The fact that the US spends more per-person for medical care than any other country in the world and yet lags nearly all other Developed Countries (and some Developing Countries) in life-expectancy is extremely puzzling.
If you start slicing-and-dicing the data, you quickly notice that US citizens of Asian decent and Whites track with the Developed Nations. It is only when you fold in the Blacks and Native Americans that the numbers puke. THIS IS NOT A VALUE JUDGEMENT. THIS IS A MATTER OF FOLLOWING THE NUMBERS like a beagle follows the scent of a bunny.
Statistically, there are not enough Native Americans to yank the over-all numbers very much. That is not true with Blacks who comprise approximately 13% of the US population. So any attempts to address the embarrassment of the US Life Expectancy at Birth numbers must understand why too many Black Americans die too young.
One approach
One approach involves looking at the various causes of deaths and focusing on those causes that show the largest differences between Whites and Blacks. The power of this approach lies in regression-to-the-mean. It should be easy to move large excursions from the mean (average) toward the average.
If you use that approach, then the largest leverages are in:
Homicide and legal interventions (Death-rates in Black men more than six-times that of White men) is the cause-of-death with the largest disparity between Blacks and Whites.
Infectious diseases other than HIV and Pneumonia/Flu (Death-rates of Black men more than five-times that of White men) is the second largest disparity.
Mortality of infants within five days-of-birth (Death-rates of Black males and females approximately three-times that of Whites) is third.
Asthma (Death-rates of Blacks more than three-times that of Whites) is a close fourth.
From a NUMBERS* standpoint, homicide deaths tend to "take-out" men early in life with the 19-to-35 period being the most dangerous time. That is like getting a 20% on a question on a test when there are not very many questions. It has a huge impact on the final score.
From a NUMBERS standpoint, infant mortality has a huge impact on life expectancy at birth because it is the same as getting a "zero" on an assignment instead of partial credit.
From a NUMBERS standpoint, infectious diseases are a mixed bag. Some infections like sepsis are more likely in people over fifty. While tragic to them, it does not impact the NUMBERS like an infant dying. Other infections (like STDs) are more likely to impact younger people.
*NUMBERS are a tool. It is not an attempt by me to minimize or politicize tragedies. Numbers are a way of thinking that can give us the power to make the greatest difference the quickest.
Homicides: Black Male vs White Male (source)
- 1960s: 42.3/100k vs 3.9
- 1970s: 78.2/100k vs 7.2
- 1980s: 56.6 vs 8.4
- 1990s: 52.3 vs 7.3
- 2000s: 35.9 vs 5.5
- 2010s: 34.5 vs 4.7
Something happened between the 1960s and the 1970s. Some folks think it was LBJ's "War on Poverty" that changed the Black Husband from an economic necessity into an expendable sperm-donor. That loss of status and the resulting lack of alpha-role models in the home left a generation of boys morally adrift.
Infectious Diseases Black vs White mortality rates (Note: Black MEN have significantly higher disparities than Black WOMEN)
- Tuberculosis: 4.2X White death-rate/100k population (source)
- Mycosis: 3.0X
- Gastro-intestinal: 2.7X
- Urinary-tract: 2.5X
- HIV: 2.5X
- Sepsis: 2.2X
- Liver and bile-duct: 1.9X
Infant Mortality Black vs White mortality rates
- Preterm, immaturity: 167/100k vs 52/100k (100k population under one year of age)
- Sudden Infant Death: 76/100k vs 28/100k**
- Other/unspecified: 70/100k vs 24/100k
- Accidental suffocation in bed: 51/100k vs 18.2/100k**
- Other preterm issues: 47/100k vs 15.2/100k
- Premature rupture of membranes + Incompetent cervix: (35+22)/100k vs (14 + 7)/100k
Some doctors now consider SIDS to be a form of suffocation and would lump these two together.
Editorializing
Several factors come into play in these differences and they are mutually reinforcing.
One factor is that many Black people are deeply suspicious of the "Establishment" and that includes the medical profession.
Factory-medicine where the patient sees a different doctor on every visit does not foster relationships and relationships are the foundation of trust.
Poverty and the aging housing-stock comes into play for asthma and TB.
Other cultural issues (Black and White) are major players. White practitioners can be quick to dismiss some symptoms (like bizarre behavior) as drug related when it can be a legitimate symptom of a UTI, low blood pressure or cerebrovascular or other diseases.
And yet somehow, it's not the responsibility of the black community to address this without yelling GIMME DAT more.
ReplyDeleteAs someone that had to work on an Indian Reservation the lack of concern for others, even for themselves health wise was appalling. Babies often die because both parents are drunk, drugged or just not home to care if it is fed or warm.
As EMS I have heard many such current stories with blacks and low-income druggies from EMT's and Police where they respond to a crisis and it's heartbreaking.
How many old-men are still alive because their wife kicked us in the ass and had us seek medical attention?
DeleteA wife has a perspective that we don't have. From our side of our eyeballs, we might think we are acting totally normal but from their side of our eyeballs they have alarms going off.
The fragmentation of Black families vaporized that safety net.
Yep, and the same forces are creating men as sperm donors across our once fine Republic.
DeleteThat's why I added current EMT perspective that includes all "races" as defined by economic level and social-vs drug using levels.
You and I are lucky to HAVE WIVES that CARE ABOUT US.
What else happened between the 60's and 70's that involved a large number of dead black males? Were the statistics controlled for deaths in the Vietnam War (or other military deaths)? Just a question that popped into my head... Dunno if it was significant enough to skew the results.
ReplyDeleteTwo-thirds of US deaths in Vietnam occurred in 1967, '68 and '69. That would have poofed-up 1960s numbers and not 1970.
DeleteRegardless, the CDC counts war related deaths as separate from homicides.
The "large number" was 7,243 out of a total of 58,220 KIA.
Deletehttps://www.archives.gov/research/military/vietnam-war/casualty-statistics
SIDS has been linked to vaccinations.... Its a bit tin-foil-hat, but all the same, The KungFlu was tin-foil-hat territory until about 6 months ago.
ReplyDeleteThe current trend is to think of SIDS as the baby "bulldozing" into a corner with a bunch of blanket or stuffed toys wadded up beneath his mouth and nose.
DeleteRecommendations are to have your baby sleep on his back and to strip the bed of "waddable" materials and keep the bedroom warm and put your baby in a one-piece sleeper.
The higher mortality rates are obviously due to racism. And in case you missed the memo - math is racist too, you hateful white supremist!!! We’ve established mathematically that 2+2 CAN SO equal 5. So what good is your math anyways, you stupid old white man!
ReplyDelete😂👍🏿
And before some idiot says it - IQ stats are racist too!!!
Well yeah, then there's that. Forgot about that whole 2+2=5 thing, sorry. Thanks for the reminder.
DeleteSo once again, it comes down to the Black Culture causing their problems. And once again, they won't fix their problems, but they will bitch about it and expect the whites to fix it.....usually with more funding.
ReplyDelete'Tis strange that every other race but the Native Americans and the Blacks can fix themselves, but those two cannot.
The issues are not fixable unless the culture chooses to fix them.
OK, B, let's flip that around.
DeleteWhat should be a healthy skepticism regarding the infinite benevolence of the entire medical (including pharma) profession was poisoned by the Covid misadventures to where many Whites are at least as cynical as Blacks.
All-or-nothing is primitive (and satisfying) way of approaching life but most real-life exists in the shades of gray between the two. Without applying cold, clinical study and withholding judgement, we will decay to the level of inner-city Detroit everywhere.
Entropy always wins. The best we can do is to fight the good fight and delay it as long as possible.
Yes, the U.S. does spend more per person on healthcare than any other country yet lags pathetically. This is due to the conflict between maximizing profit in private health insurance and the goal of providing comprehensive and decent medical care. In countries with universal healthcare systems, the government takes responsibility for health outcomes, which leads to better public health metrics, such as higher life expectancy. In contrast, the U.S. relies heavily on a profit-driven private insurance system, which incentivizes minimizing payouts rather than ensuring broad access to care.
DeleteSystemic racism in healthcare exacerbates disparities in health outcomes between Black and White Americans in an already flawed and imbalanced system.
Black Americans face higher rates of hypertension, diabetes, and heart disease due to a combination of genetic, socioeconomic, and environmental factors.
Historically, Black Americans have faced barriers to accessing quality care, such as lower rates of insurance coverage and a lack of providers in predominantly Black communities.
Black women are three times more likely to die during childbirth compared to White women, regardless of income or education.
Studies show that healthcare providers sometimes underestimate the pain levels of Black patients, leading to undertreatment.
The market-driven approach to healthcare inherently struggles with the notion of equity. Private insurers prioritize profit over universal access, while programs like Medicare and Medicaid aim to fill the gaps but are often underfunded or politically constrained. This mismatch ultimately creates a system where costs are high, outcomes are poor, and racial disparities persist.
Well, Joe, while whites and others are now "poisoned" against the medical profession, we still are smart enough to take care of ourselves. Black people are (mostly) not willing to do that. Yes, It is a racist observation, but that does not make it any less true. Trends are what they are, and there is historical evidence to back up what I said. All of it. It does not granulate down to every individual, but as a group, it mostly works. The diets, the choices, The lifestyle, the culture all make for a less healthy population in that group and a lesser chance of living longer. .
DeleteI'm sorry if that bothers you, or it makes you think less of me.
The culture is what is the issue. Perhaps their thought processes as well, but the culture is the poison.
Nah, B, I don't think less of you.
DeleteI agree that main-stream "Black Culture" is deeply and profoundly broken. But as a guy who spent a lot of years thinking in terms of industrial processes, the term "Black Culture" is not a viable input parameter. Nor is "Systemic Racism".
I will quibble that there are a lot of White people who do not take care of themselves. We used to see them at Walmart and at the Secretary of State but now they have their groceries delivered and select e-Service for S-o-S.
I think I will do a couple of follow-up posts tomorrow on this topic. It seemed to generate a lot of interest.
RJW:
Delete"In countries with universal healthcare systems, the government takes responsibility for health outcomes" I am not aware of any government run health care system that truly takes responsibility -- controlling costs with rationing of care is much more the norm.
America does NOT have a private health care system. Much more than 50% is driven directly by government through Medicare and Medicaid. Regulatory requirements from government drive even more.
Health is significantly driven by personal choices. Genetics plays a role. Socioeconomics plays notable role, but is also influenced by individual choice.
I work at a health system that is very rural, poor, and close to majority African American among the almost 2 million in our region. We experience these issues on a daily basis. We have small community hospitals, comprehensive academic hospital, and multiple physician practices.
I long ago lost count of the patients who are knowingly not compliant with the simplest health activities, even when they have numerous family members dead from strokes, heart disease, diabetes, etc.
Anonymous, Thank you for sharing your perspective. You raise valid points that highlight the complexity of healthcare systems and health outcomes. Let’s dig into the issues you mentioned:
DeleteYou’re correct that governments in universal healthcare systems often manage costs by rationing care, setting treatment priorities, or creating waiting lists for non-urgent services. While these systems don’t "take responsibility" in the sense of guaranteeing perfect outcomes for every individual, they do focus on ensuring that care is accessible and equitable within the constraints of their budgets. This contrasts with the U.S., where the hybrid system creates fragmentation in coverage and access.
The U.S. healthcare system is neither purely private nor entirely public. While Medicare, Medicaid, and other government programs drive a substantial portion of healthcare spending, they coexist with private insurance, who remain a major player. And yes, government regulations shape even private sector operations, further blurring the lines. This mixed approach creates inefficiencies, as public and private interests often conflict rather than align.
Your point about personal responsibility is crucial. Many health outcomes are indeed shaped by lifestyle choices, such as diet, exercise, smoking, and medication adherence. Noncompliance, even when patients are aware of their risks, is a significant challenge in healthcare, and your daily experiences underscore how pervasive this issue can be.
Changing habits is notoriously difficult, even when individuals have seen the consequences of inaction.
In underserved communities, mistrust of the healthcare system and limited health literacy can exacerbate noncompliance.
While individual choices play a significant role, they often interact with socioeconomic and systemic factors:
For many rural and poor patients, preventive services are harder to access, even with insurance.
Community hospitals and small clinics may lack the infrastructure to provide comprehensive support for chronic conditions.
Effective interventions often require tailoring to cultural norms and practices within specific populations.
Given the challenges you describe, addressing noncompliance and improving health outcomes requires both systemic and community-level strategies.
Leveraging trusted community members to bridge gaps between patients and healthcare
Expanding access to mental health resources and behavioral interventions to address underlying factors affecting compliance.
Your work in this complex environment shows how deeply interconnected personal, systemic, and societal factors are in determining health outcomes. Addressing these requires a mix of individual accountability, community engagement, and systemic reform.
If they could only realise the opportunity before them, of joining a successful culture. When in Rome, do as the Romans. Or, insist on remaining in barbarism and reap that crop. The next Penny/Neely incident might just be Penny breaking Neely's neck in the first ten seconds because it is safer and one will be railroaded anyway. Neely even insisted he was ready and willing to die. Winner! Wnd the next proto-Neely getting the same adjustment on his first chimp-out, not the the four hundredth, and not by a whitey, but by his own kin because they whiff the wind of change and are given encouragement to fly straight or not at all. Change the education to favour homeschooling, change the music away from glorifying decadence, change the language away from ghetto alley ebonics, change the clothing from gand and prison fashion, and crush down hard on petty crime and even harder on major ones. Murder, rape, kidnapping.....death by hanging. Drug dealing....same. Reward decency, protect it. Hang the culture killing commies, and the open satanists, and the abusers of children, and the sodomite evangelists. Behave, or go, or die.
ReplyDeleteWinner winner chicken dinner!
DeleteI recall not being afraid of being around blacks, as I was taught to treat everyone individually and not make assumptions. Then rap music not only became socially acceptable, but you couldn't criticize it. This 'thought process' that everything in that culture is above reproach (reasons never explained), is going to end up being the source of a fire and killing that hasn't been seen on this planet for 75 years.
Its a clash of cultures. Western (white) culture is systematically being replaced, so of course there is friction. The State is endorsing one, punishing another. Strauss & Howe cover this in their seminal book. One will win, one will enter the dustbin of history. And a whole lotta people are going to die in the process.
Culture matters. When it's OK to be a single mom with MANY Baby Daddies AND the STATE supports single moms better than married couples.
ReplyDeleteWhen instead of words and fists you drop into shooting randomly at everybody at the party AND it's nearly illegal for Police to Arrest you (let alone actually Punish you) well what's that sowing the wind thing again?
You get what you subsidize.
Saw it on the Indian Reservations, saw in when doing missionary work in Africa and even some parts of South America.
Oooh oooh now do: IQ, homicide, education, violent crime, poverty, general crime.
ReplyDeleteIt never ceases to amaze me how people point to the South and our high levels of negative statistics. They would have you believe the caricature of the “toothless Inbred redneck” being responsible for these statistics. That’s not it at all. Change one demographic and watch us soar to the top overnight.
Excellent primer! In his old age a reporter asked the famous bank robber, Willie Sutton why he robbed banks? That's where the money is. Solve the biggest problem, save the most people.
ReplyDeleteOne small correction. Sudden Infant Death Syndrome is misspelled. Correct spelling is Vaccine Induced Injury. If you can see it with the Corona Vaxx, you should be able to make the leap to understanding that babies are much more vulnerable . And are being sacrificed to BioPharma profits the same as Corona Vaxx victims
SIDS has been around a long time. Unless one can prove early vaccines like Polio, TB and Mumps had anything to do with the SIDS mortality rate, then attributing it currently to the Kungflu vaccines is a stretch.
DeleteMike G. Sids AND vaccines have both been going up since they started over-shotting infants and toddlers. They have been putting poison (as a preservative and/or absorber) in vaccines forever. Notice how folks, of all ages, "died suddenly" or were sickened, maimed, disabled, co incident with the Covid clot shot? and continuing with elevated rates still. Everybody I've asked, in my small town, Tennessee knows someone that died or had a severe reaction to the clot shot.
DeleteYou're suffering from information underload and normalcy bias. Consult a conspiracy theorist acquaintance or two. There are millions of others with your condition. There's still hope.
Maybe it's information "overload."
DeleteBesides, I'm one of those conspiracy theorists. I did not take the clot shot. Hell, I don't even get flu shots.
+1
DeleteToday I saw a sign at the CVS pharmacy.
Delete15+ vaccinations for one year olds available here
That made me shudder. Even taking C19 out of the mix, I thought that many jabs in the first 12 months borders on intentional abuse.
Thoughtful information.
ReplyDeleteNo easy answers.
My comment above in response to RJW
Don_RN