> In 2021, Joseph et al. published a paper in Obstetrics & Gynecology demonstrating that the entire recorded increase in maternal mortality since 2003 was due to a change in the way data was gathered. In 2003, U.S. states began to include pregnancy checkboxes on death certificates. This led to a whole lot more women who died while pregnant being identified as such. The apparent steady increase in maternal mortality was due to the fact that states adopted this new checkbox at different times:
> In fact, when the authors looked at the common causes of death from pregnancy, they found that these had all declined since 2000, implying that U.S. maternal mortality has actually been falling. Meanwhile, a CDC report in 2020 had found the same thing as Joseph et al. (2021) — maternal mortality rose only in states that added the checkbox to death certificates.
The CNN article is about this [1] study, which is based on OECD 2023 maternal mortality data. OECD says here [2] about "Definition and Comparability":
> Maternal mortality is defined as the death of a woman while pregnant or during childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from unintentional or incidental causes. This includes direct deaths from obstetric complications of pregnancy, interventions, omissions or incorrect treatment. It also includes indirect deaths due to previously existing diseases, or diseases that developed during pregnancy, where these were aggravated by the effects of pregnancy.
Edit: [1] Also references [3], a 2022 CDC report saying over 80% of pregnancy-related deaths were determined to be preventable.
That may be relevant to something, but not to why the difference is so drastic between Norway and US.
It is indicative of the US healthcare system, however, that up until 2003 it wasn't even known, statistically, that women were actually dieing of childbirth.
It is very relevant. The US definition of maternal death is very expansive. The expanded definition counts any reason a woman who was recently pregnant and dies.
The prototypical example is murder by a spouse. While tragic and extremely important to collect for policy reasons, it is not what “maternal death rate” typically measures.
The study cited uses OECD data. If the US does not adhere to the OECD guidelines for the data fields, for example by collecting a too broad measure and not correcting for it, studies are going to compare apples to pears. Not saying that the conclusion is false. But researchers should do their due diligence on the way international statistics are compiled.
If the US collects the data in a different way and then doesn't publish anything else, there is no other data available. All you can do is include a note that explains why the numbers aren't comparable.
Sorry, the 'should' probably has an unintended negative connotation when talking about a specific study.
To delve a little deeper. They seem aware (under HOW WE CONDUCTED THIS STUDY [1]): "While the information collected by the OECD reflect the gold standard in international comparisons, it may mask differences in how countries collect their health data. Full details on how indicators were defined, as well as country-level differences in definitions, are available from the OECD."
They do not mention the specific CDC caveat mentioned above regarding the check box on US death certificates.
And then the pincher: The study points to CDC [2] where explicitly this effect is mentioned as a possible issue with the reporting via death certificates ("Efforts to improve data quality are ongoing, and these data will continue to be evaluated for possible errors.").
I'll leave the interpretation to you. They mention there is a gold standard and that some countries might not follow that gold standard. The conclusion is mainly based on US CDC data vs. OECD non-US data. They link to a CDC report mentioning this issue. Should they mention this fact in the study in the main body, or is this transparant enough?
Going back to the Noahpinion link with graph above in this discussion. For me the time series gives quite the hint that ICD-10 is not being followed appropriately and that false conclusions may arise. If this were my report, I'd take one or two paragraphs to explain why this issue doesn't affect my conclusions in the main body of text.
And then even a 'How to solve this (partially)'. As an actuary I know death is very unlikely in the childbearing age. Show a comparison table of deaths per 100k for women in the age of 20-40 between countries, including the 'US-Black' category. If that comparative line is a lot more flat (my expectation), I would really presume there is a data collection issue. The other interpretation would fail Occam's razor (that non-pregnancy death in US / US-Black categories are less likely than in other OECD-countries). First inkling: [OECD - 3], US ASMR in Women up to 20% higher than other countries.
Reporting differences don’t fix the fact that they also claim that 80% of these deaths are preventable.
The US healthcare system is always being designed around profit requirements and care constraints, and not vice versa. Nobody here (save for Medicare) really knows what the proper reimbursement is for care, and we waste needless amounts of time and money on quackery (naturopaths, supplements, chiropractic) instead. The reason why we open more “cancer centers” rather than adequate emergency or trauma care is because these hospital systems want to sell a Veblen good to wealthy people with cancer. There’s hope though, if we erase the weird private insurance industry we might start seeing prices and care reflect needs vs. means.
NVSS has reported monthly updates on this since the 60s, it's wrong to say it wasn't known statistically I think. Maternal mortality review committees have existed since the 1930s also which provide extra data. Maternal mortality is one of the most important vital metrics to track for any country so it indeed would be surprising not to have more data.
It’s amazing how often you find out the differences in metrics are due to how data is collected not due to actual differences.
I read a good paper(1) about newborn deaths rates in Cuba. It’s often touted that Cuba has amazingly low newborn death rates which obvious means communism has far better healthcare than capitalist systems.
Turns out it’s a reporting artifact. If you correct for it, they have the same death rate as other Central American countries with similar GDP per capita.
It's explained in another comment. The US tracks it by asking "is this person who died, pregnant?". If the answer is yes, then it's a "maternal death".
Norway only counts pregnant women who died because of their pregnancy.
> Among the 525 pregnancy-related deaths, an underlying cause of death was identified for 511 deaths. In 2020, the six most frequent underlying causes of pregnancy-related death—mental health conditions, cardiovascular conditions, infection, hemorrhage, embolism, hypertensive disorders of pregnancy—accounted for over 82% of pregnancy-related deaths (Table 4).
> Among the 525 pregnancy-related deaths, a preventability determination was made for 515 deaths. Among these, 430 (84%) were determined to be preventable (Table 6).
This shows they didnt just take a yes\no for pregancy and +1ed the statistic, like you suggested. They reasoned about the causality and preventability.
> This shows they didnt just take a yes\no for pregancy and +1ed the statistic, like you suggested.
I didn't suggest that.
What I said was how numbers were reported. The US reports all deaths in pregnant women, regardless of cause. Norways only reports maternal deaths when the cause is pregnancy complications.
So you want to use only the richest and most sophisticated EU countries but then compare them against a federation of US states that includes the likes of Mississippi and West Virginia?
The difference between New York (the highest US state by per capita GDP, ~$91,000) and Ireland is larger than the difference between Mississippi and a per-capita GDP of literally zero.
Also, I forgot, it's a disingenuous comparison if you know anything about how life, subsistence, marginal savings rate & co work, which I assume you do if we're discussing these kinds of topics.
The scale of "GDP per capita and how people are living" is roughly this:
At a "GDP of literally zero" you're DEAD.
At a GDP of 1k, you can afford a cheap bicycle.
At a GDP of 10k, you can afford small, old, beat up and unsafe cars.
At a GDP of 30k, you can afford almost all modern amenities, they'll just be smaller, older, have fewer features.
At a GDP of 80k you can do whatever the hell you want if real estate expenses aren't killing you.
So no, you can't freely compare a country at 10k with one at 80k and try to bail out the comparison with PPP.
And the difference between 1 billion and 1 billion 30k is 1 billion. Percentages matter, thresholds matter. The person having 1 billion 30k doesn't have a materially different life to the person having 1 billion. The person having 30k is reasonably well off, the person having 0 is dead. The person having 40k is also reasonably well off while the person having 10k is poor (and NOT US poor, world standards poor; which BTW, is about the global average, which makes the average person in the world poor by modern development standards).
It's an average. You can average zero in with 140 and still have a higher average than the average of 90 and 40. And what do you expect if you don't average in the zero?
How does moving the discussion to the legibility of the rate of change
help us understand why large numbers of women are still dying from
pre-industrial causes in the richest nation?
Man! this plus the teenage suicide/mental health rate stats also possibly being an illusion (Obamacare changed data rules the same time mobile social media was taking off, obfuscating everything) has really thrown me for a loop. Not sure what to believe!
A related effect is there is a real tendency in online debates to use countries that speak exotic foreign languages as examples. So there is no way of working out what the data actually represents, what the known strengths and weaknesses are or what they are trying to measure. Or what the legal framework is.
I got a great laugh out of that, they've done an impressive job anglicising their website. But it doesn't really change the fundamental point. It doesn't take long to get to "Most of the content here is only available in Norwegian" [0]. And the articles on the Norwegen version of the site seem to be different to the English.
It can take a surprising amount of research sifting through who-knows-what to figure things out. One fun introductory challenge I recommend is figuring out what the components of the inflation index actually are; it usually takes a few rounds of sleuthing unless you have a muscle memory of where the right manual is. It is hard enough in the same language and with a familiar government. It isn't easy to do in a foreign language and unfamiliar government.
If your're most interested in blog posts google translate is great for exotic languages.
But for the data they're all there in English [0].
And if you're after methodology, analysis or understanding medical data, they follow WHO standards and publications are all in English on pubmed.gov [1] for the explicit purpose of international collaboration (which is the norm in medicine and public health for most developed nations).
I applaud the enthusiasm but I'm not that interested in Norway's medical system. I'm making a point about the larger issue of using foreign data. I spend a lot of time arguing with people on the internet for fun and education; and it is extremely common to get a cheerful comment which - after a few hours of investigation - appears to be an incorrect interpretation of data.
It is hard enough to do for systems that are part of the English speaking world or big, easy to track metrics. It is substantially harder to do for fiddly data series from foreign systems where the primary source material is in a different language.
> And if you're after methodology, analysis or understanding medical data, they follow WHO standards and publications are all in English on pubmed.gov
This goes to the main point - if it turns out that they don't follow WHO standards in an area or there is critical data not on pubmed.gov, what is the expected path for finding that out?
Because in English I have a much better chance of being able to figure that out. The countries are familiar and there is a better chance that the criticisms of the major institutions are well known. In a Norwegian context that already rather challenging task is even harder.
EDIT
An example occurs to me a few minutes later; there was an interesting theory that Japan had a lot of old people because there were unusually strong pension & tax incentives to lie about elderly relatives being alive when they were in fact dead.
The Japanese stats office could be following WHO standards and publishing all their information on pubmed.gov and the series would still be incomparable with other countries if there is an unusual incentive for the stats to deceive coming form an unexpected angle.
Keeping on top of that sort of thing in foreign legal systems is simply hard.
For the point of arguing with strangers, yes, I agree that neither PubMed nor any other entities will provide you with what you need. I don't think that it is possible to acquire an understanding of an issue without some domain knowledge, at least on how to get the data.
But to gain a deeper understanding of the flaws of any country's health (or any) system, there is no way around that except by comparing it with data from other countries. And that might be hard, which is why professionals spend a lot of time on it.
I don't think that is an in-depth on methodology, they seem to be talking about how the WHO does things. And that doesn't seem to translate the graphs.
But regardless, the bigger point is that the default position isn't that Stats Norway data is automatically comparable with everyone else's data. The world is large and complicated; it is quite easy for small details between systems to do surprising things.
Are saying that Norway speak an exotic foreign language, so we should ignore their results because some people feel that we cant trust their information? Does that mean that we should not compare the US system to these other nations? Who can we compare it to in that case, UK, Australia and New Zealand?
You can make judgements on uncertain data. It is a reasonable thing to do. It just happens that, given the number of people who muck up data that should be familiar to them, I say there is a lot of misplaced confidence in how well people understand other countries - confidence that often grows because the average person has very limited material to cross-reference with because they can't read a lot of publicly available stuff.
Yeah this roenxi user is one of the most talented mental gymnasts on HN. In past arguments I have been honestly suspicious that I was taken in by a performance artist.
OK thats all fine, this kind of discrepancies/errors happen all the time in statistics. You for some reason completely avoid massive discrepancy between 0 and what US reports. The fact that its slowly falling from relative stratospheric heights gives no comfort to common US citizens, when clearly it can be done much, much better.
I think we all know most probably the main reason - US healthcare is a business with huge prices compared to anywhere else in the world including nations with higher salaries, not public service. So its all nice and top notch if you have millions in some form, not if you are remaining 95% of the country. General compassion to fellow citizens in need is not a strong point of US in general, is it.
People like me could move literally anywhere in the world if wanted. I moved to Switzerland from my crappy home country for example. But hell will freeze sooner than I would want to raise my kids or get old in US, no thank you for many reasons and this being one of biggest.
Obesity in America is an undeclared national emergency. POTUS should invoke the Defense Production Act to nationalize the production of generic tirzepatide at a cost of $50/month for bulk compounded injectables. Compensate Lilly $10 billion and let that be that because national welfare is more important than profits.
This reply is so "American" I find it hard to believe it's not satire.
The, IMO, logical solution would be to change the underlying problem. Maybe even through some "national emergency". Force the food industry to change, help people to make healthy decisions, punish/rewards etc. But no: let's put everyone on medication.
I could imagine the latter to be a legitimate option if a country's people have some genetic trait that makes obesity harder to fight. But I don't believe that's the case in the US.
Nobody wants their car infrastructure taken away or reduced. But everyone loves living in the places where car infrastructure was taken away or reduced. It's a well-known conundrum. One that takes strong political will, leaders, a crisis or all of that.
I live in the Netherlands, which in the '70s and '80s was just as car infested as any place. Part luck, part timing and part political caused it to turn away from that, invest in bikes. And not top-down, nor bottom-up, just an accidental "perfect storm". We're now a in a situation where PT, car and bike infrastructure are a complex network that co-exists and is highly efficient. Where virtually everyone has (at least) one bike, takes that to work/school on average almost daily and also travels by car, train and other PT a lot. But where, above all, this is commonly seen as something good and people do feel really happy in it.
And even here, still, removing stroads or parking lots to turn them into parks, restaurant-areas or pedestrianized areas, will always meet a lot of resistance from people who think the cars are crucial to their lives/businesses/shops/schools. Yet when it's pushed through, generally, even those opposing it, often are much happier with the space after cars were removed from it.
However, I’m struggling to imagine how centralised actions would work. e.g.:
* Food and food ingredients are probably part of the problem, yet lots of people in America also manage to not be obese. There are some low-hanging fruit (eg high fructose corn syrup and saturated fats), but how far to go and where to stop? Also, this would generate a huge fight with those industries affected.
* We could create economic incentives or disincentives, but give there’re links between obesity and lower socioeconomic status, this would hit poor people harder and potentially exacerbate inequality.
* Education also seems like a rational response, but agreeing the ‘truth’ to educate people with would be a difficult fight! As in, the ‘Standard American Diet’ pyramid taught for generations and supported by “experts” is arguably a very bad diet to teach people to follow, yet misaligned incentives and economic influences meant that it persisted for generations. If that dogma was changed, where to go: low carb, vs. plant-based, vs. calorie counting, vs. paleo/primal, vs. intermittent fasting…?
And ultimately, as we saw during the pandemic, large groups of people are able to be stubborn and make scientifically bad decisions, especially in this world of ever-more polarised politics. You really think the anti-maskers will cope well with centralised (“communist”) meddling with their freedoms around food and drink?
> However, I’m struggling to imagine how centralised actions would work.
Don't imagine, just have a look at what is happening in other countries. Overlooking the world outside of the USA is also very "American".
Chile has the same problem with obesity. Some national policies where introduced, including mandatory information on food packages and a sugar tax. Of course, it did not magically solve the problem, but the obesity pandemic is decelerating, and the sales of unhealthy food have dropped, especially for children.
Other countries have introduced similar rules for mandatory package labels. In this domain, Mexico and Canada are ahead of the USA.
Adding one can of soda to your diet, and changing nothing else, will see you gain 10lbs in a year, or 50 in five. Sugar alone explains a substantial portion of the obesity epidemic. A sugar tax, were there political will for it, would go a long way and be far and away the simplest approach. Our political system is just so dysfunctional right now, it shard to imagine it happening anytime soon at scale.
I'd say that "centralized" action should first and foremost counter the "centralized systems" that cause this. food lobby, medicine lobby, car manufacturers. All their marketing, sales and "information supply".
One can argue that e.g. Coca Cola or Mac Donalds are mere players in a vast decentralised market, but everyone knows they are at best oligopolies and at worst centralized monopolies with a clear financial incentive to sell their inherently unhealthy products. Your local farmer, selling stuff for home cooked meals isn't anything close to a true competitor to these multinationals.
Eliminate zoning to enable functional walkable communities
Tax sugar (and eliminate subsidies for corn that goes into corn syrup)
The anti-maskers are going to be crybabies about literally anything. If we invented yellow paint today they’d insist it couldn’t be put on roads because they sometimes prefer to drive on the left side. We can’t let our country be permanently held hostage by the tyranny of the minority.
This idea is the natural conclusion of interventionist medicine culture where preventative measures and working the root causes are both disliked.
It has been shown, for example, that statins prevent much of the heart disease that kills middle-aged people, but this medication needs to be taken for decades before. And yet in many countries, although it is a known fact and statins are safe, doctors don’t prescribe it until people have heart failure and it won’t help much anyways.
Our approach to pain management has also shifted a lot in the last 2-4 decades. Managing pain was about finding the root cause and treating it. Now its about hiding the symptoms with paracetamol and ibuprofen.
Exercise is a known and very effective treatment for obesity. Many cultures in the East accept it and group exercises in public are common. We in the West also know the science, but more often than appropriate make fun of Asians exercising in the parks every morning. Then we medicate for all the symptoms of diseases that obesity brings. Doctors do not even prescribe exercise to most obese people. That is a prescription which is very effective with $0 monthly costs.
The goal is not quality of life. It is not to prevent disease, or to holistically treat it. The goal is to do interventions to prevent death.
And maybe that’s more liberal in a way — people can live their lives more consequence-free, enjoy unhealthy habits, and know that some % will be bailed out of their coffins just before things get bad enough. Ozempic is such a bail-out.
Yes, Ozempic is an effective drug in reversing obesity. It is a great drug. It will give people back many years of their lives that would have been lost to obesity. Maybe it is even as effective as good exercise habits, which cost $0 and have about 0 side-effects. It is definitely not a better option than exercise for most of the population. But if it’s the only option possible in our healthcare culture, then it is still very valuable. It just won’t end the obesity epidemic. A health culture that only prevents death simply does not concern itself with improving the quality of life.
Unfortunately, we are also quite proud to have such a dysfunctional culture.
> Exercise is a known and very effective treatment for obesity. Many cultures in the East accept it and group exercises in public are common.
The second sentence. What does this mean? Are you talking about elderly Chinese people doing Tai Chi? It is neither building muscle (resistance training) nor improving cardiovascular health. Sure, it might help with mental health, like yoga, but not for muscles/heart/lungs. And the rest of "the East"? Have you seen India? There are an incredible number of obese people in that country. I would guess that Korean, Japanese, and Vietnamese have lower obesity rates because of portion control and caloric density in their traditional diets. However, in the urban populations of Korea and Japan, obesity is rapidly increasing as processed food increases in their diets.
I was not taking about specifically Tai Chi. But I remember from public health classes in medschool that it is known for increasing flexibility and mobility, as well as improving balance and reducing falls in elderly. I also remember something about backwards walking/sageru exercises in Japan, but it is difficult for me to find much online about it.
I was talking about the broader culture that values Tai Chi. Tai Chi is one of “morning exercises” in China. Others include just walking. But my point was about a culture that incorporates morning exercises as a norm. Japan has “radio taiso”, which is a similar phenomenon. I think the West had a similar culture in the 80s and 90s. I was actually growing up in the Central Europe then, and it was normal in elementary and middle school to start the day with a 30-minute exercise lead by school staff.
I don’t know how to label this culture but “culture where it is the norm to exercise daily”.
Yes, as you say, obesity also has many, many other causes. And many other cures. It’s definitely not so one-dimensional. But exercise is very effective, and a culture that promotes exercise daily for everyone, at all paces, would benefit us a lot in the West.
I think people tremendously underestimate what 30 minutes of daily body weight exercises like push-ups, squats, and sit-ups, plus a little bit of walking can do for the said weight. There are many, many technology workers that now just work from home and barely walk at all. Not the majority, but many. There are many more office workers that just commute to work with their cars and never walk more than that demands. In that context, 30 minutes of morning exercise is quite a lot.
Yes, exactly right. Because they don’t work that well in this interventionist mode when they are prescribed to already treated patients.
The study you shared talks about primary and secondary prevention in a clinical setting. So this is for people who either have heart disease or are likely going to develop it. At that point, it seems like it is already too late and I would say primordial prevention[0] is better. When I say prevention, I speak as not a medical professional, and I mean it in the common sense of the word, which aligns with primordial prevention.
There seems to be extensive research that they work well if prescribed preventatively decades in advance, and it’s covered in a few recently popular books by doctors on the topic of lifespan vs. healthspan. For example, Outlive: The Science and Art of Longevity by L. Attia.
Moreover, the study you quoted shows a 9-29% relative reductions of the outcomes. About 1% is absolute. For the entire population, 1.3% fewer will die from a myocardial infarction. But it is a 29% reduction in the sub-population that would die from it. And those are fantastic results with only primary and secondary prevention. Unless I misunderstand something.
The study you provided is relevant and valuable for critical reading of such books as the aforementioned. Thank you.
The healthier answer simply isn't feasible, unfortunately: it means bulldozing the suburbs, confiscating most cars and handing out bicycles in exchange, and building new, walkable cities and forcing Americans to live in them. Also needed would be strict regulations on food quality, and banning some ingredients.
The drug may be a band-aid solution, but if it actually works for making people lose weight, it's better than telling them to eat better and get more exercise and then being shocked when they don't.
I very strongly disagree. Fixing our food, transit, and social systems is absolutely worth it. There are very simple measures we can take like offering a subsidy for e-bikes like we do for electric cars that would get more people outside. Taking measures to make more healthy food more accessible to people who need it would absolutely be worth it.
Cities all over the country are already assessing which roads can be converted from four lane stroads to two lane streets with protected bike lanes on either side. We can provide federal funds to encourage more of this.
Weight isn’t even the only problem with our culture. Being stuck in cars and eating unhealthy food also affects rates of heart disease and depression. Making those people lose body fat might help with those factors, but I suspect it would do so less than actually making healthier food options more accessible.
For those that really feel medication is their best choice, when we have made sure other options are available, we should also offer free medical care to all people. But that should not be the primary solution to this problem for most people!
The "simple measures" you name are things that require political will, and America doesn't have it. That's why these things are infeasible: American voters have to want them, and have to elect people who will enact them. They're not going to do that, outside of a few select municipalities (where obesity probably isn't a big problem anyway, because the people there are wealthy and educated). Even worse, America is almost certainly going to elect Trump for a 2nd term; the country is swinging conservative, so these "simple measures" you name definitely aren't happening any time soon. Look at NYC for instance: the Democratic state governor just scrapped their congestion charge program, so living in blue states and electing Democrats isn't any kind of guarantee of positive change either.
Honestly most of the stuff I mentioned is pretty in line with Bidens infrastructure plan which did actually pass! But even if you say my proposal is pure political fantasy, so is giving everyone ozempic. If we’re actually going to dream of fantasy proposals, “give everyone drugs to mask one symptom of our many problems” seems to me an impoverished fantasy.
It’s not the cars and it’s not the walking. Ignore the unique cities like LA and NYC, and daily suburban life is the same in Santa Clara or Little Rock or St. Louis or Charlotte. But some cities are full of morbidly obese people, while some (e.g. Bay Area, where you drive everywhere) have basically none of it.
Also exercise really doesn't burn as many calories as people think. You usually need to work out as much as a pro athlete or olympian to burn a noticeable amount of calories from exercise. The reality is that a lot of Americans just eat too much.
Building walkable cities (at large scale) in the US is impossible. Not because of physics or resources, but because of politics and American voters' preferences.
Sure, there's a small portion of the electorate that wants this, but they're a minority and not powerful enough to get real change outside of a few localities.
100 years ago the US had ~76m inhabitants - a fifth of what we have today - plus horses and buggies were used broadly throughout the country. The streets in our older cities weren't born from nothing but aether when cars were invented.
I'd dig one deeper and look at the reasons why it's "not feasible" and the change that first. If people propose "national emergency" as a solution, clearly such options should be on the table.
It's not feasible for various reasons, but they mostly boil down to "political will". There's two main causes I see: food/nutrition, and lifestyle (i.e. not enough exercise, and using cars, which is caused by urban design). There simply isn't enough political will to make any significant change on either of these fronts. Don't forget, the US is almost certainly going to elect Trump for a 2nd term, so obviously there isn't going to be any positive change in either nutrition or urban design for quite some time.
So, basically the US electorate chooses to be obese? If so, the underlying question is: why do they choose this?
I can think of several reasons, but to me the most obvious cause is "runaway capitalism", where a few big corporations lobby and market and (mis)inform, to make people think this is what they want, just so they can sell more cars, sugar, processed (high marging) foods and so on.
Not to make this an anti-capitalist rant, to be clear. Just that I'm fairly sure we're seeing a clear limitation of "free markets", where people simply aren't the rational homo-economicus that many promised we'd be.
There's tons of healthy food options available to consumers these days, even in regular supermarkets. They all have "organic" food aisles now. Some Americans have become more conscious of this and have adjusted their diets. (Of course, there's also some companies trying to profit off this unfairly, like advertising "gluten free" on foods that would never contain gluten anyway, and also pushing gluten-free foods as "healthier" when there's really no evidence for that, they're healthier of course for people with a gluten allergy or sensitivity but that doesn't extend to everyone.)
In a democratic society, it's the people's responsibility to be educated about issues, so they can vote accordingly. Most Americans are making conscious choices to eat bad foods, not exercise, live in suburbs with car-dependent lifestyles, etc. They could move to inner cities and/or push locally for more density and anti-car measures, but they don't, outside of a few select places.
Instead, a large chunk of American society "educates" itself about conspiracy theories and the "importance" of guns and religion, and votes accordingly, and what you get is the society you see now.
Why? It works and is (so far as we can tell, except for a few exceptions like thyroid cancer) completely safe. It would have immediate results. Sure, it would be better to fix the root causes. But we are so far from being in a position where that is feasible.
The general consensus seems to be that obesity is not lifestyle related, those affected can't do anything about it, and the only option is taking a drug (that has other severe side effects imo).
Caloric restriction and exercise of course do not work because thermodynamics are subjective.
Describe as you see it the process and ideal timeline that sees every 500lb and under American lose weight and regain the health benefit that comes from it.
Do you support the use of statins and diabetes medications in this population for this process or do you consider that cheating as well?
Obese people generally have lower lifetime healthcare spending. The third knee replacement and a year in assisted living is expensive, and in the US that senior-care cost is primarily borne by the government as opposed to the health insurance paid by the working. Which is why ozempic blows up the federal budget - obese people dying young is a very cheap solution to the problem, and it’s not a cost that’s borne by the government.
I don't think this is obviously true, if it is true. You're the one equating money with obesity. You shouldn't do that and then instantly deride the previous person for doing it. They didn't.
So, socioeconomic status vs personality traits it is?
How does personality develop?
Is it somehow inherent to sub-humans or a product of ones environment?
Of course its a socioeconomic factor. If you try to argue against this one, you have essentially only the other option left and derserve to be ripped apart in the comments.
Others have asked for the root cause before, here is my grand take: better education <- fair taxation <- social mobility <- wealth distribution <- matured laicists and a healthy democracy. I tried to put capitalism in there but it just lingers all over it. That socialist take is also my broad explanaition why other developed countries habe better health metrics. Guess what happens when you argue against this one :)
> Guess what happens when you argue against this one :)
I'll assume you'll either accidentally or deliberately find a way to box what I'm saying into a much narrower confine, which you will then threaten to beat the straw out of. Given it's happened twice now.
> Of course its a socioeconomic factor. If you try to argue against this one, you have essentially only the other option left and derserve to be ripped apart in the comments.
Everyone seems very keen to accept that obesity is linked to maternal mortality without actually looking at any of the details, how the deaths occur, how they could have been prevented, etc.
Wow Tonga is running away with it. Based on their population apparently just under 30,000 more people got wicked fat in 8 years? What have they been eating on that island
- Their original food culture was wiped by colonialism
- Now they rely on imported foods without regard for its composition
Phrased differently:
It is easier for imported foods to beat existing options, because the island culture does not preserve attractive options so well. And it is easy for imported foods to be unhealthy.
> ... Pacific islanders are more prone to obesity than people in other nations. Now a new study led by the University of Oxford has examined why islanders on Nauru and in the Cook Islands in the Pacific have the highest levels and fastest rates of obesity increase in the world. On both the islands, between 1980 and 2008 the increase in the average body mass index was four times higher than the global average. The paper, published in the journal Public Health Nutrition, provides a novel theory for why obesity levels are so high there. It suggests that social changes, introduced when the islands were under colonial rule, have significantly contributed to unhealthy dietary habits.
They don't - not to the same degree. Most imports to the southern pacfic islands come from NZ and Australia. Both countries have their own obesity issues, but not to the same rate as in the islands.
Orthogonally, the USA has a fentanyl epidemic, and neither China or India (who export fentanyl) nor Mexico (where it flows into the USA) have a fentanyl problem.
That's true, but that's not saying that Mexican culture is going to the US and making people die from drugs. If it were Mexican culture to take fentanyl and Mexicans weren't dying from it, we'd probably look outside of fentanyl to explain the US deaths from that hypothetical culture.
Anecdotally and from my own experience living in a couple of small towns in Mexico. Cartels don’t allow the sale of fentanyl in their hometowns because they know what it does to a population.
I rather strongly doubt the "Norway has zero" statement. It does not directly reference any study nor does any other article stating the same. I don't doubt that it is lower or even rounds to 0 per 100,000, but actually 0 is almost certainly wrong.
In 2021 [0], the deaths per 100,000 in Norway was 1.7 which is ~80 maternal deaths. I find it hard to believe that Norway happened to go from 80 to 0 in two years even including a generous amount of luck.
First, mothers-to-be in the US need single-payer healthcare, not be sentenced to prison for having a miscarriage, and not told they must be dying of sepsis before they can receive healthcare.
In a Where To Invade Next? (2015)-style of policy prescriptions, the US should copy baby boxes, use policies that work, and measure the results of experiments with creative solutions as long as they work rather than putting the military-industrial complex and profits of big pharma and megahospitals before lives and the standards of living of regular people to not go bankrupt.
Income limits usually apply still. In my state, its up to 32K for pregnant women or for those with a child under age 1. For children 1 and 5 it goes down to about 20K.
If you're above those limits, no medicaid. You can go on ACA/Obamacare plans but those are (much) more expensive even with subsidies, at least in my state.
A birth all in all is surely way above 10k dollars. So people are literally expected to pay 5k+ to have a child? If that's not stressful enough for many poorer people I don't know either
If it's an emergency of some sort, it's probably 100% covered. The thing though is that MedicAid is run similarly to Medicare where private insurers get involved but provide really shitty plans with terrible formularies and very limited choices for providers. Also, there's widespread healthcare provider bias, stigma, and discrimination against MedicAid patients.
> Out of pocket costs cannot be imposed for emergency services, family planning services, pregnancy-related services, or preventive services for children. Generally, out of pocket costs apply to all Medicaid enrollees except those specifically exempted by law and most are limited to nominal amounts. Exempted groups include children, terminally ill individuals, and individuals residing in an institution
There's an incredible variety of health care needed in the 9 months before birth, and well after. That care is poorly covered in the US compared to most developed nations.
We were both in college when my first child was born with one $13/hr summer internships's worth of income. Medicaid covered 100% of everything; I paid $0 out of pocket.
This is false. Medicaid coverage is better than even European healthcare systems. It will cover rare disease drugs that aren’t paid for in the EU (it has to by law).
Plus the OOP expenses are basically zero.
While true not all doctor accept new Medicaid patients, you can find care.
>First, mothers-to-be in the US need single-payer healthcare, not be sentenced to prison for having a miscarriage,
In your opinion, sure, but American voters disagree, which is why it's like this. American voters chose the Supreme Court that made this recent change.
I'm pretty sure that the commenter was referring to baby boxes as in "box of supplies to be able to take care of a baby" [0] and not as in "box to abandon a baby if you cannot take care of it" [1].
I know they have this in Finland, but I suspect it's more as tradition than need. The other Nordic countries does not have anything like that. In Norway there's a diaper brand that gives out boxes to new mothers, but it's more like a fun thing than something that is needed.
What works is a proper health care system with a predefined care path for pregnancies including regular checkups, access to courses and educational material about pregnancy and child birth, low bar for paid sick leave for pregnant women and paid maternity leave mandated by law.
Yes, without much knowledge on the subject, I do intuitively agree with you. I don't think baby boxes per se can make that much of a difference — they're more like the "icing on the cake" of a solid social support policy to help expectant and new mothers.
Since you dug up those links from Wikipedia, it should be noted that baby hatch is first in the list on baby box, indicating it’s the more common usage.
But also maybe the term baby box is too ambiguous to be used at all, if it means both of those things.
The US just deserves better. To meet it feels all of this hinges on that zero-sum mentality of "if I help the other guy that means I have it worse", when in reality helping others will also improve the society as a whole. I mean maybe there are people who find appeal in a society of armed, rugged individualists under constant existential stress where even those that "have made it" are at constant risk of crossing paths with a desperate peer at the verge of making a bad decision — but to be honest to me that sounds rather dystopian.
It is nice to be part of a society that is stable and where people care for each other and the value of that reaches far beyond what the bean counters would quantify in measurable terms — but that doesn't mean there are no measurable terms Q.e.d.
> but to be honest to me that sounds rather dystopian.
It sounds that way because it's a dystopian description written in crayon. It's not real.
The US has loads of charity happening; it gives the most in aid; it makes the most businesses (which increase the size of the pie, and are win-win, and not zero sum mentality - other than the people who complain about billionaires); it has by far the most resident migrants of any country[0]; it's just really silly to characterise the US like this. The biggest line item in the 2024 federal budget[1] is healthcare, at $1.53tn. Second is social security, at $1.45tn.
Overseas it spends a fortune too. Just recently it's spending $61bn more[2], making its own citizens poorer, on Ukraine defence and humanitarian aid.
Making the most businesses is not a net positive. Lots of businesses monetize horrible things. It's pretty off topic from maternal deaths, am I supposed to be comforted that there's another landlord or AI startup?
Aside from being about 1/80th the size of the US, and far less obese, their "scale" of obesity is far lower. I had a super-super morbidly obese teacher in college who took up an entire table, and had students do anything for her that required movement. This is relatively common in the US. Once you're at the weight a routine trip to the doctor could have you leaving in a body bag. It's incredibly misleading, and frankly a miracle our health care system can even keep most of these people alive as long as they do, let alone through pregnancy, which is effectively a surgery.
It needs to spend smarter, not more. It's already spending way more per capita then any other nation. It just doesn't have a lot to show for it in terms of key statistics like average age, child mortality, or indeed maternal deaths. Throwing more money at the problem will just ensure more money gets misspent.
Regardless of how you feel about diversity or who's fault all the differences in groups are, it's disingenuous to compare the least diverse country in the world to the most diverse like this.
Wealthy white people in America surely have great maternal mortality rates, too.
"In 2021, the maternal mortality rate for non-Hispanic Black (subsequently, Black) women was 69.9 deaths per 100,000 live births, 2.6 times the rate for non-Hispanic White (subsequently, White) women (26.6)"
Where does wealth and healthcare come from? The natural state of the world is no wealth and no healthcare. Someone has to build civilization, humans have to work hard to support it, and every future generation has to be committed to maintaining it. Diversity is antithetical to all of this.
That's not a diversity issue, that's a "people not playing the game" issue, leeches can have any skin color or country of origin. I know white trash that are more of a burden to society than some of my immigrant friends (what HN call "expats" because they somehow think they're not migrants)
Yes, this is a diversity issue. If you want people to play the game you can't replace them with hostile outsiders and call them "white trash". Thanks for illustrating my point.
There are hostile outsiders of course but the extreme vast majority of people play the game.
Do you really think the US (aka #1 economy in the world aka #1 power in the world) has the same life expectancy as Sri Lanka because """diversity""" ? There are a dozen of things that have more impacts. Like half of the US being obese, or 15%+ have diabetes, &c. (which are both factors in maternal death btw). Time to wake up and take a good hard look in the mirror
The US has been socially destroyed in the unrelenting pursuit of diversity, and as you've observed, our life expectancy has been dropping for years. Nobody cares about anything, the game is already over. This isn't our country anymore.
Are you implying that the ethnic homogeneity of Norway is the reason for the low maternal death rates in Norway? Or are you saying it's the economic "diversity" (i.e. inequality) in the US that's the problem? What exactly makes such a comparison disingenuous?
Interesting timing as one of those freakonomics-wannabee blogs only yesterday tried to discredit the idea that the US had a maternity problem with a weirdly political attack.
Apparently some statistical change in 2003 somehow caused a much higher death rate of mothers in the decades before it even happened and simultaneously caused a disproportionate amount of black mothers to die.
You have to be really careful with time-travelling, genocidal statistical errors but apart from that there's nothing we can do to prevent the 80% of these deaths that are preventable, says the only developed country where this happens.
In the USA, the main issue is that a lot of people are poor and can’t afford healthcare. And that’s really on them. They have to really do their best, stop being so lazy and just stop being so poor.
It’s the land of equal opportunity, a level playing field and if you can’t make it, you’re not working hard enough. They should really take personal responsibility seriously.
If you just felt for a split second any doubt about me being serious or not that should mean something.
I have been thinking about this being poor thing. Isn't it like all of the losing weight advice. Earn more, spend less and save more simple to do it. It is all about money in and money out. If you have more money coming in and less going out you will be rich.
Trivial advice to follow and anyone should be able to do it right?
US public spending on healthcare dwarfs every European nation. The US public healthcare expenditure per capita is greater than Norway's Public + Private expenditure.
This is exactly why. Yes, this comment is in jest, but something like it is the culture in the US, from way back when it really was an unexplored continent where you could get rich just by doing anything.
This mindset has persisted to varying degrees, and it's why Americans are so opposed to a social safety net. After all, the only way for someone to be poor in the US is to deserve it.
It's true: if you're poor in the US, you definitely deserve it. This is true if you're a malnourished young child too: if you deserved a better life, you would have been born to richer parents.
I think the social darwinism in culture is in part the result of decades of red scare brainwashing and its fallout, like identitarian consumerism. It's really what sets the US apart. As a western nation, the US seems to lack a generation of collectivist (youth) revolt as a cultural balancing force. "The left" is, has been a joke in America.
I mean seriously, you still witness pavlovian reflexes on anything "social" all the time. Sometimes feeling mindlessly automatic, it's rather disturbing.
Exactly, and the "social safety net" gets the same scare. What? You want healthcare? That's socialism, one step closer to communism, which everyone knows is the devil!
Ah, the American dream/philosophy: "If you work hard, you'll be successful". If you believe this, then you have to believe the reverse: "If you're not successful, that's because you're a lazy fuck". Just look at OP preaching this.
"equal opportunity", maybe a few decades ago. I could throw in the words "systemic racism" in here but you'll dismiss me as a stupid woke-brain whose arguments aren't worth listening to.
Meanwhile you don't realize how much luck you (or other billionaires) have encountered..
The hard truth is that these babies are lucky to have been born in a country of equal opportunity, and those who don't manage to live beyond a year simply haven't worked hard enough.
Providing for the needs of lazy babies is the first step towards socialism.
> In 2021, Joseph et al. published a paper in Obstetrics & Gynecology demonstrating that the entire recorded increase in maternal mortality since 2003 was due to a change in the way data was gathered. In 2003, U.S. states began to include pregnancy checkboxes on death certificates. This led to a whole lot more women who died while pregnant being identified as such. The apparent steady increase in maternal mortality was due to the fact that states adopted this new checkbox at different times:
> In fact, when the authors looked at the common causes of death from pregnancy, they found that these had all declined since 2000, implying that U.S. maternal mortality has actually been falling. Meanwhile, a CDC report in 2020 had found the same thing as Joseph et al. (2021) — maternal mortality rose only in states that added the checkbox to death certificates.