Why do Americans die earlier than Europeans?

A recent paper by demographers Sam Preston and Yana Vierboom showed that there are an additional 400,000 deaths in the USA in 2017 that would not have occurred it the USA experienced European death rates. That is about 12% of all American deaths and higher than the COVID-19 death toll of around  380,000 in 2020.  In a Guardian article earlier this month they identified major factors contributing to this US “mortality penalty” including overweight and obesity, drug overdose, lack of health insurance, suicide, lack of gun control and racism. These deaths tend to occur at younger ages than Covid deaths on average, so that total potential years of life lost are three times greater for the excess deaths than for Covid in 2020 (13 million versus 4.4 million).

Preston and Vierboom used data from the Human Mortality Database (HMD) for their analysis. They calculated death rates based on the five largest European countries, whose combined population size is very similar to that of the United States: Germany, England and Wales, France, Italy, and Spain. They also argued that using these larger European countries  to provide a mortality standard would avoid unrealistic expectations that might result from comparisons including small countries with possibly exceptional combinations of factors affecting mortality (e.g., climate, diet, social history, and healthcare delivery).

A few days ago, I downloaded updated data from the HMD and replicated and extended their analysis to include years up to and including 2020, drawing on recent data from Eurostat and national health statistics agencies (see here for details of data, sources and methods).

The figure above shows the ratio of US death rates to the average death rates for the five European countries (the “European standard”) by age, in 2000, 2010, 2019 and 2020. US mortality rates are consistently higher than the European standard for all ages below 80 years and the ratio has gotten progressively worse throughout the 21st century. The peak ratio for 25-29 year olds corresponds to death rates for US 25-29 year olds that are three times higher than those of the European standard.

The next figure shows the annual trend in total excess deaths in the USA above the number than would have occurred if the US population had been subject to the age-sex specific death rates of the European standard. This excess rose from 219,000 in the year 2000 to 410,000 in 2019 and 616,000 in 2020. Although there were over 380,000 Covid deaths in the USA in 2020, the European standard also includes substantial numbers of Covid deaths, and the Covid excess for the USA is “only” 136,000 deaths.

I next estimated the contribution of various factors to the US excess death rate using information on cause-specific deaths and death attributable to selected risk factors in Europe and the USA. I also made estimates of the excess deaths associated with lack of health insurance or under-insurance in the USA compared to Europe where all the countries have universal health insurance, based on a study of the death rates in the non-insured in the USA. Together, the six factors identified in the following graph account for around 80% of excess deaths in the USA. 

For 2020, the leading cause of excess deaths was overweight and obesity (around 154,000 deaths), followed by Covid-19 (136,000 deaths), drug use and overdose (103,000 deaths) and lack of health insurance (74,000 deaths). Excess deaths due to homicide and suicide were smaller at 20,200 and 11,200 respectively. If the USA had the European standard death rates for gun homicides and gun suicides, it would have 15,900 fewer gun homicides and 19,200 fewer gun suicides. Around 40% of the latter would still commit suicide by other means. The figure also illustrates the dramatic rise in drug overdose deaths, the vast majority due to opioids both prescription and illicit, which has occurred over the last decade. In a previous post, I examined this in more detail and noted that, in 2019, the USA accounted for an astonishing 40% of estimated global drug deaths.

Why does the US perform so poorly in these areas? Preston and Vierboom argue that a lack of federal oversight and regulation, powerful lobbying structures, deindustrialization of American jobs, and systemic racism combine to create “an annual tsunami” of excess deaths. And that is even without the complete mishandling of the response to Covid by the Trump administration and many state governments.

Premodern religious values and happiness

I recently came across a ranking of countries by average reported happiness. This year’s World Happiness Report, released on March 20, uses data from the Gallup World Poll to calculate average reported happiness by country for over 150 countries for years 2005 to 2020. The focus of the report is on the impact of COVID-19 on happiness in 2020 by comparison with years 2017-2019. I was interested to see to what extent modern versus premodern religious values might explain variations in happiness across countries, along with a number of other factors that were examined in the World Happiness Report. I have posted here previously on my analysis of premodern or “fundamentalist” religious values.

The main measure used for happiness in the World Happiness Report is based on the national average response to the question on life evaluation in the Gallup World Poll (GWP). The English wording of the question is  “Please imagine a ladder, with steps numbered from 0 at the bottom to 10 at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you. On which step of the ladder would you say you personally feel you stand at this time?”

The following graph shows the happiness rankings of 101 countries for which I have both happiness measures and estimates of the modern/premodern religious values index I developed (see here). The happiness scores are averages for years 2017 to 2019.

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The Marvel Cinematic Universe: My rankings from best to worst

My previous post described my recent viewing of all 23 movies in the Marvel Cinematic Universe (MCU) and examined differences between my rankings of the movies and the rankings of critics, journalists and viewers. This post gives brief reviews of the MCU movies explaining why my rankings are sometimes quite different to others, and presents these in order from best to worst. Every other ranking I examined presents them in the opposite order from worst to best. However, I didn’t want to make readers plough through reviews of the worst movies first. Apart from the fact that nobody may be interested to read all my reviews, I’ve done them mainly to explore what I love and don’t love about the MCU, I’ve also included an index below, so you can jump straight to any particular review that interests you.

Warning: there are spoilers ahead.  If you haven’t seen these movies, watch them in timeline order first. In each review, I also give the median ranking from the 23 rankings I analysed in my previous post. The range in brackets gives the 25th and 75tb percentiles of the ranks.

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Watching all 23 Marvel Cinematic Universe movies in timeline order

My sons have been fans of the Marvel superhero movies for most of their lives and insisted I watch Marvel’s latest offering, WandaVision, a nine part TV series released weekly on Disney+ from January15th to March 5th this year.  When we got past the first two episodes, I was hooked. But the boys needed to explain quite a few of the characters and Easter Eggs to me and I realized my knowledge of the Marvel Cinematic Universe (MCU) was quite inadequate.

In just over eleven years since Iron Man was released in 2008, Marvel has released 23 movies that are all part of the same universe, the MCU. I saw quite a few of these in cinemas when first released or later on TV, but not all of them. So I decided to watch all 23 in timeline order, the order in which their events occurred in the MCU. WandaVision and the currently running Disney+ series The Falcon and the Winter Soldier are also part of the MCU, as is Black Widow due to be released in May. but I restricted my timeline viewing to the 23 movies in the following Table that were released before this year.

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Psychedelics and the health risks of drugs, alcohol and tobacco

In the last decade or so, there has been a renaissance of interest in the therapeutic potential of psychedelics. While natural psychedelic substances have been used by humans for many thousands of years, psychedelics had a massive cultural impact on the West in the 1950s and 1960s. Albert Hoffman, a research scientist working for the Swiss pharmaceutical company Sandoz, accidentally invented LSD (lysergic acid diethylamide) in 1938 and discovered its psychedelic properties five years later. In 1955, a New York banker named Gordon Wasson sampled the psilocybe (magic) mushroom in Mexico and published an article on his experience in Life magazine.

Scientists discovered the role of neurotransmitters in the brain in the 1950s, and psychedelics inspired scientists to search for the neurochemical origins of mental disorders previously thought to be psychological. Psychedelics were also used in psychotherapy to treat various disorders, including alcoholism, anxiety and depression, with some promising results, although these studies generally did not reach modern standards of research design.

However, psychedelics were also embraced by the counterculture and became linked in the mind of authorities with youth counterculture and the anti-Vietnam war protests. By the end of the 1960s, most Western governments had outlawed and forced underground the psychedelic drugs which had been legal in most places previously, and also shut down all scientific research.

In the 1990s small groups of scientists managed to start conducting various trials of the therapeutic uses of psychedelics and this has led to the so-called psychedelic “renaissance” in which larger well-designed trials of psychedelic use for treating a range of mental disorders are being carried out by research groups at institutions such as Imperial College London, Johns Hopkins University and New York University. Just today, it was announced that the Australian government will be providing $15 million funding for clinical trials into the use of psilocybin and other psychedelics for the treatment of mental illnesses, including depression and PTSD. Michael Pollan’s book How to Change Your Mind gives an excellent account of the history of psychedelics, both above ground and underground, and the psychedelic renaissance, and was a best seller. See also this article by Michael Pollan on the “Psychedelic Renaissance”.

As part of my work on the global burden of disease for the World Health Organization (WHO), I carried out several assessments of the direct and indirect health impacts of the use of drugs, alcohol and tobacco. I recently did an approximate update to year 2019 for deaths directly due to drug use disorders (overdoses and directly toxic effects) and indirect deaths from road injury, suicide and infectious diseases attributable to drug use. A proportion of HIV, hepatitis B and hepatitis C deaths can be attributed to injecting drug use with contaminated needles. The great majority of direct and indirect deaths due to drug use are due to the use of opioids, both illicit and pharmaceutical opioids. Very few deaths are associated with psychedelic drug use, but I was curious to get a ballpark estimate for comparison with other drug deaths. I will present a brief summary of the broad estimates of drug-attributable deaths, then review evidence on the likely contribution of psychedelic drugs.

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Revisiting The Hobbit movie (yes – as one movie not three)

Having recently re-read The Lord of the Rings trilogy (see my earlier post) and realizing that Peter Jackson had changed more in the movie versions than I had realized, I decided to rewatch the three Lord of the Rings (LOTR) movies for the third time, but this time in the Extended Edition, which I’ve never seen. I purchased a copy of that, which has just arrived. But I have been pondering whether to watch the Hobbit movies before watching LOTR.  I really disliked Peter Jackson’s padding out the story with made-up elements that were not in the book, and spinning it out to three overblown movies. There were some aspects I enjoyed, but I just could not bring myself to watch them again, let alone in the extended editions.

Then I stumbled across a “fan edit” of the Hobbit movies to make a single movie (of length just under 4 hours) which is reasonable faithful to the book, removes excess material and the more ridiculous action sequences. This fan edit, called “The Hobbit – The Cardinal Cut” is described here and can be downloaded or watched on Youtube.

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How long ago were the events of The Lord of the Rings?

As I discussed in my previous post, Tolkien set out to create a mythology for the English in the Lord of the Rings (LOTR), the Silmarillion and related writings on Middle-earth. He presented himself not as the author of LOTR, but as the translator of various histories written by Bilbo, Frodo and others in the Third and Fourth Age of Middle-earth. This makes Tolkien quite unusual among modern writers of fantasy in presenting it as set in the real worlc albeit in an imagined prehistory. What happened in that period before the Earth’s actual recorded history is otherwise remembered down through the generations as folk myths and legends, especially among the Old English. Tolkien’s life work was an attempt to reconstruct our prehistory, and more specifically the prehistory of the English. Critics Lee and Solopova commented that “Only by understanding this can we fully realize the true scale of his project and comprehend how enormous his achievement was” [1].

Tolkien described the region in which the Hobbits lived as “the North-West of the Old World, east of the Sea” in LOTR, ie. essentially Europe (including Britain). However, as he noted in a letter [2], the geographies do not match, and he did not consciously make them match when he was writing. In another letter [3] he became much more specific, saying “If Hobbiton and Rivendell are taken (as intended) to be at about the latitude of Oxford, then Minas Tirith, 600 miles south, is at about the latitude of Florence. The Mouths of Anduin and the ancient city of Pelargir are at about the latitude of ancient Troy.” In the Prologue to LOTR, Tolkien also notes that “Those days, the Third Age of Middle-earth, are now long past, and the shape of all lands has been changed…”

Fascinated by the detailed chronologies and calendars set out in the Appendices to LOTR and elsewhere, I have naturally wondered how long ago from now the events of LOTR took place. About 15 years ago, I came across an article in the Journal of the Tolkien Society [4¡ which deduced that the Fourth Age began on Wednesday 18 March 3,102 BCE.  The events of LOTR took place during the preceding year.  Despite the bizarre exactness of this, I was quite impressed by the argument, which I summarize here briefly.

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On re-reading the Lord of the Rings 50 years later

My first encounter with Middle Earth was when I came across The Hobbit in my first year of high school. The Hobbit gave me the same sense of the numinous and of “Northerness” as earlier had C.S. Lewis’s Chronicles of Narnia. I had borrowed it from the local library, did not remember the name of the author and only several years later as a teenager did I discover the Lord of the Rings (LOTR).  It was originally published in three volumes in 1954 and 1955, 18 years after the Hobbit was published in 1937. The Lord of the Rings became immensely popular in the 1960s with the publication of the Ballantine paperback editions, and in North America, the publication of the Ace pirated edition.  I first read it in 1969, when I purchased the 1968 first edition of the George Allen and Unwin one volume paperback with cover illustrations by Pauline Baynes:

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