"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?
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...
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.
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?
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.
Well, I don't think that is going to "solve" the underlying problem. It might help the government pay for things, but it's not going to solve the obesity epidemic. There are already huge intrinsic and extrinsic negative impacts to your life if you are obese. One more negative impact is not likely to suddenly make you thin. What we need to do is figure out why people are getting fatter despite how much they don't want to be fat.
Those are hypothetical causes but they don't actually line up with all the observations. For instances, poor people are fatter than rich people. Shouldn't rich people be fatter since they
1) don't have to work as much manual labor
2) have more access to food.
You can try complicate the explanations to account for this but the fact is that it shows that the 'obvious' reasons most people surmise are not so clear cut and need to be tested like any hypothesis. It's a hard problem to test and there are several other competing hypothesis. The best I can say for my own beliefs is that we need to have more studies that need to be done before I'm convinced of any of them.
I suspect there is no one-size-fits-all solution for obesity: some people experienced sustained weight loss only after undertaking a vegetarian diet, some only by a ketogenic diet, some only by getting into sustained exercise, and some only by a laproscopic band. For some people, obesity isn't even associated with poor health.
Sorry, but exercise doesn't require a gym membership, that's just nonsense. Look at the guys in prison. Go run around your block, do pushups, and pull-ups in your house. I've never spent a dime in a gym, and I exercise five days a week.
Also exercise is not for weight loss, it's for exercise.
There have been poor people throughout the history of time, why is it that obesity rates have been going up? Shouldn't they stay the same, or decrease, as more people move away from the have not, to the have something? Spent a month in India, tons of poor people, very few fat ones. The majority of overweight people were the affluent, that just didn't care, because they were well fed, and had essentially slaves working for them to do all of the hard physical work.
Hyper levels of advertising with the primary messages being lack of self discipline is the definition of having fun, and sensible time preference judgment, or application of any judgment at all, is for boring low social status people because cool people live for this instant only and never judge anything ever.
Not too surprising that being immune or actively avoiding that toxic culture, results in both wealth and fitness.
You're right, having them pay more, isn't going to make them thin. People are going to do what they want regardless, just like smokers. People will smoke, while they are hooked up to oxygen keeping them alive. However, the cost of that shouldn't be redirected to people who have made an effort to live healthy their entire lives.
The problem with that logic is that people with unhealthy behavior actually cost the system less. It's way cheaper to be relatively sickly for a few decades then die of lung cancer or heart disease at 50 than be relatively healthy and die of cancer or alzheimer's at 90.
Not saying something like that might not be a good idea from a public health perspective. I'm not educated enough on those issues to have an opinion.
Cancer, and Alzheimer's are generally not preventable. Being fat is. If you want to compare fat people dying of heart disease, and smokers dying of emphysema, fine. But don't compare an avoidable problem, with an unavoidable one.
Why not? We're talking about average lifetime medical costs, so who cares if one is preventable and one isn't?
From a public health perspective yes that absolutely matters, but all I'm saying is this narrow claim: You will not save money on medical costs if you get your population to act healthier and they die of unpreventable diseases instead of preventable ones.
If you want to be fat, please raise your hand. Those who think being fat is fun or desirable, hands up.
Nobody? Really?
What you're proposing is to pile additional hardship on people who are likely already unhappy with their current situation, and may also feel powerless to fix that part of their lives. On its face, your proposal lacks both compassion and efficacy.
It's also horribly authoritarian, and would likely discourage people from seeking preventative health care, just because the nurses weigh you at your office visit. Think about the potential unintended consequences before firing off a glib, "fix it with market incentives" proposal, paired with reasoning by [car] analogy.
On average, healthy people lived 84 years. Smokers lived about 77 years and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people.
Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.
The cost of care for obese people was $371,000, and for smokers, about $326,000.
Interesting. I went and read the study which does support what the NYT is saying more or less [1].
The main factor as to why this is the case is important though. The longer you live the more costs you incur on the system because you end up getting another sickness which costs a lot more to treat, they specifically quote Alzheimers, than obesity and lung cancer.
One thing they did not take into account though is the lack of productivity i.e. the costs of being disabled (possibly b/c it is a dutch study using dutch data and parameters), in the USA diabetes is a disability and incurs significant other costs on the system which were not taken into account. It would be interesting to see what the comparisons would look like once that is taken into account.
But its certainly the case that smoking is much cheaper overall. It doesn't lead to disabilities and people die younger and incur far less costs.
Came here to say the same thing, it's absolutely INSANE how much we subsidize, for example, corn. So it's no wonder there's plentiful cheap corn being stuffed into processed foods (incidentally also increasing the amount of processed food) and overwhelmingly what our cattle are fed with.
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.
Have you seen what is in the school breakfasts and lunches that are provided to students now? It's sugar cereal, donuts, pastries, and fruit juice. The only thing nutritious is the carton of milk, and three-quarters of them opt for the chocolate milk.
Still, as bad as it is, it's better than nothing - I grew up in a pretty depressed, white-trash area where better than 50% of kids were on free-and-reduced lunch subsidies, and for not a few, breakfast and lunch at school might be the only meals they got some days. But for god's sake, we can do much better than we're doing, and it shouldn't cost any more than the sugar-blasted packaged garbage we're shoveling at kids today. Make a big batch of scrambled eggs, give them a piece of toast with peanut butter (although I supposed peanut allergies have ruined that), oatmeal, something with a little protein or complex carbohydrates in it, a piece of fruit. It's not rocket science.
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.
> I know if you grow up poor you just can't afford to buy healthy foods b/c they're too expensive
I feel that's a common misconception. Sure, you can't buy fresh, organic foods but I'm able to build muscle on about ~$10/day and stay healthy as a horse.
Frozen peas (most frozen veggies) are $1 for 4 servings; canned black beans and chickpeas are $0.89 for 4 servings; whole-wheat bread is $3-4 for 18 pieces; 1 gallon of water is $0.89 (if you faucet water isn't drinkable); etc.
You certainly can eat healthy on the cheap. It's just that most people don't want to make the sacrifice.
$10 a day is $300 a month, which is a lot to someone near the poverty line (~$1000 a month). The maximum SNAP (food stamps) benefits for an individual is $194. I know SNAP is supposed to be supplemental, etc., but the government has decided someone who is very poor shouldn't have access to the level of nutrition you're talking about.
You can eat on $200 a month without much problem. I received max SNAP benefits for several months and I spent about $120 a month on food, so I had money left over at the end (being a vegetarian helps).
This really isn't relevant to the point at hand (or maybe it is, who knows?) but I think poor people would have an easier time if the means testing for food stamps were looser. The benefits fall off steeply. If someone is making a thousand dollars a months and working full-time or close to it, the government can chip in more than $10-20 to give them access to healthier food.
I'm sorry, I should've been more specific. It's $10/day for me because I'm building muscle and eating 3,600 calories a day.
If necessary, like when you're in a maintenance phase, you could get it to $5/day.
I hear you and agree. I think the means testing for food stamps should be looser too. It's funny, I know a couple people on food stamps and I know a few vegans. What you say is true.
I don't know. It would be interesting to know what the research says. I lived in poverty for much of my younger life and we wouldn't buy a lot of health foods because they were expensive. I remember fruits and meat were a rarety you got exited about. And I was lucky because my parents still tried to feed us healthily - we had a garden and chickens.
Its also probably true that you don't need as much variation and nutritionists say - you could probably live healthily off of potatoes and eggs.
I've also lived off of what you suggest and its not that pleasant. If you want fresh salads and vegetables the price starts going through the roof, so you're basically stuck with the cheapest canned/frozen stuff. Sure you can do it and I have but its not surprising people don't stick to it long when most of the tasty alternatives are either too expensive or just plain junk food.
> Its also probably true that you don't need as much variation and nutritionists say
Yeah, I've felt the same, and that's why I put it to the test. I can't necessarily extrapolate. All I can say is for the better part of 2.5ish years I've been eating the same thing everyday and my health (according to my yearly checkups) has been stellar.
Of course, you have to hit your macro- and micro-nutrient requirements in your daily regimen.
> I've also lived off of what you suggest and its not that pleasant.
It's a matter of perspective, I guess. I look forward to peanut butter peas or greek yogurt with honey roasted peanuts mixed in or overnight oats made with frozen blueberries and soymilk.
I guess I was just trying to offer up that there is a way to eat healthy, cheaply. Because I certainly didn't know about it until later in life.
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.
> The last time it tried to interfere with the market
OTOH, the first few times it interfered with the market they solved widespread nutritional deficiencies that were killing, crippling, and otherwise substantially harming hundreds of thousands of people every year. I'm speaking of the fortification programs:
On balance I'd prefer they keep at it. Anyhow, the government was simply echoing the advice of the medical establishment. At worse they've merely been a few years behind those recommendation, which is nothing on the scale of a lifetime.
If you have a beef, it's with he medical and nutritional sciences, which invested too much confidence in what should have been recognized as problematic research results.
>Anyhow, the government was simply echoing the advice of the medical establishment.
No it absolutely wasn't. It was echoing the advice of the agriculture lobby. The medical establishment sent its information in and the FDA altered it. And guess what? The food guidelines from this year were manipulated by the agriculture lobby too. http://time.com/4130043/lobbying-politics-dietary-guidelines...
I only skimmed your article, but it appears those instances were almost entirely labeling guidelines. Example: What constitutes "enriched" flour? I can see the value in that, but I hope it's clear that's very different from marketing enriched flour via the government provided education system.
You said that the gov't "told generations of kids to eat a pound of bread every day." That seemed clearly a reference to the food pyramid and similar guidelines which recommended relative proportions of carbohydrates, proteins, and fats. Those recommendations were largely reflective of the medical consensus, such as it was--i.e. too much group think and too much reliance on epidemiological methodologies rather than investigatory science.
Yes, the USDA is responsive to the agricultural lobby. So what? At the end of the day it doesn't matter how or why they make their recommendations, but the substance and effect of those recommendations. And my point is that in the long-term the general guidance of the USDA has reflected, more than anything else, the medical consensus. Obviously it doesn't only reflect that, but everything is effected by lobbying, even the medical consensus.
And my larger argument is that if you examine its long-term track record, on the whole it has been positive, at least in the context of nutritional policy. Yes, the USDA's fortification program was largely voluntary. So were its more modern recommendations. Sometimes their recommendations weren't voluntary, like guidelines for federally funded school lunch programs. But the same applies to their fortification programs--those school lunch guidelines also mandate fortified foodstuffs. Also, the fortification programs involved direct and indirect subsidies, which is why most basic foodstuffs (grains, salt) at retail were fortified, at least until the organic craze.
I respond because I'm tired of the narrative that when government does something stupid the answer should just be to remove government from the equation. That's not rational. In every context we should endeavor to make informed and well-reasoned judgments based on a) context, b) facts, and c) some rough assessment of our priorities. Unfortunately we've forgotten how to incorporate those three things into our discourse. We don't understand context because we reframe every issue as some ideological battle about government. We don't understand facts because we're too lazy to root them out, and too lazy to assess their relevance and strength. And we suck at agreeing on priorities because, similar to context, we confuse the means with the end--that is, we seem to think our ultimate goal is to refashion government to fit some conceptual model, rather than to refashion particular laws and agencies to best meet some quantifiable goal, like a lower incidence of diabetes.
This retreat and resort to ideology and abstract modeling is not only a political pathology, but arguably it has been the problem with nutritional science. For example, when I mention "epidemiological methodologies" above I'm implying, among other things, that we committed a category error: too much salt might be "causative" of high blood pressure on a population wide scale, but on an individual scale it doesn't cause anything in most people, and the particular issue in the subset of the population responsive to high salt intake wasn't something you'd expect given the large population studies. The population-wide mechanism was empirically sound (lower average salt consumption, improve average outcomes) but not reflective of the underlying pathologies at the micro-scale and ultimately suboptimal.
IOW, yes, if _everybody_ reduced salt consumption to some common recommended level then population-wide health could improve. But there's a better equilibrium to be found by understanding the details and taking a more nuanced approach, allowing us to improve health even more. Likewise, maybe we might all be better off on average if the USDA disappeared overnight. But perhaps there's a better equilibrium where the USDA still has a role. We can't know without making a careful assessment, and continually re-making that assessment.
Let's stop being lazy. Let's dig into the details. It's difficult a...
>I respond because I'm tired of the narrative that when government does something stupid the answer should just be to remove government from the equation.
Don't pretend like you're presenting anything but an equal and opposite narrative. This government program, which is nothing more than bought and paid for marketing by lobbyists, has literally killed millions of people. How many people need to die before you'll say enough is enough?
If the government got out of the way then people would seek out the information they need and they would get it from a variety of sources such as books, their personal physicians (probably the best choice), or other sources. Unreliable sources would relatively quickly fall by the wayside. But the government voice is a foghorn which cannot be ignored, especially when you put it in the school curriculum.
>Let's stop being lazy. Let's dig into the details.
I'm right here with you. One-size fits all nutrition recommendations from the government is a disaster. When the government becomes a voice for nutrition recommendations its scope makes it, in effect, the only voice. That makes the government voice the ripest target for manipulation. Instead, the voice of the scientific community at large should be out there. It's there today, but it's drowned out by the government fog horn. If you want nutrition information, the best person to talk to is probably your doctor because they will know pretty near the latest medical information and be able to adjust it for you as an individual.
Central issue: medical consensus in food pyramid era.
I think the only thing you two actually disagree about (because I certainly agree with most of what both of you said) is the medical consensus at the time of the food pyramid, and the only thing that has been contributed to that is a Wikipedia link. Now I have a high degree of faith in Wikipedia and also fully expect the food pyramid was bought and paid for, but following through on Wikipedia to the links supporting this brings 2 book links and a USDA.gov page. Perhaps reading the books would provide a high degree of good explanation, but I still don't know what the medical consensus at the time was. My contribution is a crappy link ( http://www.nytimes.com/2007/10/09/science/09tier.html ) that suggests the medical consensus indeed thought fat was a greater enemy and am left with no solid belief of the central issue. Stuff is hard.
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.
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.
The problem is fitness alone is not a cure for obesity. I think diet is the biggest factor in American obesity, even though lack of exercise is obviously a big problem as well. Portion sizes are inflated compared to other countries, soda is cheaper than water in some places, and high sodium and high fat foods are consumed daily by many people. Not to mention high-calorie "coffee" from places like Starbucks.
People are down voting you but the cold hard truth is you can maintain a healthy weight by diet alone. No amount of excerise is going to offset eating a whole pizza and cheeseburgers everyday unless you're training at Olympic athlete levels.
You aren't going to put on weight or maintain an unhealthy weight if you aren't eating excess calories.
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.
It's really not. BMI is wildly outdated, and especially doesn't deal well with anybody who has a larger body frame. At the thinnest I've ever been in my life, when you could see every rib hanging out, I was still forty pounds heavier than what BMI charts calculated my weight ought to be.
I don't know for a fact, but I would very much expect the answer to be yes. The relevant metrics to look at would be body fat percentage, cholesterol, triglyceride, and blood sugar levels, resting heart rate and blood pressure, and insulin sensitivity. After correcting for those, weight is just not a risk factor, so far as I know.
The Army solved this decades ago with tape tests. Been a quarter century since I had to take one, but it used to be the ratio of various bodily circumferences. If your stomach to chest ratio or your neck to bicep ratio were reasonable, you were OK regardless of physical weight. It takes perhaps a minute per soldier, as compared to recording weight which takes only seconds, so the simple BMI is still useful as a time saving prescreen. It worked very well decades ago, so an optimist would think the Army still tapes and a pessimist would assume it no longer tapes.
I would imagine if 320 million people are going to be measured for financial punishment purposes, there would be a startup opportunity in some kind of 3-d scanning appliance that could auto-generate circumference measurements.
Of course where money is involved corruption will develop and inevitably there will be clinics where patients are asked politely to measure themselves and record their own numbers, such that the promised savings will never occur.
Yes some people will always try to commit insurance fraud. That's nothing new. Insurers typically guard against that by looking for suspicious data patterns. And most providers won't participate in fraud due to the risk of getting kicked out of insurance networks, or being punished by state licensing authorities.
We already have a 2D scanning appliance which can measure body fat to 1% accuracy, even for weightlifters. It's called a DEXA scan. Currently scans cost about $50 and take several minutes, so not really practical for screening millions of people every year. But I'm sure engineers are working on improving cost and speed.
I'm also wondering why people have the impulse to solve other people's problems whether they asked for help or not (compare this map with a Trump voter map and see how much they tend to like things like the ACA).
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.
...you can also factor in the time value of money since the goal, at least in this conversation, is to increase lifespan and health decades in the future.
And in a hyper-youth centered culture, "I'll have a lot of fun when I'm 25" counts for a lot more than "I'll be dead at 75"
Assuming exercise isn't fun. Physical therapy is supposed to be a brutally painful and exhausting way to repair damage that you'll feel better about in the distant future. Exercise should be fun. If you're not having fun, with fun people, you're probably doing it wrong.
Your example is just one way of exercising, though. There's no getting around it requiring some time, but you can likely do a decent bodyweight-style workout without a gym membership, without a commute, using only implements you can find in your community. Some space to jog, do pushups, something you can hang from to do pullups, etc. People have been training themselves to have fairly large amounts of muscle and endurance in jail, in 3rd world countries, and plenty of other places besides expensive gyms.
[ why is >> was this text in a SCROLL RIGHT to read ?? ... and then not? ]]
What is it tied to? Fun anecdote. Waiting for an x-ray, after strenuous exercise fall, having walked to the medical office, co-workers broke ice with each other by congratulating each other on having eaten large meals I long ago swore off of, or having supplemented such with 'desserts' in the olden days, now new normal, that are seemingly a perk of having gone outside from the office. Persons not unhealthy at that age, but as salaried and the more intelligent sector of American society, the grim role modelling I envisage at/in their household making ostensibly an outlier of olden day fast-til-we-can-eat-thank-god thinnesses now regaled as outliers, even chastised as unforgiving, a not easily solved, if ever, politically at least, pattern of ever-larger waistlines and expenses to be borne by the 'olden days' non-soda non-dessert daily small sector of society that comprises now a small minority more rural and unrepresented in the new normal. Hope this does not sound harsh. [[ why is >> was it a SLIDER btw [ now is not ] ]]
What is it tied to? Fun anecdote. Waiting for an x-ray, after strenuous exercise fall, having walked to the medical office, co-workers broke ice with each other by congratulating each other on having eaten large meals I long ago swore off of, or having supplemented such with 'desserts' in the olden days, now new normal, that are seemingly a perk of having gone outside from the office. Persons not unhealthy at that age, but as salaried and the more intelligent sector of American society, the grim role modelling I envisage at/in their household making ostensibly an outlier of olden day fast-til-we-can-eat-thank-god thinnesses now regaled as outliers, even chastised as unforgiving, a not easily solved, if ever, politically at least, pattern of ever-larger waistlines and expenses to be borne by the 'olden days' non-soda non-dessert daily small sector of society that comprises now a small minority more rural and unrepresented in the new normal. Hope this does not sound harsh.
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'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.
I was just a reader so far but I had to register now.
As someone who works full-time in this field:
- You are right about the definition of life expectancy.
- I have never ever heard this definition of longevity. It is sometimes used as a synonym for life expectancy.
- No one dies of old age.
My sensitivity to the difference between these terms comes from reading Ray Kurzweil's (and many others') bullshit arguments about how humans will eventually become immortal through technology. He intentionally conflates trends in life expectancy with longevity, as do other charlatans who will sell you a cryogenic chamber or life extending elixir. Having life expectancy increase does not mean that large numbers of humans are going to start living to be older than 100 years. The longevity of humans has been around 80 years and barely changing for thousands of years. The life expectancy of different regions has varied wildly depending on how many people die young.
I'm fairly stunned if you work in this field that you wouldn't have heard of the concept of longevity, or at least maximum lifespan, as something distinct and opposed to life expectancy. It's quite important to rule out accidental causes of death if you want to have any chance of understanding how long humans can possibly live. Being able to make statements about diet and exercise requires being able to factor out all car and sports accidents from the average.
Here's what Wikipedia says: "Longevity, maximum lifespan, and life expectancy are not synonyms. Life expectancy is defined statistically as the mean number of years remaining for an individual or a group of people at a given age. Longevity refers to the characteristics of the relatively long life span of some members of a population. Maximum lifespan is the age at death for the longest-lived individual of a species. Moreover, because life expectancy is an average, a particular person may die many years before or many years after the "expected" survival. The term "maximum life span" has a quite different meaning and is more related to longevity."
To be fair, the Longevity entry echoes what you said, that some people use it as a synonym.
My hope was that the NIH would be more careful, because they're scientists working in the field, and they know better than to use vague terms that have easily misunderstood meanings.
> No one dies of old age.
True, but you know exactly what I mean, right? Whatever you want to call it, natural causes? Ideal conditions? What is the correct term for people who grow old and don't die of an accident?
Thank you. I agree with many of your points.
Of course, I know about the discussion of (maximum) life span and also of life expectancy. And, obviously, the maximum and the expected value (life expectancy) of a random variable is something different.
I also agree with your statement that life expectancy depended heavily on how many people die young. Absolutely. But what is not correct is the statement about the number of centenarians. Please check, for instance, the Human Mortality Database yourself at www.mortality.org to see how quickly the number of them is growing. This does not only have something to do with larger birth cohorts entering those ages but also because of major reductions in mortality among people aged 80-100. And I would be very curious if you were able to provide a scientific reference to your statement that human longevity (do you mean maximum life span?) has been around 80 years for thousands of years. Do you agree with me (if you refer to maximum life span) that this is different now?
And -- as you say correctly -- I also agree with you that it would be advisable not to use vague terms. And in my opinion longevity is a vague term since some people use it for life expectancy others for life span. So it would be better if people use those clearly defined concepts to avoid confusion.
My comment about "no one dies of old age" refers to the fact that a certain cause (ICD 10 code) has to be entered on the death certificate. But I also agree with you here: the precision of this information at very high ages might be problematic due to multimorbidity. Your question concerning the "correct term..." I do not want to claim that I know the correct term. In my experience, people usually differentiate between senescent mortality and non-senescent mortality.
Final remark: It seems you are familiar with James Fries' influential paper from 1980 in NEJM [0] since he is talking about "ideal conditions" and "natural deaths", which is pretty close to what you write in your last sentence. :-)
I'm a bit of a hypocrite demanding clarity from the NIH but not being clear enough myself. :P I'm in full and complete agreement with you that vague terms should be avoided. "Mean lifespan" would be better than both life expectancy and longevity. "Top 10% of lifespan distribution" would be clearer than longevity, and probably more informative than "maximum lifespan".
Maybe I should have said that the number of people living to be older than 130 isn't going up, instead of 100. Yes, there are more centenarians now. Yes, there are more people over 80 now. None of that means that we've increased the maximum possible human lifespan in any way. All it proves is that we've decreased the number of people who died before they could have, right? Better medicine, fewer murders, safer cars, cleaner air, less food poisoning. All these advancements help us "live longer", and yet none of them increase the maximum lifespan. We are getting asymptotically closer to the maximum possible, more and more people are approaching the limit, but there is no evidence yet that the limit is moving or has ever moved, and that's all I want to be clear about.
I'm mostly making an argument to counter people (not you) who are, for whatever agenda, intentionally suggesting that increases in life expectancy are due to increasing maximum lifespan. It's a common tactic, and it's a falsehood. The problem here is that the NIH is doing it a little bit. They did paint a picture of huge variability in life expectancy and then conclude that diet and exercise are the major solution.
"But nearly three-fourths of the variation in longevity is accountable to behavioral and metabolic risk factors, including obesity..."
I would be willing to bet that this statistic is citing longevity as I've described it, and not life expectancy. I don't believe it's true that 3/4 of the variability of life expectancy is due to diet and exercise in combination with genetics. But "behavioral" risk factors is super duper fudgy, so I have no idea. Is dying of road rage or a skydiving accident the kind of behavioral risk factor they're talking about? I don't know, because they quoted a statistic that you could interpret to mean almost anything.
If that's the case as I suspect, then this article has knowingly and intentionally mis-used the terms and left a misleading impression without saying something technically untrue, precisely because the popular lay-person's understanding is that they're synonymous.
Scientific references for longevity being constant... I don't have a definitive source, I've mostly had many long discussions about this with my brother who just finished his PhD in anthropology and told me about longevity being constant. Before that I was under the mistaken impression that quotes you get in school about historic people dying at age 35 meant that nobody lived past 40. Lots and lots of people believe this, and it's not true. Here are a few things I got poking around just now:
The stats about huge increases in life expectancy for people over age 10, 15 or 21 are all trending in the direction of people who make it to 20 can expect to live to near 80, ...
I don't know; that's a good question. As long as most people die old then probably yes. But longevity is more closely related to the maximum, and median doesn't give you information about the maximum. And there have been times in the last millennium when the median would have reflected high infant mortality, and not the age of people who live a long life and then die of "natural causes". Anyway, nobody really reports medians. Life expectancy is an average measure.
> And there have been times in the last millennium when the median would have reflected high infant mortality
Sure. During the peak of the Spanish flu, median probably would have been 18 years old or even worse, given infant mortality was close to 50%.
I found some numbers:
* the US had 200.000 deaths (7.7%) for unintentional injury + suicide + homicide
* the "years of potential life lost" are estimated to be 35 on average for unintentional injury + suicide + homicide, or 7 million man years.
* the life expectancy in the US in 2015 was 78.8 years
Putting things together, the life expectancy for people who don't die from unintentional injury + suicide + homicide is 81.5 (78.8 + 35 * 0.077).
I couldn't find data for median age at death in the US. But in LA county in 2012 the median age at death for men was 74 years and 82 years for women, while life expectancy was 79.0 and 83.7 respectively. So median age at death is actually _lower_ than average.
That's actually not surprising if you think about it. If most people die old, there are many people that live even a few years longer than the average. These easily offset the fewer people who die of violent death when computing the average. The US has 5 million people over 85, which account for several tens of millions of man years of "life gained".
"life expectancy is the average age at death for all people, and longevity is the average age at which people die of old age."
Which matters if the accident rate is steeply increasing (only, surely) since it's at a historical low. Is your argument that opiods have accomplished this?
"life expectancy is the average age at death for all people, and longevity is the average age at which people die of old age."
Which matters if the accident rate is steeply increasing (only, surely) since it's at a historical low. Is your argument that opiods have accomplished this?
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.
From a mathematical perspective: If you can't separate an observation from potential sources of bias, what good is your analysis? The fact that the observation holds despite bias is a strong indicator of its validity.
From a business perspective: an informed citizenry makes the best customers.
From a leadership perspective: citizens need to engage.
Actually, looking at the coasts and major metro areas (masses of population) it holds quite well. I'd be shocked if there was no variance, particularly in low population areas like the Mississippi floodplain.
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.
My gut feeling is that the average life expectancy is determined less by what percentage of population has access to top quality medical services and how good that top quality is, but instead mostly by how many people have to postpone or limit basic medical services.
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."
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?
118 comments
[ 3.0 ms ] story [ 27.4 ms ] threadAfter 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?
You can try complicate the explanations to account for this but the fact is that it shows that the 'obvious' reasons most people surmise are not so clear cut and need to be tested like any hypothesis. It's a hard problem to test and there are several other competing hypothesis. The best I can say for my own beliefs is that we need to have more studies that need to be done before I'm convinced of any of them.
I explain this here:
https://news.ycombinator.com/item?id=14353914
It's cheaper to not exercise.
Also exercise is not for weight loss, it's for exercise.
Also works for saving: earn more and spend less, duh!
Making friends: be nice more and mean less, duh!
Stress: sleep and relax more and worry less, duh!
Marriage: communicate and date more and fight less, duh!
Fat people want to be thinner. There are plenty of negative incentives to being fat. There's something subtler and more complex going on here.
Not too surprising that being immune or actively avoiding that toxic culture, results in both wealth and fitness.
Advertising Kills.
Not saying something like that might not be a good idea from a public health perspective. I'm not educated enough on those issues to have an opinion.
Yet here you are, posting things like this:
> The problem with that logic is that people with unhealthy behavior actually cost the system less.
Without any data.
I posted what I am educated about, and did not post an opinion about what I am not educated about.
> Without any data.
Apologies. I posted a nytimes story that links to a study in another comment in this thread: https://news.ycombinator.com/item?id=14353347
From a public health perspective yes that absolutely matters, but all I'm saying is this narrow claim: You will not save money on medical costs if you get your population to act healthier and they die of unpreventable diseases instead of preventable ones.
Nobody? Really?
What you're proposing is to pile additional hardship on people who are likely already unhappy with their current situation, and may also feel powerless to fix that part of their lives. On its face, your proposal lacks both compassion and efficacy.
It's also horribly authoritarian, and would likely discourage people from seeking preventative health care, just because the nurses weigh you at your office visit. Think about the potential unintended consequences before firing off a glib, "fix it with market incentives" proposal, paired with reasoning by [car] analogy.
A person who eats healthy, exercises and takes care of themself ends up paying for those who don't.
On average, healthy people lived 84 years. Smokers lived about 77 years and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people.
Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.
The cost of care for obese people was $371,000, and for smokers, about $326,000.
http://www.nytimes.com/2008/02/05/health/05iht-obese.1.97488... (numbers from 2008)
The main factor as to why this is the case is important though. The longer you live the more costs you incur on the system because you end up getting another sickness which costs a lot more to treat, they specifically quote Alzheimers, than obesity and lung cancer.
One thing they did not take into account though is the lack of productivity i.e. the costs of being disabled (possibly b/c it is a dutch study using dutch data and parameters), in the USA diabetes is a disability and incurs significant other costs on the system which were not taken into account. It would be interesting to see what the comparisons would look like once that is taken into account.
But its certainly the case that smoking is much cheaper overall. It doesn't lead to disabilities and people die younger and incur far less costs.
[1] http://journals.plos.org/plosmedicine/article?id=10.1371/jou...
Even without a national health care system, taxpayers are paying for those who don't take care of themselves.
But the right fix is definitely the food situation. Everybody already eats.
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.
Still, as bad as it is, it's better than nothing - I grew up in a pretty depressed, white-trash area where better than 50% of kids were on free-and-reduced lunch subsidies, and for not a few, breakfast and lunch at school might be the only meals they got some days. But for god's sake, we can do much better than we're doing, and it shouldn't cost any more than the sugar-blasted packaged garbage we're shoveling at kids today. Make a big batch of scrambled eggs, give them a piece of toast with peanut butter (although I supposed peanut allergies have ruined that), oatmeal, something with a little protein or complex carbohydrates in it, a piece of fruit. It's not rocket science.
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.
I feel that's a common misconception. Sure, you can't buy fresh, organic foods but I'm able to build muscle on about ~$10/day and stay healthy as a horse.
Frozen peas (most frozen veggies) are $1 for 4 servings; canned black beans and chickpeas are $0.89 for 4 servings; whole-wheat bread is $3-4 for 18 pieces; 1 gallon of water is $0.89 (if you faucet water isn't drinkable); etc.
You certainly can eat healthy on the cheap. It's just that most people don't want to make the sacrifice.
You can eat on $200 a month without much problem. I received max SNAP benefits for several months and I spent about $120 a month on food, so I had money left over at the end (being a vegetarian helps).
This really isn't relevant to the point at hand (or maybe it is, who knows?) but I think poor people would have an easier time if the means testing for food stamps were looser. The benefits fall off steeply. If someone is making a thousand dollars a months and working full-time or close to it, the government can chip in more than $10-20 to give them access to healthier food.
If necessary, like when you're in a maintenance phase, you could get it to $5/day.
I hear you and agree. I think the means testing for food stamps should be looser too. It's funny, I know a couple people on food stamps and I know a few vegans. What you say is true.
I don't know. It would be interesting to know what the research says. I lived in poverty for much of my younger life and we wouldn't buy a lot of health foods because they were expensive. I remember fruits and meat were a rarety you got exited about. And I was lucky because my parents still tried to feed us healthily - we had a garden and chickens.
Its also probably true that you don't need as much variation and nutritionists say - you could probably live healthily off of potatoes and eggs.
I've also lived off of what you suggest and its not that pleasant. If you want fresh salads and vegetables the price starts going through the roof, so you're basically stuck with the cheapest canned/frozen stuff. Sure you can do it and I have but its not surprising people don't stick to it long when most of the tasty alternatives are either too expensive or just plain junk food.
Yeah, I've felt the same, and that's why I put it to the test. I can't necessarily extrapolate. All I can say is for the better part of 2.5ish years I've been eating the same thing everyday and my health (according to my yearly checkups) has been stellar.
Of course, you have to hit your macro- and micro-nutrient requirements in your daily regimen.
> I've also lived off of what you suggest and its not that pleasant.
It's a matter of perspective, I guess. I look forward to peanut butter peas or greek yogurt with honey roasted peanuts mixed in or overnight oats made with frozen blueberries and soymilk.
I guess I was just trying to offer up that there is a way to eat healthy, cheaply. Because I certainly didn't know about it until later in life.
They are harvested closer to the ideal time and don't degrade during shipping and so on.
Of course not all vegetables, but there are many that stand up well to freezing. Just don't leave them in an auto defrosting freezer for a long time.
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.
OTOH, the first few times it interfered with the market they solved widespread nutritional deficiencies that were killing, crippling, and otherwise substantially harming hundreds of thousands of people every year. I'm speaking of the fortification programs:
On balance I'd prefer they keep at it. Anyhow, the government was simply echoing the advice of the medical establishment. At worse they've merely been a few years behind those recommendation, which is nothing on the scale of a lifetime.If you have a beef, it's with he medical and nutritional sciences, which invested too much confidence in what should have been recognized as problematic research results.
No it absolutely wasn't. It was echoing the advice of the agriculture lobby. The medical establishment sent its information in and the FDA altered it. And guess what? The food guidelines from this year were manipulated by the agriculture lobby too. http://time.com/4130043/lobbying-politics-dietary-guidelines...
I only skimmed your article, but it appears those instances were almost entirely labeling guidelines. Example: What constitutes "enriched" flour? I can see the value in that, but I hope it's clear that's very different from marketing enriched flour via the government provided education system.
Yes, the USDA is responsive to the agricultural lobby. So what? At the end of the day it doesn't matter how or why they make their recommendations, but the substance and effect of those recommendations. And my point is that in the long-term the general guidance of the USDA has reflected, more than anything else, the medical consensus. Obviously it doesn't only reflect that, but everything is effected by lobbying, even the medical consensus.
And my larger argument is that if you examine its long-term track record, on the whole it has been positive, at least in the context of nutritional policy. Yes, the USDA's fortification program was largely voluntary. So were its more modern recommendations. Sometimes their recommendations weren't voluntary, like guidelines for federally funded school lunch programs. But the same applies to their fortification programs--those school lunch guidelines also mandate fortified foodstuffs. Also, the fortification programs involved direct and indirect subsidies, which is why most basic foodstuffs (grains, salt) at retail were fortified, at least until the organic craze.
I respond because I'm tired of the narrative that when government does something stupid the answer should just be to remove government from the equation. That's not rational. In every context we should endeavor to make informed and well-reasoned judgments based on a) context, b) facts, and c) some rough assessment of our priorities. Unfortunately we've forgotten how to incorporate those three things into our discourse. We don't understand context because we reframe every issue as some ideological battle about government. We don't understand facts because we're too lazy to root them out, and too lazy to assess their relevance and strength. And we suck at agreeing on priorities because, similar to context, we confuse the means with the end--that is, we seem to think our ultimate goal is to refashion government to fit some conceptual model, rather than to refashion particular laws and agencies to best meet some quantifiable goal, like a lower incidence of diabetes.
This retreat and resort to ideology and abstract modeling is not only a political pathology, but arguably it has been the problem with nutritional science. For example, when I mention "epidemiological methodologies" above I'm implying, among other things, that we committed a category error: too much salt might be "causative" of high blood pressure on a population wide scale, but on an individual scale it doesn't cause anything in most people, and the particular issue in the subset of the population responsive to high salt intake wasn't something you'd expect given the large population studies. The population-wide mechanism was empirically sound (lower average salt consumption, improve average outcomes) but not reflective of the underlying pathologies at the micro-scale and ultimately suboptimal.
IOW, yes, if _everybody_ reduced salt consumption to some common recommended level then population-wide health could improve. But there's a better equilibrium to be found by understanding the details and taking a more nuanced approach, allowing us to improve health even more. Likewise, maybe we might all be better off on average if the USDA disappeared overnight. But perhaps there's a better equilibrium where the USDA still has a role. We can't know without making a careful assessment, and continually re-making that assessment.
Let's stop being lazy. Let's dig into the details. It's difficult a...
>I respond because I'm tired of the narrative that when government does something stupid the answer should just be to remove government from the equation.
Don't pretend like you're presenting anything but an equal and opposite narrative. This government program, which is nothing more than bought and paid for marketing by lobbyists, has literally killed millions of people. How many people need to die before you'll say enough is enough?
If the government got out of the way then people would seek out the information they need and they would get it from a variety of sources such as books, their personal physicians (probably the best choice), or other sources. Unreliable sources would relatively quickly fall by the wayside. But the government voice is a foghorn which cannot be ignored, especially when you put it in the school curriculum.
>Let's stop being lazy. Let's dig into the details.
I'm right here with you. One-size fits all nutrition recommendations from the government is a disaster. When the government becomes a voice for nutrition recommendations its scope makes it, in effect, the only voice. That makes the government voice the ripest target for manipulation. Instead, the voice of the scientific community at large should be out there. It's there today, but it's drowned out by the government fog horn. If you want nutrition information, the best person to talk to is probably your doctor because they will know pretty near the latest medical information and be able to adjust it for you as an individual.
I think the only thing you two actually disagree about (because I certainly agree with most of what both of you said) is the medical consensus at the time of the food pyramid, and the only thing that has been contributed to that is a Wikipedia link. Now I have a high degree of faith in Wikipedia and also fully expect the food pyramid was bought and paid for, but following through on Wikipedia to the links supporting this brings 2 book links and a USDA.gov page. Perhaps reading the books would provide a high degree of good explanation, but I still don't know what the medical consensus at the time was. My contribution is a crappy link ( http://www.nytimes.com/2007/10/09/science/09tier.html ) that suggests the medical consensus indeed thought fat was a greater enemy and am left with no solid belief of the central issue. Stuff is hard.
(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?)
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.
You aren't going to put on weight or maintain an unhealthy weight if you aren't eating excess calories.
https://www.theguardian.com/society/2017/may/17/obesity-heal...
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534511/
I would imagine if 320 million people are going to be measured for financial punishment purposes, there would be a startup opportunity in some kind of 3-d scanning appliance that could auto-generate circumference measurements.
Of course where money is involved corruption will develop and inevitably there will be clinics where patients are asked politely to measure themselves and record their own numbers, such that the promised savings will never occur.
We already have a 2D scanning appliance which can measure body fat to 1% accuracy, even for weightlifters. It's called a DEXA scan. Currently scans cost about $50 and take several minutes, so not really practical for screening millions of people every year. But I'm sure engineers are working on improving cost and speed.
Let people eat what they want to eat. Quit trying to micromanage other people's lives.
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.
Assuming exercise isn't fun. Physical therapy is supposed to be a brutally painful and exhausting way to repair damage that you'll feel better about in the distant future. Exercise should be fun. If you're not having fun, with fun people, you're probably doing it wrong.
There are people who genuinely don't enjoy exercise, despite no indication that they would somehow not benefit from the effects.
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/
Death by car crash, for example, affects life expectancy heavily, but doesn't contribute to longevity at all.
All accidental deaths & infant mortality lower life expectancy but not longevity.
I'm fairly stunned if you work in this field that you wouldn't have heard of the concept of longevity, or at least maximum lifespan, as something distinct and opposed to life expectancy. It's quite important to rule out accidental causes of death if you want to have any chance of understanding how long humans can possibly live. Being able to make statements about diet and exercise requires being able to factor out all car and sports accidents from the average.
Here's what Wikipedia says: "Longevity, maximum lifespan, and life expectancy are not synonyms. Life expectancy is defined statistically as the mean number of years remaining for an individual or a group of people at a given age. Longevity refers to the characteristics of the relatively long life span of some members of a population. Maximum lifespan is the age at death for the longest-lived individual of a species. Moreover, because life expectancy is an average, a particular person may die many years before or many years after the "expected" survival. The term "maximum life span" has a quite different meaning and is more related to longevity."
https://en.m.wikipedia.org/wiki/Life_expectancy
To be fair, the Longevity entry echoes what you said, that some people use it as a synonym.
My hope was that the NIH would be more careful, because they're scientists working in the field, and they know better than to use vague terms that have easily misunderstood meanings.
> No one dies of old age.
True, but you know exactly what I mean, right? Whatever you want to call it, natural causes? Ideal conditions? What is the correct term for people who grow old and don't die of an accident?
I also agree with your statement that life expectancy depended heavily on how many people die young. Absolutely. But what is not correct is the statement about the number of centenarians. Please check, for instance, the Human Mortality Database yourself at www.mortality.org to see how quickly the number of them is growing. This does not only have something to do with larger birth cohorts entering those ages but also because of major reductions in mortality among people aged 80-100. And I would be very curious if you were able to provide a scientific reference to your statement that human longevity (do you mean maximum life span?) has been around 80 years for thousands of years. Do you agree with me (if you refer to maximum life span) that this is different now?
And -- as you say correctly -- I also agree with you that it would be advisable not to use vague terms. And in my opinion longevity is a vague term since some people use it for life expectancy others for life span. So it would be better if people use those clearly defined concepts to avoid confusion.
My comment about "no one dies of old age" refers to the fact that a certain cause (ICD 10 code) has to be entered on the death certificate. But I also agree with you here: the precision of this information at very high ages might be problematic due to multimorbidity. Your question concerning the "correct term..." I do not want to claim that I know the correct term. In my experience, people usually differentiate between senescent mortality and non-senescent mortality.
Final remark: It seems you are familiar with James Fries' influential paper from 1980 in NEJM [0] since he is talking about "ideal conditions" and "natural deaths", which is pretty close to what you write in your last sentence. :-)
[0] http://www.nejm.org/doi/full/10.1056/NEJM198007173030304
Maybe I should have said that the number of people living to be older than 130 isn't going up, instead of 100. Yes, there are more centenarians now. Yes, there are more people over 80 now. None of that means that we've increased the maximum possible human lifespan in any way. All it proves is that we've decreased the number of people who died before they could have, right? Better medicine, fewer murders, safer cars, cleaner air, less food poisoning. All these advancements help us "live longer", and yet none of them increase the maximum lifespan. We are getting asymptotically closer to the maximum possible, more and more people are approaching the limit, but there is no evidence yet that the limit is moving or has ever moved, and that's all I want to be clear about.
I'm mostly making an argument to counter people (not you) who are, for whatever agenda, intentionally suggesting that increases in life expectancy are due to increasing maximum lifespan. It's a common tactic, and it's a falsehood. The problem here is that the NIH is doing it a little bit. They did paint a picture of huge variability in life expectancy and then conclude that diet and exercise are the major solution.
"But nearly three-fourths of the variation in longevity is accountable to behavioral and metabolic risk factors, including obesity..."
I would be willing to bet that this statistic is citing longevity as I've described it, and not life expectancy. I don't believe it's true that 3/4 of the variability of life expectancy is due to diet and exercise in combination with genetics. But "behavioral" risk factors is super duper fudgy, so I have no idea. Is dying of road rage or a skydiving accident the kind of behavioral risk factor they're talking about? I don't know, because they quoted a statistic that you could interpret to mean almost anything.
If that's the case as I suspect, then this article has knowingly and intentionally mis-used the terms and left a misleading impression without saying something technically untrue, precisely because the popular lay-person's understanding is that they're synonymous.
Scientific references for longevity being constant... I don't have a definitive source, I've mostly had many long discussions about this with my brother who just finished his PhD in anthropology and told me about longevity being constant. Before that I was under the mistaken impression that quotes you get in school about historic people dying at age 35 meant that nobody lived past 40. Lots and lots of people believe this, and it's not true. Here are a few things I got poking around just now:
http://www.livescience.com/10569-human-lifespans-constant-2-...
http://www.ancient-origins.net/news-evolution-human-origins/...
The table in Wikipedia's article gives some indication too (Life expectancy at older age):
https://en.wikipedia.org/wiki/Life_expectancy#Variation_over...
The stats about huge increases in life expectancy for people over age 10, 15 or 21 are all trending in the direction of people who make it to 20 can expect to live to near 80, ...
Sure. During the peak of the Spanish flu, median probably would have been 18 years old or even worse, given infant mortality was close to 50%.
I found some numbers:
* the US had 200.000 deaths (7.7%) for unintentional injury + suicide + homicide
* the "years of potential life lost" are estimated to be 35 on average for unintentional injury + suicide + homicide, or 7 million man years.
* the life expectancy in the US in 2015 was 78.8 years
Putting things together, the life expectancy for people who don't die from unintentional injury + suicide + homicide is 81.5 (78.8 + 35 * 0.077).
I couldn't find data for median age at death in the US. But in LA county in 2012 the median age at death for men was 74 years and 82 years for women, while life expectancy was 79.0 and 83.7 respectively. So median age at death is actually _lower_ than average.
That's actually not surprising if you think about it. If most people die old, there are many people that live even a few years longer than the average. These easily offset the fewer people who die of violent death when computing the average. The US has 5 million people over 85, which account for several tens of millions of man years of "life gained".
Sources:
* https://www.cdc.gov/injury/wisqars/fatal.html
* http://publichealth.lacounty.gov/dca/data/documents/mortalit...
* http://webcache.googleusercontent.com/search?q=cache:bOUTEt_...
Which matters if the accident rate is steeply increasing (only, surely) since it's at a historical low. Is your argument that opiods have accomplished this?
Which matters if the accident rate is steeply increasing (only, surely) since it's at a historical low. Is your argument that opiods have accomplished this?
From a business perspective: an informed citizenry makes the best customers.
From a leadership perspective: citizens need to engage.
- 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.
http://gotz.web.unc.edu/2016/12/20/election-maps-representin...
(it's the 2016 popular vote)
Healthy food usually has a cost in time, skill, and/or money.
"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 sounds interesting. If this is indeed the case, what could be the reason?
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?