Our Neighbors’ Health

I’m teaching a short course on Vietnam this month as a prelude to the trip I’ll be leading there in November. We’re doing a quick review of The War (the American War, as locals remember it, as opposed to the French War and various Chinese invasions), historical patterns prior to that, and the country’s development in the fifty years since American troops left. It’s important as well to look at current demography—the rural/urban split, ethnic diversity, the population pyramid, and life expectancy.

The latter invites comparisons to North American circumstances, although estimates will vary according to the source you’re using. The World Population Review seems reliable enough, and it pegs the USA’s life expectancy at 78.2 years, Mexico’s at a predictably lower 74.8, and Canada’s at the typically superior 82.8. Vietnam comes in at a Mexico-like 74.6. But it’s improving, and the USA is not.

We’re #1! (not)

In fact, browsing through the WPR tables, you come across some remarkable—even astounding—data. The USA of course trails such health-stalwarts as Japan and Switzerland, but by 6.4 and 6.0 years. The much-ridiculed French lead it by 5 years; the economically “retrograde” Italians and Spaniards by even more. The United States trails—and often trails significantly—Greece, Portugal, Kuwait, even Kosovo. It trails Thailand by a year and a half; likewise Puerto Rico, though the latter doubtless benefited from the paper towels The Former Guy threw at them after a devastating hurricane. The United States barely edges Cuba, by a month. It loses to China by three.

Let’s repeat that: the United States trails China in life expectancy. Are Chinese parents now enjoining their children to clean their plates by flipping the old mantra? “Think of all the starving children in America.”

For me this is all mind-boggling. I grew up hearing that the United States was #1. As a social studies teacher my dad would bring home discarded textbooks, and when I was at home from school with a cold or flu I would page through the tables in back. The good old USA led the world in steel production and iron mining, in wheat harvests and home ownership, in health, wealth and income, in trains, planes and automobiles. Later, in high school, Amway founder Richard DeVos came in for a special assembly and recited the same statistics over against the wretched Communists in the Soviet Union. After thirty minutes of materialistic crowing he attributed the whole thing to America’s outstanding religiosity.

Now DeVos’s strong suit was inspiration, not analysis. For the latter I eventually came upon Max Weber, then much later the remarkable opening chapter of Harriet Beecher Stowe’s tribute to her native New England, Old Town Folks. But however God and goods were to be parsed, we Boomers had no doubt that America was #1. Now, per the WPR’s computation, in life expectancy “we’re #67”! Taking out tiny states like Lichtenstein and Monaco and Vatican City, the rating goes up to 54. But still the conclusion is amazing: the United States places out of the top fifty countries in the world for life expectancy.

Your Research Dollars at Work!

No doubt people like an old college acquaintance who went on to become a hot-shot surgeon can find in the latest data a ready explanation for this poor performance. After all, American Indians and Native Alaskans have recently fared worst by far among American groups, losing 6.4 years of life expectancy over the past three years to land back where they were in the 1940s. African Americans and Hispanics trail the mean as well. “Those are the bleeps who are skewing our statistics!” protested the surgeon back in the day.

Only white guys are doing badly too. The anti-vaxxers among them have been paying with their lives during COVID times, but well before that this demographic was falling in life expectancy to deaths of despair by way of opioids and suicide. They are truly one (as the old missionary hymn put it) with their Black, brown, and Red brothers in succumbing above average to cancer, diabetes, and heart disease, the leading killers even during COVID. Then there’s gun violence too, though that’s half covered by suicide.

This is not just astounding; it is tragic. The U.S. used to do better, and it still could. For why it’s not I found this piece by two Emory University scientists to be quite revealing. First, funding is not the issue. Health care takes up a staggering 18 percent of American GDP, 2.5 times the average of economically comparable countries. Included in that figure is no less than 50 percent of the world’s spending on health research. Is the bad magic of the Pentagon being repeated here—i.e., spend more on “defense” than the next ten countries put together and prove unable to win a war since 1945?

Well, the corporate controls on these budgets are comparable but the answer probably lies elsewhere. Most U.S. health-research dollars address individual-level care rather than social-support systems vital to well-being—as it were, bailing out single boats in trouble rather than reforming the boat-production business so that all vessels do better. High as the U.S. rates in health spending, it rates last among comparable countries in spending on the social support systems vital to overall well-being. Call it American reverse alchemy—gold input, lead output.

Individualism Re-visited

Is the problem good old American individualism? To a large extent, yes. A couple years after hearing that DeVos speech I struggled through John Kenneth Galbraith’s The Affluent Society (1958) and remain seared today by the “private wealth – public poverty” syndrome he unmasked behind the consumerist frenzy of America when it really was #1. At the same time, we heard back then—and hear no less today—all about pulling yourself up by your bootstraps. By extension that means our health is a matter of our own responsibility. Growing up Christian Reformed I heard that God was in charge of everything, yet somehow we were each of us our own little Captain Ahab, piloting our own ship.

The master analyst of American individualism in the age of Stowe and Melville was, of course, Alexis de Tocqueville (1805-59). “Democracy” in his famous book on the subject was not first of all a matter of liberty or politics but of equality in legal status. Nobody in America, Tocqueville observed, was the legal “better” of anyone else, quite contrary to the situation in his native France. Ironically, everyone in America was therefor in a frenzy to “better” himself (the her-selves—also the Black-selves and Native-selves—he recognized to be quite another matter) and that meant gaining status over against their neighbor. Free and sovereign as they prided themselves to be, Americans could only know who they were by measuring where they stood compared to others—and it had to be above somebody else.

This explains why Tocqueville turned out to be the better prophet of America than his late contemporary Karl Marx—and also why the U.S. can have great health-care for many individuals and falling life expectancy for the whole. Marx saw the poor as raging against the rich, determined to overthrow them. But Americans, Tocqueville observed, hoped—no, knew they were destined—to be rich themselves (Rich DeVos’s own secret sauce). In their free and open society they above all dreaded falling—dreaded poverty and so feared and derided not the rich but the poor. So if poor others are suffering poor health, kinda good for me.

And the lawyer asked Jesus, “who is my neighbor?”