Life Expectancy: A Proxy for Quality of Medical Care?

International life expectancy figures were released yesterday, and today’s papers are full of stories about how the U.S. is slipping in the “rankings.” The Associated Press begins its coverage as follows:

Americans are living longer than ever, but not as long as people in 41 other countries.
For decades, the United States has been slipping in international rankings of life expectancy, as other countries improve health care, nutrition and lifestyles. Countries that surpass the U.S. include Japan and most of Europe, as well as Jordan, Guam and the Cayman Islands.
“Something’s wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries,” said Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington.

These numbers will generally be used to bash America’s health care industry, and to imply that we need to adopt socialized medicine. In fact, though, one would need a lot more information to tell how much, if anything, the life expectancy numbers have to do with quality of health care.
The deaths that impact life expectancy data the most are those of young people. But what are the leading causes of such deaths? In the U.S., as of 1996, motor vehicle accidents, murder and suicide accounted for well over half of all deaths of persons aged 15 to 24. Rates of death from these causes vary widely from country to country, for reasons having nothing to do with the quality of health care. The murder rate in the U.S. is much higher than in most of Western Europe and many other countries. I haven’t seen current data, but in 1980, American males between the ages of 15 and 24 died in car accidents at almost exactly the same rate as in France and Germany, but at double the rate in the U.K., and triple the rate in Japan. AIDS is another common cause of death in young people which varies widely from country to country, and which no amount of health care can cure.
The infant mortality statistics are likewise misleading. The leading cause of infant mortality in the U.S., according to the C.D.C., is “congenital malfor


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