The United States - despite spending more on health care - has the lowest life expectancy of any economically advanced nation.  We're not allowed to discuss why.  Our moralistic approach to public health has also made us worse in preventing H.I.V. infection than Iran.


The Stanton Peele Addiction Website, December 4, 2010. This blog post also appeared on Stanton's Addiction in Society blog at

We're Not Interested in Whether You Live – We Want You to be Good

One of the few things some liberals laud George Bush for is his overseas AIDS program. But George Bush is a kooky Christian - that is, a typical Republican. So his international initiative focused on treatment - and on abstinence from sex and injectible drugs.  If you're going to do these things - well, Christians and Republicans reckon you ought to die.

Which brings us to Iran. You know, the country led by that fanatic completely out of touch with reality and his merry band of Islamic clerics - or what is referred to as a conservative (to say the least) theocracy. Yet those nutty Iranians adopted needle exchange as a policy where the United States has not - despite its endorsement by the Surgeon General, American Medical Association, Centers for Disease Control and Prevention, and American Public Health Association. There are more cases of H.I.V. infection in our nation's capital than there are in Tehran - although there are more injecting drug users there.

In its refusal to deal with drug injection as the source of a second wave of H.I.V. infection (following the original wave involving homosexual men), the United States resembles no other Western country, but is perhaps closest to Russia, which likewise buries its head in the sand.  We simply don't want to suggest that we accept drug use - just like the Russians don't recognize it in their country.

Aren't we great in America - with our international programs to help others? We know so much, and are so free with our generous help. So it is perhaps surprising to learn:

By any measure, the United States spends more on health care than any other nation. Yet according to the World Fact Book (published by the Central Intelligence Agency), it ranks 49th in life expectancy. . . .

Peter A. Muennig and Sherry A. Glied, researchers at the Mailman School of Public Health at Columbia University, compared the performance of the United States and 12 other industrialized nations. . . . In addition to health care expenditures in each country, they focused on two other important statistics: 15-year survival for people at 45 years and for those at 65 years.

The researchers say those numbers present an accurate picture of public health because they measure a country's success in preventing and treating the most common causes of death - cardiovascular disease, stroke and diabetes - which are more likely to occur at these ages.

Life expectancy increased over those years in all 13 countries, and so did health care costs. But the United States had the lowest increase in life expectancy and the highest increase in costs.

How the hell did we pull that off?

Which brings me to the second example of how we may not be healthy or live as long as other comparable economically well-off nations (and actually quite a few below us economically) but, more important than that, we are so good - and that's what really counts after all - isn't it?

In trying to ferret out why we fare so poorly - dropping like flies (so to speak) when we reach middle age relative to comparable countries, investigators are puzzled because, in terms of health behaviors, although we are fatter than other nations, they have been catching up, and we smoke less. So, in sum, these behaviors cannot explain our bringing up the rear in survival rates.

We might still be missing something, however.  Epidemiological studies of coronary artery disease (including heart attacks, strokes and diabetes), which is the greatest killer of Americans, identify these as the top three factors: smoking, ___________, overweight. Ooops, I left out the second, didn't I? Well, you don't want me to say something bad, do you? Let me just say that, in mentioning smoking and obesity, but not the second most important factor, I am simply replicating the above discussion in the NY Times on this question.

None of us wants to talk to you impressionable 45-65 year-olds about this subject - you simply can't be trusted with such information.

We'd prefer you die