One measure of longevity that may better reflect the quality of a medical care in a country is life expectancy at age 50. According to a recent article in the Penn SAS Magazine (p. 16-p.17) life expectancy in the U.S. for non-smokers is 84.9 for females and 81.2 for males. These figures rank 7th and 9th among all developed nations.
Longevity for smokers is significantly shorter. In the U.S., the longevity is 82.3 for females and 78.5 for men. These figures rank 17th and 14th among developed nations.
The observation that the life expectancy for smokers is shorter is not surprising. However, why does the U.S. rank so much worse for life expectancy for smokers than non-smokers? Is the U.S. medical treatment for smokers so much worse than that of other developed countries? I would guess not.
The likely cause of the ranking change is due to the selection of people into the smoking group. It many be the case that smokers in the U.S., are poorer, less educated and more likely to be obese than non-smokers. Thus, because the group of smokers is at a socioeconomic disadvantage, this can explain why the U.S. longevity ranking is lower for smokers than non-smokers.
Many people stereotype that in France, smoking may be more respectable in high class society and smoking may not be as concentrated in poorer individuals. In fact, we observe that France ranks 4th in female life expectancy for non-smokers but 3rd in female life expectancy for smokers. A similar phenomenon may exist in Spain; the life expectancy for non-smoking females ranks 11th, but the life expectancy for smokers is 5th in the world. However, these trends are not as strong for differences in male life expectancy between smokers and non-smokers.
When we deal with self-inflicted addictions I tend to ignore the common ideas such as life expectancy. One person once told me of the Heroin Addict theory in that this stuff is so good it can kill you.
Why should the medical field be so concerned with self-inflicted addictions? We worry about diabetes, hypertension, heart disease etc. but is it our need to concern ourselves with those who choose to act in ways that are not in their best health interest? Why should this be a part of our concern for the costs of healthcare?
In fact, lower life expectancy due to personal choice simply lowers the cost of healthcare as death comes sooner. In the end, no pun intended, those with their addictions are happy.
As a relative lay on his deathbed his wife could not bring hereself to adminster morphine because he might become addicted. One had to ask, “Who cares?” He is going to die anyway and at least he will be more comfortable.
FactCheck.org took a look at the longevity rankings last year, based on a reader’s complaint that the data included mortality by act of violence, and by motor vehicle accident, which skewed the data in favor of other countries when the subject under consideration was a comparison of health care systems. FactCheck found that to be true: when you take out death by those two causes, the US vaults to near the top. FactCheck argued that those data should be left in. However violence and MVA rates are not directly related to health care coverage, cost, access or quality. The US just has a lot of violence and car accidents per capita (ranked #1 in both) compared to other countries.
Superb blog, by the way. I learn something almost every day. Many thanks.
D
Smoking has become a “poor folks” disease. And that added life expectancy impact (socio-economic status) is likely a major factor.
I’d also suggest that smokers are more obese than the “rest of us” and I suspect that their diets are poorer. So multiple related risk factors.