Fast food addiction, free-refill-fueled soda addiction, tobacco addiction, weakly trained near universal use of automobiles for daily travel, and unequal access to healthcare are staples of American culture so I am only surprised the spread is not worse.
This has very little to do with location or genetics and everything to do with education and culture.
Depends on country I think. At least here in Norway, after the ban on smoking indoors at public places like restaurants and bars 20 years ago, smoking went way down.
When I visited New York a few years ago I was shocked about how much smoking there was everywhere.
Of course, people didn't quit nicotine entirely, many moving to snus[1] instead.
> Fast food addiction, free-refill-fueled soda addiction, tobacco addiction, weakly trained near universal use of automobiles for daily travel, and unequal access to healthcare are staples of American culture
Every one of those points is also true in Europe (apart from possibly healthcare), unfortunately. Car dependency and car-centric development is almost everywhere, places like the Netherlands are an outlier. Fast food and ads thereof are also everywhere. Many people smoke. Etc.
> Car dependency and car-centric development is almost everywhere
It's the degree of things. I live in Ireland, in a village of a few thousand people a few km outside the city, what you might call a "suburb" in the US. I don't even have a driver's license. It's rarely an issue and can go about my life by foot. bike, and public transport.
> It's rarely an issue and can go about my life by foot. bike, and public transport.
You are a very unusual person then, as the vast vast majority of people in not urban core Ireland have (and use) a car. I live in a Dublin suburb, and we're one of the few married couples that don't have two cars.
> I live in Ireland, in a village of a few thousand people a few km outside the city, what you might call a "suburb" in the US.
Whatever villages that used to exist in the US have been drowned out by car-centric suburbs that were build around them. The 'village' is now the downtown-ish area of the community that tourists go see.
Never been to US but saying car centric development in Europe is similar to US sounds crazy to me. It's not just Netherlands. Vienna, Budapest, Stockholm, Barcelona, Germany and Switzerland... is it really true people in America take buses and trains as often as in those places? and they are also so well maintained? is it just propaganda that public transport in US sucks outside of maybe NYC
I live in a rural village about 5 hours' drive from NYC. There is no public transport here.
If I drive 45 minutes to the nearest city, I can catch a train—but that train will only take me to a few destinations (primarily Albany, NYC, or Boston one way, or Buffalo, Chicago and points west the other way).
Some cities (outside of major metropolitan areas, which do generally have some kind of rail system) have intracity buses, but they tend to be underfunded and dirty.
In 1990, there was no difference in life expectancy between wealthy white Americans and comparably wealthy Europeans (Fig 3 in the first link) Since then a gap has opened up among all levels of income (even the wealthiest white Americans now have lower life expectancy than comparably wealthy Europeans.) The second link looks at the biggest death causes (heart disease and cancer being #1 and #2) and conclude Americans have worse outcomes for both of these conditions.
Basically, Europe continued to improve while America stagnated in life expectancy over this time.
Interestingly, even in 1990, comparably poor Europeans had longer life expectancy than white Americans. So this isn't exactly new, but it seems all of American life expectancy has been stagnating, and wealth can only mitigate this to a certain degree.
I get the feeling that Universal Healthcare (medicare for all) would probably level the difference? What else is responsible for the almost 4yr difference with e.g. France? Is it diet? Is the air/water worse in the US?
Probably a combination of Universal Healthcare, Food Regulations (from what I understand, food quality regulations in the US are lacking compared to the EU), more balanced cultural attitudes towards work-life balance, less car-focused cities and more walkable cities.
That is likely more due to epigenetic factors than individual diets.
A lot of Eastern Europe was doing very poorly a generation or two ago, and we know that living through a period of hunger will cause your children to be more likely to gain weight.
> I get the feeling that Universal Healthcare (medicare for all) would probably level the difference?
Sometimes my wife convince me to try American candy/foods that we buy in these "foreign foods stores" locally, because she grew up eating some of them in her country.
And every time we check the contents by reading the nutrition-labels or checking with apps like Yuka, it turns out that the stuff Americans put in the mouth and stomach are filled with stuff that is outright illegal to put in foods here in Europe.
So if I were to guess, it would be related to what is legal to put in foods/consumables.
There's lots of stuff like that, the way chickens and eggs are cleaned etc.
It sometimes is annyoying though, especially around foods and medicine when something is not yet approved in Europe e.g. It's really hard to get Allulose (sugar alternative with similar properties benefitting baking); As far as I can tell it's not actually "illegal" in Europe, it's just not approved as a food, so no-one risks importing it..
It's not just the universal healthcare enables access to healthcare to more people. When healthcare is something being paid for by everyone, the state of other people's health matters to you too (not just your own).
Therefore, things like public smoking bans (as we have in the UK) as well as public health campaigns around alcohol consumption and healthy eating become palatable. Regulating harmful foodstuffs becomes more important. The cost of smokers' adverse health was (and still is) enormous, and reducing that burden benefits everyone.
> Smokers actually cost less than non-smokers because they die a decade and a half sooner, and old age is where most expense happens.
This is often mentioned, but it's simply not true. It's not old age itself that costs money, it's the part of your life where you need care and support. This is old age in otherwise healthy people, but smokers don't just drop dead one day, they go through as many if not more years of care and support as everyone else, they just do it younger (which costs in lost productive years too).
There's more. Traffic accidents, Americans have more than twice as many fatal accidents as Europeans and 3-4 times as many as France/Finland/…, and the age of people dying in traffic pulls down the overall average. And of course crime. Americans shoot each other, and that's not just 95-year-olds, so that'll pull down the average as well.
What shocked me about the US when I went, was how much peptobismol people chugged down.
There was not one meal in my 1 week stay there that I could digest without issue.
Annual sales of Pepto Bismol look to be well under $0.50 per person, so while the American diet and food quality is appallingly worse than Europe, I suspect your one week of stomach upset is not be a great source from which to extrapolate.
Fair enough, maybe it was just the amount and variety of peptobismol products that I noticed were for sale everywhere. For example just in the Hotel where I was staying, they had a bunch chewable peptobismol gummy bears + the ordinary bottles for sale.
Eating food and drinking water in a strange place can upset your stomach even if the people who live there all the time are fine. This is a very well-known phenomenon.
I doubt you can free healthcare your way out of obesity. You can't even healthcare your way out of obesity when you make it really, really personally expensive to be obese. And obesity is almost certainly the mortality bottleneck these days.
Obesity is primarily caused by the 1-2000 micro-decisions we make each year about what to eat, when, and how much. A free visit to the doctor now and then is just not going to move the needle much on that one way or another for most people, most of the time. Even if it could we have to ask why a $0 doctor visit would be so much more effective than a $100 doctor visit.
No, the effects you're seeing what Europeans are more fit than Americans on average is coming from somewhere else. I think the real answer is the obvious one: Food here in Europe is simply worse tasting than in the US in general. I've been here for 5 years across twice as many countries; I've never had a pizza here that even matches Little Caesar's back at home, in terms of lighting up my little monkey neurons, to say nothing of Costco. If I ever go back home I will break and get one of the two within a week of reaching the airport.
Capitalism is an optimization process that has optimized the heck out of food reward signal. Your only real options are either to be poor enough that capitalism doesn't care about getting you the 'good stuff' - easier said than done when being poor sucks, and when the good stuff is constantly getting cheaper over time anyway - or you fight back with even harder optimization in the reverse direction. You could argue Europe is some mixture of both compared to the US.
I think free healthcare means government must want ppl to be healthy. Unhealthy people literally take money from government's pocket, so gov uses various regulation against unhealthy stuff and does healthy lifestyle promotion
Can you explain how you disagree. You mean people have as much money as the government to waste on their health issues? Or you mean people without free healthcare can self regulate habits and be totally not influenced by corporate advertisement and cheap unhealthy stuff dominating food markets? I think that's maybe too rosy
Imagine the government pays for healthcare. The government can pass laws. What is cheaper for gov, to pass laws or to pay for healthcare. Of course they prefer to pass laws which regulate unhealthy stuff and run promotions to get people be healthy. Regular people cannot do this.
Alright, now imagine the government doesn't pay for healthcare. This is the literal cheapest thing for them, as it now costs $0, and they don't have to spend time worrying about law.
If the government isn't paying for your healthcare, then you have to pay it yourself. If you are fat, statistically, you will probably end up paying a lot more over time. This is not "wasted" money - no money you spend on your health is totally wasted. The good news is, you personally benefit from this money more than anyone else who could possibly spend it on your behalf - you reap the health benefits, the extra Christmases with the family, the bigger smiles from strangers.
Now how much does being fat cost over a lifetime? Frequently in the range of tens or even hundreds of thousands of dollars. That's pure medical costs, before we even consider how much the intangibles are worth.
The thing is: Most people understand this. If you understand this, and are still fat, then on some level you are indeed saying that the money isn't worth the trade-off of changing your whole lifestyle to (a) fix this and then (b) ensure you don't end up there again.
To me that's proof that being fat is a very hard thing to change just by throwing money at it. The literal best, most incentivized person, the fat person themselves, can't even figure out how to change it, not even with at minimum tens of thousands of dollars on the line. There are probably government interventions that probably could move the needle at scale, but they are probably not "let's subsidize spinach farmers" or whatever, because an extra $2 per week for spinach is just not that much money compared to even a single $50,000 gastric bypass. If it were as easy as throwing money at the problem, people would already be doing it given the stakes at play.
American baby boomers hobby in retirement is going out to eat as much as possible and drinking beer/wine. Or they travel to other countries to go out to eat as much as possible and drink beer/wine/cocktails.
All the baby boomer men in my family would be dead if it wasn't for the American health care system.
Even suffering heart attacks, they didn't miss a beat to get back to going out to eat, drinking beer/wine and being massively overweight.
If you go to any restaurant at night it will be packed with fat old people stuffing their face. Most on medications so that they don't have to change their lifestyle.
No country has ever had the BMI of old people that America has right now. It is a wealth curse.
Some of those you'd assume are to do with health care in general, but some (alcohol and tobacco consumption) are more like direct causes in and of themselves.
Comically, this is also basically a map of countries in Europe scored based on how convenient the existence of each country is to the kind of people who make us-europe comparisons
Take the absolute value and the numbers and you get an ok map of how likely someone is to be trying to mislead you if they're comparing all of the US to just this one nation.
You could make a pretty similar map with US states vs US average.
Any analysis like this that doesn’t factor in the East needing to catch up after 50 years of communist policies is misleading. I would be curious to see the improvement rate in say, Poland and Croatia over the last twenty years factored in and projected into the next two decades. Especially if we include economic success; Poland for example is probably going to be more economically successful than places like Portugal, if it isn’t already.
For Germany, it is instructive to compare detailled maps of life expectancy vs. household income. Both seem to be very much correlated.
A clear East vs. West and to a lesser extent North vs. South difference is obvious. In Western Germany, most region with very low life expectancy are those regions that were under strong economic pressure in recent decades (usually former mining areas, such as the Ruhr Area and the Saarland).
This. This picture only looks at current boomers which heavily favors those in western Europe who live like kings due to wealth, taxation and policies being catered towards them since they make a majority of the voters and caught the good times of economic growth and wealth building, but some of those economies kinda stagnated post 2008, which will mostly affect future generations of retirees not the current ones.
So I expect the picture of future retirees will look very different between countries with growing economies and the ones with declining/stagnating economies.
The country I'm from and the country I'm living in right now are both "democratic socialist", has been called "socialist hellhole" by more people than I can count, and they both sit at +4.0 and +4.4.
So I guess the positive ones are the "democratic socialist" countries?
Sure it isn't a socialist country, but many Swiss policies would be considered socialist in US politics, eg: if you are sick/ill you receive 80% of your salary for 720 days.
> Social democracy and democratic socialism are related but distinct political ideologies. Social democracy, often associated with the Nordic model, focuses on regulating capitalism to create a strong welfare state and reduce inequality through social programs, while generally supporting a mixed economy with private ownership. Democratic socialism, on the other hand, envisions a more fundamental transformation of the economic system, often including greater public or worker ownership and economic democracy, while also emphasizing democratic principles.
All countries in West Europe implement social democracies. They greatly outperform the US.
Countries in Eastern Europe are still enduring their legacy of communism/democratic socialism, but 30 years ago they experienced a radical swing towards the blend of neoliberalismo professed by the US.
Lastly, you look at data showing how the US greatly underperforms in key quality of life metrics, and the conclusion you opt to extract is cherry-pick those to look down on? That's tragic.
While genetics might play a small role for very specific reasons (eg a society thats prone to sickle cell disease will likely live shorter), there’s no such difference in large, diversified populations like US/Europe.
And most of the US gets a lot more sun exposure than most of europe. Also African americans...Well just black people in this context are more than twice as likely to get prostate cancer (more like 3 times given lower detection i've heard it said) supposedly because they have higher testosterone.
Not many ancestrally native Americans in Europe, relatively few jews compared to the USA (but more other semetic groups, I don't know if that balances or not), the sub-saharan Africans in Europe had a lot more volunteers and less industrialised human trafficing and are in any case very much more diverse genetically than people think due to superficial characteristics like skin colour (seriously, substitute race discussion about skin to be about blonde vs brunette to see how silly the groups are), and there's more of Irish in the US than the current population of Ireland.
What typical Reddit ignorance that compares the avg life expectancy of the whole USA with a range of 68 years for tribal people to 85 years for “Asians”, a 17 year spread, to individual European countries.
It has always baffled me a bit that Europeans keep making this basic type error, by comparing individual European countries that were relatively cohesive and healthy until recently, to the whole of the USA that suffers from a whole host of benefits of diversity. Europeans simply have no understanding of the real America beyond what they see in movies or hear on Reddit. How could they, most people in America don’t even have a clue what America really is like due to endless barrages of propaganda from childhood on.
> by comparing individual European countries that were relatively cohesive and healthy until recently
The first one doesn't include a few European countries. The second is completely backwards - health generally has been on the way up across the board for decades.
This has very little to do with location or genetics and everything to do with education and culture.
When I visited New York a few years ago I was shocked about how much smoking there was everywhere.
Of course, people didn't quit nicotine entirely, many moving to snus[1] instead.
[1]: https://en.wikipedia.org/wiki/Snus
Every one of those points is also true in Europe (apart from possibly healthcare), unfortunately. Car dependency and car-centric development is almost everywhere, places like the Netherlands are an outlier. Fast food and ads thereof are also everywhere. Many people smoke. Etc.
It's the degree of things. I live in Ireland, in a village of a few thousand people a few km outside the city, what you might call a "suburb" in the US. I don't even have a driver's license. It's rarely an issue and can go about my life by foot. bike, and public transport.
You are a very unusual person then, as the vast vast majority of people in not urban core Ireland have (and use) a car. I live in a Dublin suburb, and we're one of the few married couples that don't have two cars.
Whatever villages that used to exist in the US have been drowned out by car-centric suburbs that were build around them. The 'village' is now the downtown-ish area of the community that tourists go see.
I live in a rural village about 5 hours' drive from NYC. There is no public transport here.
If I drive 45 minutes to the nearest city, I can catch a train—but that train will only take me to a few destinations (primarily Albany, NYC, or Boston one way, or Buffalo, Chicago and points west the other way).
Some cities (outside of major metropolitan areas, which do generally have some kind of rail system) have intracity buses, but they tend to be underfunded and dirty.
In 1990, there was no difference in life expectancy between wealthy white Americans and comparably wealthy Europeans (Fig 3 in the first link) Since then a gap has opened up among all levels of income (even the wealthiest white Americans now have lower life expectancy than comparably wealthy Europeans.) The second link looks at the biggest death causes (heart disease and cancer being #1 and #2) and conclude Americans have worse outcomes for both of these conditions.
Basically, Europe continued to improve while America stagnated in life expectancy over this time.
Interestingly, even in 1990, comparably poor Europeans had longer life expectancy than white Americans. So this isn't exactly new, but it seems all of American life expectancy has been stagnating, and wealth can only mitigate this to a certain degree.
A lot of Eastern Europe was doing very poorly a generation or two ago, and we know that living through a period of hunger will cause your children to be more likely to gain weight.
Sometimes my wife convince me to try American candy/foods that we buy in these "foreign foods stores" locally, because she grew up eating some of them in her country.
And every time we check the contents by reading the nutrition-labels or checking with apps like Yuka, it turns out that the stuff Americans put in the mouth and stomach are filled with stuff that is outright illegal to put in foods here in Europe.
So if I were to guess, it would be related to what is legal to put in foods/consumables.
https://impact.economist.com/sustainability/project/food-sec...
It sometimes is annyoying though, especially around foods and medicine when something is not yet approved in Europe e.g. It's really hard to get Allulose (sugar alternative with similar properties benefitting baking); As far as I can tell it's not actually "illegal" in Europe, it's just not approved as a food, so no-one risks importing it..
- Titanium dioxide (E171)
- Potassium bromate
- Azodicarbonamide
- Propylparaben
I'm sure there is more, and there is probably also stuff that is banned in the US but not in Europe.
Therefore, things like public smoking bans (as we have in the UK) as well as public health campaigns around alcohol consumption and healthy eating become palatable. Regulating harmful foodstuffs becomes more important. The cost of smokers' adverse health was (and still is) enormous, and reducing that burden benefits everyone.
The true issue is secondhand smoke. That for me is what it all is about: preventing unwilling people from being exposed to smoke, full stop.
About as many people die from smoking than from secondhand smoke. Think for a minute how horrifying that is.
This is often mentioned, but it's simply not true. It's not old age itself that costs money, it's the part of your life where you need care and support. This is old age in otherwise healthy people, but smokers don't just drop dead one day, they go through as many if not more years of care and support as everyone else, they just do it younger (which costs in lost productive years too).
https://www.gov.uk/government/publications/cost-of-smoking-t...
There’s been a number of studies on this, and they do seem to suggest that overall smoking saves society money. E.g. here’s one from Finland
https://bmjopen.bmj.com/content/2/6/e001678
Large portion of americans eat like they have free healthcare.
What shocked me about the US when I went, was how much peptobismol people chugged down. There was not one meal in my 1 week stay there that I could digest without issue.
My understanding for Scotland/England it is a question of alcohol/drugs to some degree. I suspect it is similar for the comparison to US.
That means poorer countries tend to have worse healthcare, and less good outcomes.
It’s much more than money.
https://publichealth.jhu.edu/2024/americans-die-younger-than...
Obesity is primarily caused by the 1-2000 micro-decisions we make each year about what to eat, when, and how much. A free visit to the doctor now and then is just not going to move the needle much on that one way or another for most people, most of the time. Even if it could we have to ask why a $0 doctor visit would be so much more effective than a $100 doctor visit.
No, the effects you're seeing what Europeans are more fit than Americans on average is coming from somewhere else. I think the real answer is the obvious one: Food here in Europe is simply worse tasting than in the US in general. I've been here for 5 years across twice as many countries; I've never had a pizza here that even matches Little Caesar's back at home, in terms of lighting up my little monkey neurons, to say nothing of Costco. If I ever go back home I will break and get one of the two within a week of reaching the airport.
Capitalism is an optimization process that has optimized the heck out of food reward signal. Your only real options are either to be poor enough that capitalism doesn't care about getting you the 'good stuff' - easier said than done when being poor sucks, and when the good stuff is constantly getting cheaper over time anyway - or you fight back with even harder optimization in the reverse direction. You could argue Europe is some mixture of both compared to the US.
Imagine the government pays for healthcare. The government can pass laws. What is cheaper for gov, to pass laws or to pay for healthcare. Of course they prefer to pass laws which regulate unhealthy stuff and run promotions to get people be healthy. Regular people cannot do this.
If the government isn't paying for your healthcare, then you have to pay it yourself. If you are fat, statistically, you will probably end up paying a lot more over time. This is not "wasted" money - no money you spend on your health is totally wasted. The good news is, you personally benefit from this money more than anyone else who could possibly spend it on your behalf - you reap the health benefits, the extra Christmases with the family, the bigger smiles from strangers.
Now how much does being fat cost over a lifetime? Frequently in the range of tens or even hundreds of thousands of dollars. That's pure medical costs, before we even consider how much the intangibles are worth.
The thing is: Most people understand this. If you understand this, and are still fat, then on some level you are indeed saying that the money isn't worth the trade-off of changing your whole lifestyle to (a) fix this and then (b) ensure you don't end up there again.
To me that's proof that being fat is a very hard thing to change just by throwing money at it. The literal best, most incentivized person, the fat person themselves, can't even figure out how to change it, not even with at minimum tens of thousands of dollars on the line. There are probably government interventions that probably could move the needle at scale, but they are probably not "let's subsidize spinach farmers" or whatever, because an extra $2 per week for spinach is just not that much money compared to even a single $50,000 gastric bypass. If it were as easy as throwing money at the problem, people would already be doing it given the stakes at play.
All the baby boomer men in my family would be dead if it wasn't for the American health care system.
Even suffering heart attacks, they didn't miss a beat to get back to going out to eat, drinking beer/wine and being massively overweight.
If you go to any restaurant at night it will be packed with fat old people stuffing their face. Most on medications so that they don't have to change their lifestyle.
No country has ever had the BMI of old people that America has right now. It is a wealth curse.
https://www.nationhoodlab.org/the-regional-geography-of-u-s-...
https://x.com/TerribleMaps/status/1933586469207036321
I think the proximal answers for "why" are in the World Health Report, which tells you why people die.https://www.who.int/data/gho/publications/world-health-stati...
Some of those you'd assume are to do with health care in general, but some (alcohol and tobacco consumption) are more like direct causes in and of themselves.
Take the absolute value and the numbers and you get an ok map of how likely someone is to be trying to mislead you if they're comparing all of the US to just this one nation.
You could make a pretty similar map with US states vs US average.
Correlation is a hell of a drug[1].
[1] https://m.xkcd.com/1138/
A clear East vs. West and to a lesser extent North vs. South difference is obvious. In Western Germany, most region with very low life expectancy are those regions that were under strong economic pressure in recent decades (usually former mining areas, such as the Ruhr Area and the Saarland).
Here is a 2020 map of life expectancy: https://www.demogr.mpg.de/media/13419_main.png
And here a 2019 map of household income: https://www.wsi.de/de/einkommen-14582-einkommen-im-regionale...
Differences is smoking might also have an important impact. Here is a 2013 map: https://bilder.deutschlandfunk.de/FI/LE/_f/47/FILE_f4790b165...
This seems to imply an even closer correlation.
Of course, correlation does not imply direct causation. The underlying causalities might be various, complex and different from region to region.
So I expect the picture of future retirees will look very different between countries with growing economies and the ones with declining/stagnating economies.
Those are basically all in yellow on that map.
So I guess the positive ones are the "democratic socialist" countries?
That said, those are two micro states, so I’m not sure how applicable they are to larger countries. Switzerland isn’t huge but it also isn’t tiny.
Microstates seem to do great, I also missed Monaco with a +7.1, Andorra is between France and Spain with a +4.7
> Social democracy and democratic socialism are related but distinct political ideologies. Social democracy, often associated with the Nordic model, focuses on regulating capitalism to create a strong welfare state and reduce inequality through social programs, while generally supporting a mixed economy with private ownership. Democratic socialism, on the other hand, envisions a more fundamental transformation of the economic system, often including greater public or worker ownership and economic democracy, while also emphasizing democratic principles.
All countries in West Europe implement social democracies. They greatly outperform the US.
Countries in Eastern Europe are still enduring their legacy of communism/democratic socialism, but 30 years ago they experienced a radical swing towards the blend of neoliberalismo professed by the US.
Lastly, you look at data showing how the US greatly underperforms in key quality of life metrics, and the conclusion you opt to extract is cherry-pick those to look down on? That's tragic.
Probably loads of other differences too.
It has always baffled me a bit that Europeans keep making this basic type error, by comparing individual European countries that were relatively cohesive and healthy until recently, to the whole of the USA that suffers from a whole host of benefits of diversity. Europeans simply have no understanding of the real America beyond what they see in movies or hear on Reddit. How could they, most people in America don’t even have a clue what America really is like due to endless barrages of propaganda from childhood on.
Isn't USA a country? How is a country-by-country comparison "typical Reddit ignorance"?
I'm gonna use my typical Reddit ignorance to guess you are indeed from the USA.
Your access to booze, cigs and healthcare is very different in NM than it is in MA.
The first one doesn't include a few European countries. The second is completely backwards - health generally has been on the way up across the board for decades.