The title of today’s blog comes from the opening line of Derek Thompson’s article, Why Americans Die So Much, published in The Atlantic.
In the article, Thompson observes that U.S. life spans over the past 30 years are falling behind those of other similarly wealthy countries. The author looks at a September 2021 study by the National Bureau of Economic Research which shows that Americans die earlier than their European counterparts in every age group. American babies are more likely to die before they turn 5 compared to Europeans; American teens are more likely to die before they reach 20 than their European peers, and American adults are more likely to die before they reach 65, compared to Europeans. Overall, Europeans have a longer life expectancy.
And the study’s numbers go back several decades. The results are not due to recent COVID deaths, or the recent drug overdose crisis.
Thompson says that finding a straightforward explanation is hard. One factor is gun violence, which is more prevalent in the U.S. Another might be motor vehicle accidents: Americans drive more than residents of other countries.
The study makes three important findings:
- European mortality rates are consistent between rich and poor. This is said to be due to health improvements, which are better disseminated in Europe. The poor in America do not all enjoy the benefit of such health improvements. In America, black teenagers in the poorest areas are twice as likely to die before they turn 20 than those in the richest areas. The effect of poverty on lifespan is substantially higher in the U.S.
- Overall, Europeans live longer than Americans, even when comparing rich Americans to rich Europeans. This, it is said, “says something negative about the overall health system of the United States”.
- On a brighter note, longevity amongst Black Americans is improving, and the gap between white life expectancy and Black life expectancy is closing. This is said to be due to advances in science and technology, which are now more readily accessible to all. In addition, reductions in air pollution have helped, as Black Americans were more likely to live in more polluted areas. Other factors contributing to the closing of the gap include increased drug deaths (more prevalent amongst white Americans), and a decline in homicides, which disproportionally kill Black Americans.
Thompson concludes his article by calling for greater income redistribution and universal health care. “For decades, U.S. politicians on the right have resisted calls for income redistribution and universal insurance under the theory that inequality was a fair price to pay for freedom. But now we know that the price of inequality is paid in early death – for Americans of all races, ages and income levels.”
Thank you for reading.
Your annual physical is approaching, and you’re still averaging three to four alcoholic drinks per night – despite the fact that you told your doctor last year that you were going to cut back.
At your appointment, your doctor reviews her notes and asks how the drinking is going. You surprise yourself by blurting out a complete lie – that you’re now going drink-free every other night and have effectively cut your drinking in half.
Your doctor is pleased, and she begins her examination. In your mind, you move on too, but with one perplexing question: why did you lie?
More common than you think
First, if you do lie to your doctor, you’re not alone. In a recent survey carried out by the University of Utah, about 80% of respondents admitted they lie to – or conceal information from – their doctor on issues that could have health implications. The people most likely to do this were women, younger patients, and those who rated their own health as poor.
The top three reasons?
- Not wanting to be judged or lectured
- Not wanting to hear how harmful their behaviour is
- Not wanting to be embarrassed.
This recent CBC article has more information on the research.
A new approach
Whether you blame this lying on preachy doctors who scare people into not fessing up, or on cowardly patients who don’t own up to their behaviours, one point is crystal clear: lying to your doctor does nothing to advance your health needs.
With more health professionals now available online (either by email, chat or video conference), we now have the tools to move to a more non-judgmental “health coaching” model, with regular check-ins on areas of concern.
For example, a regular smoker will still have an annual physical with their doctor, but rather than dealing with the issue of smoking annually in a single (dreaded) conversation, the doctor diverts the behavioural elements to a nurse practitioner with experience in smoking cessation who provides online coaching on a regular basis. Even if the smoking continues, the nurse practitioner can encourage the person to adopt other behaviours that at least move the needle on health (“hey, how about walking to work twice a week – is that doable?”). And with electronic medical records, they can add any changes to your file, so that your doctor stays in the loop.
In short, we free up doctors to focus on physical health needs at annual physicals (such as blood pressure and heart and lung functions) and rely on encouraging, non-judgmental health coaches to focus on behaviours that may be harming our health (such as risky sex, poor eating, gambling or drug and alcohol issues).
Some of these models exist today in various forms. So, if you’re tired of your own “dance with the truth” at your annual physical, ask your doctor about health coaching alternatives.
Thanks for reading.
We’re lucky in Canada – our healthcare system pays for doctor bills and hospital visits, and many employer-sponsored benefit plans provide for supplementary health insurance. Even better, universal care is actually expanding in places, such as the recent introduction of free pharmacare for those age 24 and under in Ontario.
But don’t get lulled – there are costs to healthcare. With our comprehensive public coverage, it can be easy to think that your costs will be covered if you were in an accident or experienced a serious illness. But many of us simply aren’t aware of what won’t be covered. For example, out-of-pocket costs could include loss of income (especially if you are self-employed), expensive uninsured prescription drugs and medical supplies, childcare during recovery, or even home renovations to accommodate the illness. And psychological therapy fees represent another potential cost, as mental illness is one of the leading causes of disability in Canada.
So, what can you do to ensure that you are financially prepared for a sudden, serious bad health event? Here are three options to consider:
- An emergency fund/line of credit: You may need access to cash quickly if a health emergency arises and having a “rainy day fund” for unplanned or unexpected expenses is ideal for that purpose. A line of credit also serves this purpose, although it involves taking on debt and all the costs that that entails.
- Disability insurance coverage to replace income: Disability insurance replaces a portion of your income if you are unable to work due to an illness or disability. Disability policies vary widely, so even if you have coverage at work, it’s worth checking whether additional personal coverage could be beneficial.
- Critical illness insurance to cover other costs: This insurance provides a tax-free lump sum benefit upon the diagnosis of a serious illness, such as cancer, heart attack, stroke, blindness, paralysis, kidney failure and multiple sclerosis. Unlike disability insurance, the payment is not linked to your inability to return to work, and you have complete freedom to use the money any way that you wish, including paying for treatment outside of Canada that may not be covered by provincial healthcare.
Of course, rule number one is to stay healthy. But in the event you don’t, be prepared financially. A little planning can go a long way.
Thank you for reading … Have a great day,