"But nearly three-fourths of the variation in longevity is accountable to behavioral and metabolic risk factors, including obesity, exercise, smoking, alcohol and drug addiction, blood pressure, and diabetes"
What would be interesting is to see if there are places where there is perhaps an inverse relationship and figure out what there the offsetting factors are.
Does anyone have links for maps of the others by any chance?
Walkability and density is a giant, giant factor, and no one seems to want change the status quo. Anecdata, but most of the 60+ year olds I know that spent their lives in the suburbs can barely walk, all of the 60+ year olds that live in my city walk faster than I do.
To imagine that a 20 year old college kid from Akron Colorado can reasonably expect to outlive most people just born a few hours drive away in South Dakota...
It's unfortunate that this blog post does not cite another study, the results of which were published a month prior to the post's publication, which investigates in detail this issue: The Association Between Income and Life Expectancy in the United States, 2001–2014 [1].
That study actually offers insight into which particular factors correlate weakly or strongly with other factors, and offers charts and figures in key places to illustrate more detail than a mere line that mentions "socioeconomic factors, including race, education, and income, and access to health care".
It's not a long read at all, and highly recommended.
I heard a recent youtube talk by former NYC Mayor Mike Bloomberg in which he claimed one of the greatest successes of his administration is that the length of the average NYC life was extended 3 years.
Most of this was accomplished by public health initiatives such as raising the cost of tobacco to about $12-$14 per pack through NYS and NYC taxes, banning smoking in public places, hard-hitting anti-smoking ads of about $1 to $2 per capita per year. Significant efforts were made to reduce air pollution. Bloomberg is also known in his attempts to limit sugar-sweetened beverages (SSB) consumption by tax or banning the purchase with food stamp or limiting the size of fountain "Cokes" to 16 oz. These SSB attempts were unsuccessful, yet because of all of the publicity, the rate of New Yorkers who consumed at least 1 SSB per day dropped from 33% to 25%.
The politicians focus on access to care rather than on public health.
"...this study found that socioeconomic and race/ethnicity factors alone explained 60% of the variation in life expectancy. At the same time, 74% of the variation was explained by behavioral and metabolic risk factors alone, while only marginally more variation was explained by socioeconomic and race/ethnicity factors, behavioral and metabolic risk factors, and health care factors combined. Furthermore, there was very little additional effect of socioeconomic and race/ethnicity factors when accounting for all 3 sets of factors simultaneously, suggesting that the association between life expectancy and socioeconomic and race/ethnicity factors at the county level is largely mediated through behavioral and metabolic risk factors."
Maybe I'm misunderstanding how they are controlling here, but don't race, income, socioeconomic status in general change one's behavioral and metabolic risk factors (think because I'm poor I don't have access to fresh produce, or something like that)? If so, the big conclusion gained by controlling for those factors seem nearly useless to me.
We all know by now that metabolic and behavioral risk factors drive health outcomes. Are the authors just trying to point out that hope isn't lost regardless of race or socioeconomic status?
An obvious candidate is the tight coupling between access to medical services and income. Some link, naturally, exists elsewhere - but it is much higher in USA than anywhere else in the first world.
I'm disappointed by the intentional conflation of life expectancy and longevity. They are two different things, and the NIH knows it. Life expectancy has larger and sometimes completely different variations than longevity. Yet the first and last paragraphs are pretending they're exactly the same thing, using evidence and variations in expectancy to make statements about longevity.
Could someone explain how population migrations work in this model? For instance, if I am born in rust-belt county A but die in technology advanced county B, where is my data placed?
"Ezzati et al. used Internal Revenue Service tax records that record movements from county to county to explore how much migration might explain disparities. They found that in general individuals moved from high life expectancy to low life expectancy communities and not the reverse. While their finding suggests migration may not be a major factor in the national patterns, it could be an important factor in selected counties that have experienced substantial in- or out-migration. On the other hand, net immigration of young Hispanic adults with lower mortality could have tended to increase life expectancy at birth for some counties and the nation as a whole."
This is probably as good of a space as any, what do you guys see as politically feasible solutions to our obesity problem? Politically feasible would probably entail not angering food lobbies. Or is taxing corn/soda/meat really the only way?
You don't have to tax corn. Removing subsidies would be more than enough.
Oh, and the government should STFU about what it thinks is healthy. The last time it tried to interfere with the market it told generations of kids to eat a pound of bread every day. Don't tax anything you think is "bad" and don't subsidize what you think is "good."
If you absolutely must do something bring home-ec back to public schools. Teach kids how to cook. Then let them figure out on their own what they want to eat.
Obesity/lack of exercise problem is still a poverty problem.
Exercise is costly in time, and, therefore, money.
As a sort of self-performed experiment, I've exercised regularly for the last 2 years, on average of 3.5 times a week (every other day).
This required 1.25 hrs for the workout itself, another .25 hrs for the added commute, $60 for the gym membership per month, an increase in calorie consumption to compensate of about 30%, hence additional food costs of around $100/month.
That's a total of 273 hours in a year in opportunity cost and $1920 in various expenses.
Assuming a semi-skilled wage of $15/hr, that's $4095 + $1920 ~ $6000 opportunity cost per year to exercise and stay healthy.
$6000 is a make or break amount of money for poor people. I can afford it relatively easily, considering how much health benefits I receive from it, but living paycheck to paycheck, most of them likely can't.
Given that large numbers of obese people don't actually know a way to sustainably and healthily lose weight, focusing on figuring that out would be a good idea. Note that if the solution is "develop the habit of X", we'd also need to figure out how to actually develop that habit alongside raising kids, holding a job, and not alienating your spouse by hangrily shouting at them.
The most politically feasible solutions to help I can think of are education and better school lunch policies. I'd think the food lobbies would love if we provided free lunch to our students (other political factions maybe not so much). We'd of course need stricter guidelines to ensure the meals are healthy.
Another issue is it's expensive to eat healthier foods. Addressing income inequality feels like one aspect that could help as well. It's much harder to come up with a good, politically feasible solution to that.
Public-service advertising campaigns similar to those used for cigarettes. If we can convince the public that sugary/processed foods are icky, deadly, and pushed on an unsuspecting public by Big Evil Corporations, we might have a chance.
The Affordable Care Act (ACA / "Obamacare") allows medical insurers to give premium discounts to members who keep their BMI at a health level. We could expand on that. Some people do respond to financial incentives.
Why does shaming people not work? If we learnt there had been a secret government policy to reduce obesity by subtly promoting thin musicians and actors at the expense of their fatter competitors, and saw how successfully they promoted this idea of a healthy weight - we'd be in awe of this feat of propaganda/marketing/behavioural economics. That part has been done really well: in the West, fat people aren't beautiful and, with exceptions, successful people are not fat.
Gym memberships are at a high. The amount of time and money people invest purely in their fitness is at a high. Yet so is obesity. The behavioural forces making people fat are stronger even than the social, sexual and economic pressures driving people to be thin.
Well, we know the following: If people lived active lives and didn't eat too much we wouldn't have this problem. So I guess those are the only two vectors you can attack it on.
As far as eating goes, you can't really dictate quantity but I think one thing you can do is subsidize healthy foods and make them cheap and affordable so everyone can have access to them. I know if you grow up poor you just can't afford to buy healthy foods b/c they're too expensive.
As far as physical activity is concerned, we've had unhealthy foods for a long time and people have eaten unhealthily since the 50s. Look at this chart: http://wellandtrue.com/the-world-has-changed-so-have-our-wai... and you'll see that we only start getting a big spike after the 1980s when everyone basically started moving to fulltime desk jobs in front of a PC all day. So I think some kind of nationally mandated PE routine kids had to do M-F would be a start even though it'd probably never get support.
Fat tax, just like Japan. You want to be a fat ass, and drain resources, then you pay for it. Just like car insurance. You want to drive dangerous sports cars, then you pay a higher price to cover liability.
Funny how that map aligns, at least to the a first approximation, with red-blue voting. Of course, voting aligns reasonably with a number of the other variables (obesity, smoking, etc).
Ah someone just had to make it political again, sad to see this on HN, I'm sure you're the same kind of person who wonders why the country is so divided.
[+] [-] jfaucett|8 years ago|reply
After searching a bit, it seems like there is a lot of overlay with the obesity maps of the usa here: https://www.cdc.gov/obesity/data/prevalence-maps.html
not as much precision but exercise seems like it could also be a legit factor according to these maps: https://nccd.cdc.gov/dnpao_dtm/rdPage.aspx?rdReport=DNPAO_DT...
What would be interesting is to see if there are places where there is perhaps an inverse relationship and figure out what there the offsetting factors are.
Does anyone have links for maps of the others by any chance?
[+] [-] JBReefer|8 years ago|reply
[+] [-] Balgair|8 years ago|reply
[+] [-] flexie|8 years ago|reply
[+] [-] niftich|8 years ago|reply
That study actually offers insight into which particular factors correlate weakly or strongly with other factors, and offers charts and figures in key places to illustrate more detail than a mere line that mentions "socioeconomic factors, including race, education, and income, and access to health care".
It's not a long read at all, and highly recommended.
[1] doi:10.1001/jama.2016.4226 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/
[+] [-] davidf18|8 years ago|reply
Most of this was accomplished by public health initiatives such as raising the cost of tobacco to about $12-$14 per pack through NYS and NYC taxes, banning smoking in public places, hard-hitting anti-smoking ads of about $1 to $2 per capita per year. Significant efforts were made to reduce air pollution. Bloomberg is also known in his attempts to limit sugar-sweetened beverages (SSB) consumption by tax or banning the purchase with food stamp or limiting the size of fountain "Cokes" to 16 oz. These SSB attempts were unsuccessful, yet because of all of the publicity, the rate of New Yorkers who consumed at least 1 SSB per day dropped from 33% to 25%.
The politicians focus on access to care rather than on public health.
[+] [-] epmaybe|8 years ago|reply
"...this study found that socioeconomic and race/ethnicity factors alone explained 60% of the variation in life expectancy. At the same time, 74% of the variation was explained by behavioral and metabolic risk factors alone, while only marginally more variation was explained by socioeconomic and race/ethnicity factors, behavioral and metabolic risk factors, and health care factors combined. Furthermore, there was very little additional effect of socioeconomic and race/ethnicity factors when accounting for all 3 sets of factors simultaneously, suggesting that the association between life expectancy and socioeconomic and race/ethnicity factors at the county level is largely mediated through behavioral and metabolic risk factors."
Maybe I'm misunderstanding how they are controlling here, but don't race, income, socioeconomic status in general change one's behavioral and metabolic risk factors (think because I'm poor I don't have access to fresh produce, or something like that)? If so, the big conclusion gained by controlling for those factors seem nearly useless to me.
We all know by now that metabolic and behavioral risk factors drive health outcomes. Are the authors just trying to point out that hope isn't lost regardless of race or socioeconomic status?
[+] [-] PeterisP|8 years ago|reply
[+] [-] gm-conspiracy|8 years ago|reply
[+] [-] bkkssnn|8 years ago|reply
[+] [-] zajd|8 years ago|reply
[+] [-] vorotato|8 years ago|reply
[+] [-] dahart|8 years ago|reply
[+] [-] alphaoverlord|8 years ago|reply
[+] [-] afpx|8 years ago|reply
[+] [-] halestock|8 years ago|reply
"Ezzati et al. used Internal Revenue Service tax records that record movements from county to county to explore how much migration might explain disparities. They found that in general individuals moved from high life expectancy to low life expectancy communities and not the reverse. While their finding suggests migration may not be a major factor in the national patterns, it could be an important factor in selected counties that have experienced substantial in- or out-migration. On the other hand, net immigration of young Hispanic adults with lower mortality could have tended to increase life expectancy at birth for some counties and the nation as a whole."
[+] [-] crb002|8 years ago|reply
[+] [-] coldtea|8 years ago|reply
[+] [-] frgtpsswrdlame|8 years ago|reply
[+] [-] Consultant32452|8 years ago|reply
Oh, and the government should STFU about what it thinks is healthy. The last time it tried to interfere with the market it told generations of kids to eat a pound of bread every day. Don't tax anything you think is "bad" and don't subsidize what you think is "good."
If you absolutely must do something bring home-ec back to public schools. Teach kids how to cook. Then let them figure out on their own what they want to eat.
[+] [-] robertcorey|8 years ago|reply
[+] [-] antisthenes|8 years ago|reply
Exercise is costly in time, and, therefore, money.
As a sort of self-performed experiment, I've exercised regularly for the last 2 years, on average of 3.5 times a week (every other day).
This required 1.25 hrs for the workout itself, another .25 hrs for the added commute, $60 for the gym membership per month, an increase in calorie consumption to compensate of about 30%, hence additional food costs of around $100/month.
That's a total of 273 hours in a year in opportunity cost and $1920 in various expenses.
Assuming a semi-skilled wage of $15/hr, that's $4095 + $1920 ~ $6000 opportunity cost per year to exercise and stay healthy.
$6000 is a make or break amount of money for poor people. I can afford it relatively easily, considering how much health benefits I receive from it, but living paycheck to paycheck, most of them likely can't.
[+] [-] afarrell|8 years ago|reply
(I include myself in the set of people who don't know the solution, though I've never had this problem. My very naive intuition is that http://slatestarcodex.com/2017/04/25/book-review-the-hungry-... is a... reasonable jumping-off point?)
[+] [-] jay-anderson|8 years ago|reply
Another issue is it's expensive to eat healthier foods. Addressing income inequality feels like one aspect that could help as well. It's much harder to come up with a good, politically feasible solution to that.
[+] [-] ams6110|8 years ago|reply
Let people eat what they want to eat. Quit trying to micromanage other people's lives.
[+] [-] bitwize|8 years ago|reply
[+] [-] RangerScience|8 years ago|reply
But the right fix is definitely the food situation. Everybody already eats.
[+] [-] mindyourbetters|8 years ago|reply
[+] [-] nradov|8 years ago|reply
[+] [-] dmurray|8 years ago|reply
Gym memberships are at a high. The amount of time and money people invest purely in their fitness is at a high. Yet so is obesity. The behavioural forces making people fat are stronger even than the social, sexual and economic pressures driving people to be thin.
[+] [-] jfaucett|8 years ago|reply
As far as eating goes, you can't really dictate quantity but I think one thing you can do is subsidize healthy foods and make them cheap and affordable so everyone can have access to them. I know if you grow up poor you just can't afford to buy healthy foods b/c they're too expensive.
As far as physical activity is concerned, we've had unhealthy foods for a long time and people have eaten unhealthily since the 50s. Look at this chart: http://wellandtrue.com/the-world-has-changed-so-have-our-wai... and you'll see that we only start getting a big spike after the 1980s when everyone basically started moving to fulltime desk jobs in front of a PC all day. So I think some kind of nationally mandated PE routine kids had to do M-F would be a start even though it'd probably never get support.
[+] [-] jjt-yn_t|8 years ago|reply
[deleted]
[+] [-] jjt-yn_t|8 years ago|reply
[deleted]
[+] [-] overcast|8 years ago|reply
[+] [-] killjoywashere|8 years ago|reply
[+] [-] zzleeper|8 years ago|reply
- The Mississippi river is quite blue but has very low life expectancy
- Similarly in Montana and the Dakotas, the blue counties are the ones doing poorly
- From Alabama to SC, the black belt has low life expectancy and votes blue.
[+] [-] maxerickson|8 years ago|reply
http://gotz.web.unc.edu/2016/12/20/election-maps-representin...
(it's the 2016 popular vote)
[+] [-] SpartanMindset|8 years ago|reply