• Longevity gains due to health care

    In June I railed against an infographic that claimed that health care played only a 10% role in our health. I followed the “studies” the infographic cited, but they led to a dead end. A reader tried another approach, but still couldn’t find anything.

    So, I undertook my own literature review. What do studies really say about how much health care matters for our health (strictly speaking, longevity)? My latest post at the AcademyHealth blog summarizes what I found. Spoiler alert: It’s not 10%. Check it out!


    • I’m sure you’ve read the papers but in reading the abstracts, it appears that most of the cardiovascular benefits are due to changes in lifestyle and reduction in risk factors and not due to direct medical care.
      It is difficult to sort out the contributions of medical care and lifestyle changes in the individual papers and come up with an overall contribution of medical care.
      Thank you for this effort.

      • Fine. But what I quoted indicates the proportion due to treatments. And it is large. I included, in some cases, the lifestyle effects too. I think we can agree all of the above are important. I was reacting to the false meme that only 10% of health (or longevity) is due to health care. That’s clearly too low.

        • I agree that 10% is too low and I appreciate your efforts to find a more accurate number. I was just pointing out the difficulty of assigning credit for longevity to medical care vs. everything else.

    • I think people are conflating two very different questions:

      1. How much does medical care explain current health status of individuals?
      2. How much does medical care explain longevity?

      The answer to number 1 is probably very low, while the answer to number 2 is probably very high. If you look at groups around the world with long life expectancy, medical care is not the reason why. However, if you look at groups where life expectancy has increased substantially, medical care likely is the reason why. Austin, your 40-50% estimate doesn’t fit with why people in Okinawa live longer than those in the urban US south, nor does it explain the tiny difference in life expectancy in US vs. Mexico. But it does get at changes within groups.

      I think it all depends on the specific question people are asking.

    • I hope this isn’t too off topic.

      “why people in Okinawa live longer than those in the urban US south”

      Hmm. I’ve not been to Okinawa, but presumably, medical care in Okinawa is worlds better than medical care in the US south. I’d guess that the largest item making a difference would be infant and maternal mortality, since the Japanese are insane about prenatal care. Since kids were’nt forthecoming here, I have no direct experience, but apparently they provide a notebook to every woman at the point pregnancy is confirmed and have them keep detailed records for the frequent pre-natal checkups. When something goes wrong, e.g. a woman about to give birth doesn’t make it to a hospital in time, the whole country goes into a 24/7 over-the-top “we’ve got the worst medical system in the world” mode for weeks. They really care about this. And it shows in the infant mortality statistics.

      Which is a major factor in longevity.

      (Sorry about the lack of references in the above, but there are a couple below.)

      Oops, we’re all wrong: Okinawa lost its longevity lead in 2000, and is now 26th of Japan’s 47 prefectures.

      “As the post World War cohort of low birthweight infants reaches middle age, the longevity advantage of Okinawans has been lost. The loss of the longevity advantage of Okinawa over the rest of Japan may be due to the increase in non-communicable disease in the post war cohort that has experienced a higher low birthweight rate.”

      With regard to infant mortaliy:
      “Okinawa, the island prefecture that is the furthest from mainland Japan, had the third highest IMR and the highest low-birth-weight rate (LBW) among all prefectures when its statistics were integrated into Japan in 1973. Even though the LBW rate in Okinawa has remained higher than the all-Japan average, Okinawa has shown a considerable improvement in IMR and NMR. ”

      So it’s beginning to sound as though Okinawa’s life expectancy may have been a statistical fluke based on bad records prior to WWII* and inconsistent records through 1973. Oops. Of course, being 26th out of 47 in Japan still makes it one of the best places to be in the world…

    • Don’t forget the Xtian Scientists get benefit from herd immunity. Also, while they claim to refuse science based medical treatments, it’s illegal (as I understand it) for them to do so for their kids, so they are getting the benefits of some medical care as well.

    • It appears that several of the papers cited describe reductions in cholesterol as “lifestyle changes.” I guess some people do manage to reduce cholesterol levels through diet and exercise, but I have to think that the biggest factor is medical intervention, e.g. statins.