The adage, ‘a little knowledge is a dangerous thing’ is nowhere more true than when people seize on demographic or economic indicators to make a political point without really understanding what the indicator means.
Take a recent letter to the editor that opposes the Obama administration’s health proposals. The writer argues these would make U.S. health care more like that of Europe. His letter then states that death rates in the European Union, at 10.4 per thousand population, are higher than in the U.S. at 8.3. The Obama plan, he argues, thus would worsen health care in our country.
On one level, he is right. Crude death rates — the number of deaths per 1,000 people — in the EU are higher than in our country. But his conclusion that this proves EU health care inferior is incorrect.
Europeans generally live longer than we do. Critics of the U.S. health care system point to the fact that the United States ranks 30th out of United Nations member countries in life expectancy at birth, below 15 EU members including France, Germany, Italy, Spain, Belgium, the Netherlands and Greece. We are marginally below the EU average as a whole.
How can this be? How can higher death rates for Europeans be true if they live longer on average? And do longer lives mean things are better than in our country?
The answer is that, in fact, by most measures, Europeans are at least marginally healthier than Americans. This may be due in part to health care systems that are better in certain aspects but also to many other factors.
What the letter writer failed to understand is that crude death rates depend greatly on the age structure of the population. Even with faultless health care, more 70-year-olds die than 20-year-olds and many more 80-year-olds than 10-year-olds. Virtually all EU nations have older populations than we do.
The proportions of their populations over 65 are a few percentage points higher and the proportion under 15 a few points lower than for our country. This older age structure makes an important difference.
Europe did not have as significant a post-World War II baby boom as the United States. Its crude birth rates have fallen earlier and further than here. And most EU countries have not had the influx of immigrants, usually younger than the population average, that we have had.
The higher crude death rates per thousand are a simple result of the fact that more Europeans are at ages where mortality is naturally higher — not because of an inferior health system.
Similar confusion arose one year in the 1990s when lower average college admission scores were announced. What most people failed to notice was that scores for African-Americans, Hispanics, whites and Asians all had increased at least slightly. No group’s performance had declined. What happened was that more blacks and Hispanics, whose average scores remained well below those of whites and Asians, had taken the tests. This higher proportion of low-scoring minorities dragged down the average as a whole. But no group was doing worse than in prior years.
Note that while crude death rates are a very poor indicator of health system performance, alternative measures such as life expectancies and morbidity (defined as the rates of occurrence of other diseases) have their own problems. But that is the subject of a different column.
© 2009 Edward Lotterman
Chanarambie Consulting, Inc.