Nicholas Kristoff ties increased access to health care to increased longevity in an impassioned plea to pass health care reform in Thursday’s New York Times. While I want health care reform to pass, it’s a lousy argument and he gets his core fact wrong.
He bases his column on the observation that the 1940s recorded the fastest increase in longevity in U.S. history — seven years by his data. He suggests that millions of Americans gaining access to health care in that decade through expanding job opportunities, New Deal programs and military service was responsible for the rise.
Not according to this chart, provided by the Information Please website, which I hope is reputable (they do footnote their references, and their list of laudatory press clips includes a blurb from the New York Times). The second decade of the 20th century accounted for the greatest gains in life expectancy.
During the decade when the U.S. fought briefly in the First World War, life expectancy rose 5-6 years for whites and 9-13 years for blacks. That compares to just 3-5 years for whites and 6-7 years for blacks in the 1940s. In percentage terms (over the prior the decade), the increase in life expectancy in the 1910s was twice as fast as the later period and dwarfs what has happened in the modern era with its high-tech medicine and near-universal access.
What happened a century ago? The general consensus among public health experts is that life expectancy rose briskly with the advent of indoor plumbing, better housing, public sanitation and cleaner water — all products of the progressive era’s emphasis on social uplift for the lower classes.
There is a moral imperative for universal access to sickness care, and it probably can be argued that universal access to basic preventive health care services is a necessary though not sufficient condition for improving U.S.’s life expectancy ranking. But to actually move the U.S. lifespans into the upper tier of advanced industrial nations, public officials might want to take a page from that long ago era when public health mattered.
Today the issues are different: combating obesity, cleaning up the environment, and reducing income inequality, social disparities and stress. Fixing those will go a lot farther in terms of increasing overall longevity in the years ahead than getting more people access to the latest and greatest medical technologies.
