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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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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Pre-modern values, religion and culture

Many people outside the USA have watched with astonishment as fundamentalist Christians have aligned themselves with a serial adulterer and sexual assaulter who lost the recent election and is now seeking to undermine democracy in order to stay in power. Since first elected, Trump has worked hard to equate disagreement with treason. He has banished loyal opposition, sacked people for doing their jobs and called for the criminal investigation of ordinary opponents. But this alignment is not as bizarre as it seems on the surface. Fundamentalists share the value of demonizing and seeking to punish those they see as “other”, one of the key characteristics of fascism, as I discussed in my previous post. This applies to Christian fundamentalists and Muslim fundamentalists alike, as evidenced by the recent murders in France and Austria by Muslim terrorists angered by cartoons.

What is fundamentalism?

So I have extended my analysis of the the World Values Survey (WVS) and European Values Study (EVS) (see earlier post here) to see what it has to say about the extent of religious fundamentalism in the world today. Most religions developed in the pre-modern era and their sacred texts and teachings incorporate pre-modern culture and values to varying extents. Peter Herriot has written extensively on fundamentalist religious beliefs, characterized these movements as attempts to return to the pre-modern origins of their faith as prescribed by their sacred books [1]. He identifies five main general characteristics of fundamentalist religious movements:

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Trump’s threat to democracy: an attempted fascist coup?

Over recent months, there has been a steady stream of commentary in the Australian and European media arguing that the Trump program is fascist. Based on a couple of discussions with people who know much more than me about 20th century European fascism, I thought these claims were overblown, and that Trump’s program lacked a defining feature of fascism, the co-opting of industry of industry and the economy for ultra-nationalist goals. I’ve since realized this is too narrow a view of fascism, and that its expression is quite dependent on history, culture and period and may take a different form in different places and times. Mark Twain expressed this well when he said “History doesn’t repeat itself, but it often rhymes”.

Wikipedia has a good summary of the debate around definitions of fascism. But I was most struck by some of its quotations from various historians who have specialized in studying 20th century fascism (Wikipedia gives references):

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Why do people treat others with such inhumanity?

One of the key values of the Western Enlightenment that underlie the rise of science and our understanding of ourselves and the natural world is freedom of speech. Freedom of speech is under attack from the right and the left and from religious extremists. Last week, a French history teacher, Samuel Paty, was beheaded by an Islamic extremist after a lesson about free speech being a fundamental value of the French republic. And other extremists have attacked and killed people in France and Australia in the last week. Police forces and right-wing extremists in the USA have attacked Americans protesting against the extra-judicial murder of black Americans by police. And both the right and left are “cancelling” people whose views they disapprove of and in some cases making sure they lose their job or are boycotted.

Amara Green, a teenage girl who was hit in the face at close range by a deliberately aimed rubber bullet in Minneapolis, is facing months of reconstructive surgery

How can people treat others with such inhumanity?  And its not an insignificant proportionof the population. Despite horrifically cruel actions, such as separating babies and young children from their parents, locking them up, and not keeping any information that would allow the return of these children to their parents, a fairly stable 40% of Americans approve of these actions or simply don’t care all that much about them.  Evidence is now emerging of the extreme and unprovoked violence unleashed by police on peaceful protesters in the USA. There are now a number of documented cases of police vehicles being driven at speed into crowds. The same tactic that has been used with success by Islamic extremists in Europe. And clear evidence that so-called “non-lethal munitions” have been fired at point blank range at people, sometimes causing death, blindness or severe injury.

The same question has been examined in depth and debated at length regarding the role of the German people in the holocaust.  Why did ordinary Germans take part in large numbers in the rounding up and killing of Jews? This has been a question that I’ve thought a lot about, and found three books in particular to be very relevant.  I have been rereading these books over the last couple of months, as they examine these questions in depth and reach somewhat different conclusions from each other.

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Global and country-level prevalence of atheism in 2020

My previous post examined trends in religious belief and irreligion (non-religious and atheism) over the last 40 years using data from the World Values Surveys (WVS) and European Values Study (EVS) [1-4]. There is considerable interest in the prevalence of atheism, particularly from Americans, and a variety of quite different statistics are quoted, and have been written about in various media. In this post, I present my estimates of global prevalence of atheism for the year 2020 and discuss the various other sources of international statistics and the definitional issues. But first, here is my global map based on data from the WVS/EVS (see here for details of analysis).

And here is a closer view of the map for Eurasia. Further below in this post, I have included a more detailed country-level plot of all the religiosity categories (practicing religious, non-practicing religious, non-religious, atheist) for 2020.

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Is religious belief in decline and atheism on the rise?

Ronald Inglehart has recently published an article in Foreign Affairs called “Giving up on God: the global decline of religion” in which he uses data from the most recent wave of the World Health Surveys (WVS) to claim that between 2007 and 2019, the importance of religion has declined in most countries [1]. This is based on a single question on the importance of God in the respondent’s life on a 10-point scale. The average importance declined in 39 countries and increased in only 5.  Apart from the fact that this is based only on a single question on the importance of God, it also does not tell us how regional or global average ratings have changed. Depending on the relative populations and scale shifts in different countries, it could potentially even be consistent with a global average increase.

I’ve taken a closer look at trends in religious belief and practice using data from the World Values Survey and European Values Study [2-5] which have interviewed over 630,000 people in 110 countries in seven waves of the surveys over the period 1981 to 2020. These surveys include a direct question on whether you believe in God (Yes/No/Don’t know), but also “Are you a religious person” (Religious, Non-religious, Confirmed Atheist) and questions on frequency and type of religious practices, and on the importance in your life of religion and God. Of the 105 countries, 76 have data for years in range 2017-2020, and another 17 have data on or later than 2010.

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