Afghanistan, the war on terror and the war on drugs

Watching scenes from Kabul airport recently felt like déjà vu for me. The Vietnam War ended in eerily similar scenes. I’ve been astonished to read more than one article that has described the events in Afghanistan as an unprecedented military defeat for the USA, or as a sign that the era of neoliberal intervention in foreign countries was over. If the USA did not learn anything from Vietnam, why would we assume it will this time when facts and evidence are even less valued than in the past. Several commentators have noted the intersection of the US war on terror and the war on drugs in Afghanistan. I have been engaged for nearly 20 years now in work to update global estimates of conflict deaths and global estimates of deaths attributable to drug use. I was curious to look a little more closely at relevant statistics.

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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).

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A pandemic out of control

Over the last two days, I’ve been assessing the coronavirus situation across the world. I’ve posted a regional analysis of trends in new cases on my professional site (an-out-of-control-pandemic-in-most-world-regions).

I reproduce a graph of regional trends below. The dramatic difference in trajectories for Western Europe and the Americas is obvious. While levels are lower in most developing regions, this is mostly due to much lower levels of testing. But confirmed new cases in all regions apart from Europe and East Asia and Pacific are rising.

North America has the most out-of-control epidemic, and that is all due to the USA. I plotted trends for blue and red states in the USA. There is a dramatic difference, with most of the recent rise in new cases occurring in red states (that voted for Republican presidents in most of the recent presidential elections). In the week ending July 5, there were an average 226 new cases per 1 million population in red states compared to 88 per million in blue states.

In a second post which-countries-are-succeeding-and-not-succeeding, I have shown country-specific plots for selected examples of three groups of countries: (1) those that are beating Covid-19, (2) those that are nearly there, and  (3) those that need to take action.  The experiences of the first two groups of countries show that (a) it is important to act early, not wait till there a hundreds of deaths in the country, (b) it only takes about 5-7 weeks of strong interventions to get rid of the majority of cases and (c) half measures don’t work.