as they finish their working life and retire?
I might be completely off base there, and this is mostly a request for more information, not saying people should die early. As far as I'm concerned I hope we all live to 200.
Sometimes it will cause a worker (and the worker's company) to be less efficient due to health-related issues. Not to mention that caregivers (e.g., family) may also be less efficient by taking time off from work or quitting work all together.
Sometimes people will be put on disability for health reasons before they should need to retire. This is a drag on the welfare system and (often) the economy if they had been a productive member of the workforce.
There is also a potential quality of life issue (both present and expected), but that's not as easy to measure as the previous points. It also has some potentially complex implications that are beyond the scope of this post.
What would be a better scenario, though. Do we not die slowly even if we are older, which also requires more caretaking?
What's the difference between having it happen early and late?
I do agree with the Quality of life issue, though. If I'm a highly skilled worker (And thus have prospects to migrate) And some people in say, a country in Europe, live to see 150 years of age, while in my country on average people live to 70 I'm moving out as soon as humanly possible.
Realistically the gap doesn't grow that large, but I'm using hyperbole to make a point. I might be too dumb to articulate it though.
The issue in the quote is (premature?) death as it relates to economic competitiveness. That is why early -- that is, in working years -- matters more than late.
Late and slow death has its own indirect impact on economic competitiveness, but that is not the focus of the quote, imho.
People often just don't die instantaneously, they get sick and require care this taking up resources. Also, some people don't die but are permanently disabled or others get better.
Oglala Lakota County which is completely contained inside the Pine Ridge Indian Reservation is served by Indian Health Service with 94%+ of the population being eligible for free, government provided medical care. I notice, other than pointing it out on the map, they didn't discuss it in the article.
Of course life expectancy is going to vary by county, because the variables that contribute to life expectancy; income, lifestyles, dietary habits, quality of health care, and access to health care are vastly different.
I assume you'd need a broad cultural shift in attitudes about food consumption, obesity, physical activity, and vast health care networks that ignore income to change it.
I didn't look into the data, but the CDC and other agencies have policies that set values to 0 in public versions of their datasets if there is a risk of inadvertent PII disclosure. This is particularly the case with smaller cities/counties and rare diseases.
Not surprised. Visited the Midwest a few years ago, and obesity was ridiculously off the charts compared to the Intermountain West or WA/CA. The are significant social factors playing out on a wide and complex scale.
My advice, if you're stuck in one an area with unhealthy habits, is to move to an area with healthy habits.
> "We are falling behind our competitors in health. That is going to impact our productivity; that’s going to take away our competitive edge when it comes to the economy"
Interesting how it seems like health itself isn't seen as the target metric. Nope, economy is what's important.
What about from country to country. I'm from the US and, at least where I live, it is rare to see someone smoking. Second hand smoke has basically become a thing of the past. But this past week we went up to Vancouver BC and we were shocked at how many people were smoking. It seemed like you couldn't go 10 feet without walking through another cloud of second-hand smoke. Apparently the anti-smoking campaigns of the US never made it up North ;-) Or maybe their socialized medicine makes it so that they don't have to worry about health consequences as much. I don't know. I just wonder if the life expectancy is lower in Canada (or at least Vancouver) since smoking seems to still be A-OK.
There haven't been "smoking sections" in Vancouver restaurants or bars for years (decades?) and we even ban smoking in public parks ... so I'm surprised to hear your observation. I recognize that I'm likely normalized to my home city but I do travel a lot and it doesn't feel like I come home to any more smoke in my city than I'd experience in San Francisco or Seattle.
One observation that I stand behind is ... in both Canada and the USA, suburban and rural smoking rates are higher than urban.
BUT ... the theory suggested here about tourists and immigrants bringing their habits with them is good. And Vancouver is a tourist destination, which is why I was curious about the neighbourhoods you noticed the smoking in.
I wonder if you were in heavily Asian areas of Vancouver? It's my impression that smoking is most popular these days in Asian countries, so more recent arrivals would be more likely to still be smokers.
I have never noticed a particularly large rate of smoking in the areas of BC I've been to.
Less cigarette smoke is definitely a perk of living in the US. I was shocked to see the amount of smoking in Switzerland when I visited recently. I'd put it at the same amount as in India (where I am from), probably. I also remember a lot of smokers in Germany when I lived there for a couple of months in 2010.
Smoking is more prevalent in the Pacific Northwest region than it is in, say, Silicon Valley. It is still less common than some other parts of the US. This was very noticeable to me when I moved to Seattle from the Bay Area. In the Bay Area (and many other parts of California), smoking is approaching extinction.
It is a regional culture thing. Most smokers in the Pacific Northwest are strongly biased toward the lower economic strata. By comparison, in many parts of New England (for example) there are quite a few smokers in the upper half of the economic strata.
I've lived in and around Vancouver for years, and I find there is very little smoking there. Not sure where the GP's data is coming from, but he/she is drawing very broad conclusions from a very limited dataset.
If anything, (many) Vancouverites have the stereotype of being super-healthy, yoga-practicing, organic eating folks who actively shun unhealthy things like smoking. Unless it's weed :)
edit: I was talking about the GP's comment, not your's specifically.
Maybe. I actually live in Portland, Oregon and I rarely see anyone smoking. I honestly can't remember the last time I smelled second-hand smoke in Portland and the suburbs.
True, irrational shared a first hand experience and then proceeded to speculate as if that experience was evidence that smoking is more prevalent in Canada than in the US.
Not everything is the government's fault. Go observe the lifestyle choices and dietary choices some of these people make, and then add in the drinking and smoking.
And why is that a surprise ? The public schooling in USA has widely distorted the housing market creating ghettos where similar people will get clubbed together.
How is this a US problem? Everywhere I've ever visited, and I've been to as many countries as I have States, has quote on quote:
"Widely distorted the housing market creating ghettos where similar people will get clubbed together."
I think they call them neighborhoods. Rich people live in nicer houses than other people. Pretty sure it's been like this since one caveman had a bigger cave with bigger rocks to throw.
Sacasim aside I really think we need a national school system. In Georgia it varies by counties. Some counties compete on a national level others are dead last in the nation, if we aren't counting Mississippi.
You can certainly have flat spending per pupil independent of location. Which means that many inner city school districts get less money than they do today and many affluent suburbs get more.
I lived in a slum in India and went to a private school that catered to poor kids. Got scholarship and worked my way up to start living into a high-rise. The private school had a big role to play in it.
That is not possible for low income neighbourhoods for USA anymore. The mindless regulations make private schools expensive. It is not possible for a retired school teacher to run a class-room in a garage at night and call it a school. That teacher will end up in jail and sex offenders registry. The poor hispanic neighbourhoods of south San Jose will have to rely on the pathetic public schools and those schools will ensure their students flip burgers. Those kids will find it hard to move to Palo Alto.
Public schools not only distort the housing markets but they feed into that evil spiral of poverty. I would love to see department of education dismantled completely and money given to kids to chose their schools of choice and let entrepreneurs make money by catering to the needs of all kids.
India is/was a socialist state and I would expect social services to be spread more evenly than non-socialist countries. I also believe mobility is easier in developing nations and was better to some extent right after the Industrial Revolution and workers rights movements.
I am confused by your arguments. You're saying abolish public schools. Great idea then we could create pillar schools where only the elites attend like Yale and Harvard. Then the poor people will have to take out loans from the elite to attend good High Schools. Oh wait.
I'm a product of mobility. My father grew up in rural government housing in Georgia. Thankfully he went to GaTech and stayed in an environment with good public schools.
> India is/was a socialist state and I would expect social services to be spread more evenly than non-socialist countries. I also believe mobility is easier in developing nations and was better to some extent right after the Industrial Revolution and workers rights movements.
Saying "India is a socialist state" is, well, technically correct (it's in the Constitution) but a pretty misleading way to characterize the sort of social mobility in India that GP was talking about.
India is home to the longest-running continuously-serving democratically elected Communist government in the entire world. It's also home to what could be considered borderline anarcho-capitalist metropolises that are larger than many European countries.
As it turns out, the sort of mobility that GP is talking about is very rare in the states led by Communist and socialist parties, which have generally struggled economically[0]. It's most prevalent in the states (and cities) where the leftist governments never took hold, or where they were elected, but carried out very little of their vision in practice.
In any case, the scale of mobility and economic growth experienced in the economic hotspots of India (Delhi, Mumbai, Bangalore) has been made possible by the end of imperial colonialism, and the concurrent rise of a global economy. No developed country like the US will ever be able to experience that same level of rapid growth.
[0] There is one exception, though in that state, 33% of the state's GDP comes from foreign remittances (mostly from expatriates living in the Gulf), which is incredibly high, and higher than any other state. There is definitely an object-lesson in mobility to be learned there, but it's not the sort of mobility GP was referring to.
Compare you're localized (hotspot) mobility to what the West experienced at the end of the 1800s. China is a much better example and I dislike China.
You're saying I am technically correct about India being socialist.
The reason India has mobility is the same reason black markets or black economies exist in Communist countries. Where there is a lack of government or public services, black markets will form to fill the gap, capitalism. See USSR, Yugoslavia, and North Korea. Difference is India seems to allow it. There is another comment below about staring schools in a garage for poor people. From what I've seen India has these shadow schools.
I think you missed my line
> I went to a private school that catered to poor kids.
I did not go to a public school. No one I knew went to a public school because they suck everywhere like in every socialist society. India is indeed a constitutionally socialist country.
> You're saying abolish public schools.
I do not see why government should run schools. People can run better schools than government. Government must also abolish most of the regulations that require schools to have playgrounds or toilets or some other things that are not the focus of education.
The school I went to ran in an abandoned building and did not have electricity. That is how the costs were low and I could afford to go there. The teachers however were good.
> Thankfully he went to GaTech and stayed in an environment with good public schools.
That is a sad choice every American parent has to make today. I don't see why your father could not get a check of $X every month and let him send you to whatever school you wanted to go.
I am not sure I agree with you. I grew up pretty poor in India, and there were hardly ANY private schools that cater to the poor. Private schools were expensive and public schools in India are a joke. As a result almost all of the poor families I know dropped out of schools and never completed beyond middle school. I love public schooling in the US. It at least provides an opportunity for poor kids to complete schooling. An education system purely relying on private schooling will be a complete disaster like India's, where poor students simply giving up on education, creating generational poor.
> It at least provides an opportunity for poor kids to complete schooling.
It is other way round actually. What I can see is that in areas like Palo Alto where Asian parents figuratively hold Principal's feet to fire the good teachers get transferred there. The South of San Jose on other hand gets all the worse teachers where the poor parents don't have much time to wonder about the quality of teachers.
Those kids are perpetually into poverty because of the lousy education. Give them a check of $500 month for schooling and they will chose better schools.
> Private schools were expensive and public schools in India are a joke.
The quality of education in private schools is higher and the expensive part is related to that. However in terms of "cost to society" private schools are way cheaper than public schools.
To give you concrete numbers. Goa spends 40K per student per year but a private school that spends 8k per student per year delivers better result. Goa could afford to educate 5 kids with better education only if the money was given to the kid or the private school.
> An education system purely relying on private schooling will be a complete disaster like India's, where poor students simply giving up on education, creating generational poor.
It conflicts with what you are saying. Private schools have better retention and better outcomes. Public schools are where students drop out. Don't you think if we have more students going to public schools more students will give up on education ?
I think you misinterpreted what I was saying a little bit. If you have only private schools that are not affordable to a significant portion of the population, then you will have an uneducated population. A well funded, and well run public education system actually works pretty well.
> A well funded, and well run public education system actually works pretty well.
Not it does not. Public schools by definition will be run by government which will always be incompetent and provide worse education. A typical public school in India spends 5x the money to achieve lower learning outcomes that private schools.
> If you have only private schools that are not affordable to a significant portion of the population,
Unless government creates regulations that prevents people from starting schools for poor people there will be more and better private schools for poor people as they are now.
The problem is local funding for schooling I think. If funding was state level or federal and funds would be allocated to schools that need it - I.e. schools with poor students (less help from home, perhaps language issues) will be given a lot more funding per student.
Without this, what happens is that affluent people move to good school districts. These districts then get students with better academic backgrounds, fewer parents with drug/legal problems, fewer students with lanugage problems. Its pretty obvious to be a system that spirals out of control in just a few generations, creating segregated patches.
But perhaps this is how the support for the public school system is upheld? Rich people accept the system, because they can game it? If that's the case then it might be a necessary evil. Politically viable alternatives such as voucher systems will create the same effect (I know from experience).
Without looking into any statistics I can bet that Asian dominated Santa Clara will have much higher life expectancy than Alameda which has different racial profile mostly with low wage (H1Bs etc) Asian population. Merced which is highly Hispanic will be scraping the bottom.
I create a throw away account and say this almost every time a post hints at something like this: It is commonly taught at the school of public health at Cal that "your zip code is a stronger indication of your life expectancy (and quality) than the color of your skin". This has been known for years now.
If there was no difference in behavior at all between all of the people of the USA, I think you'd still see pockets of more and less progress, just due to the natural distribution of dying. I'm curious what the expected variance by zip code would be if everyone's behavior was identical.
As the article states, some countries are making more progress than the USA on modifiable risks, such as smoking. Australia is one such country. If advertising health were as profitable as advertising vices, we'd be in better shape.
It's not just lack of progress, in some areas it is regression.
You state this obvious factor as if it were immutable. The article addresses it, unsurprisingly, and provides examples that at least suggest progress can be made to limit it.
The answer is just that small counties have high variance. By chance some small counties will be a lot higher or lower than the national average.
I would be interested in seeing a Cox Proportional Hazards Model would show if the remaining changes are related to pollution, meth, economics, etc.
[0]http://marginalrevolution.com/marginalrevolution/2010/09/the...