In the case of the US it is somewhat unhelpful to look at the "United States" as a unit of measurement. There is ~10 year life expectancy difference between individual States and most of the risk factors mentioned are a function of State policy, not Federal. It also maps to large differences in population genetics across regions e.g. the famous observation that "the only person that lives longer than a Japanese woman is a Japanese woman in America" is doing a lot of work in Hawaii. There is a well-known inverse correlation between obesity and elevation which is doing work in the Mountain West.
While the lifestyle of many Americans leaves a lot to be desired, I do recognize that many parts of the US have weather/climate that is prohibitive for outdoor activity much of the year and these places tend to be fat. If you look at the life expectancies in parts of the US that are known for having human friendly weather and outdoor activity, they tend to be among the highest in the country with low obesity rates to match, but this is confounded by geography and genetics.
It is complicated. The causes are sufficiently diverse and regional that the solutions need to be local.
If we're cherrypicking like that I'm sure you can find some Japanese prefecture or Swiss canton that has 10 years+ higher life expectancy than Hawaii's 79.9 years, the US state with the longest life expectancy.
Almost every US State is larger than Switzerland -- the entire country -- never mind a single canton. If you want to get that granular some State counties have life expectancies in the mid-90s.
I think a subnational analysis of Switzerland is a good metric for analyzing subnational development in similarly sized states like MA, Kansas, Minnesota, and Mississippi.
At a macro-level or even for larger states of the US like California or Texas, not really.
The blue zone debunking was done by somebody outside of this field of study. The actual researchers who did the on the ground work to verify ages aren't so foolish as to just blanket ignore this sort of thing. Verification is more complex than "ask Bob how old he is and write it down."
"Blue zones as health miracle" is overstated. "Blue zones as simple fraud" is overstated.
>Okinawa in Japan is one of these zones. There was a Japanese government review in 2010, which found that 82% of the people aged over 100 in Japan turned out to be dead. The secret to living to 110 was, don’t register your death. (conversation article)
None of the blue zones from the actual research are cities this large. And the researchers that identified the blue zones did not get their data from government census information.
You absolutely should do the same spatial inequality analysis in Japan and Italy as well (in fact, this is the norm in Italy's policymaking space due to the documented north-south divide). Heck, this is called out in the Nature article as well if you read TFA.
The US (330m), Japan (120m), and Italy (60m) are all large countries, and in the US and Italy's case, extremely federalized with social service delivery responsibilities falling onto subnational governments.
And for large developed countries like the US, UK, France, Germany, Italy, Japan, etc their developmental indicators have largely converged at a macro-level (the difference in living standards between countries with a national HDI of 0.900, 0.920, and 0.940 are marginal), but spatial inequality continues to act as a persistent laggard.
Outliers matter. This is like statistics/EDA 101.
P.S. If you do EDA on Japan versus US from an HDI perspective, you find that the Southern Kanto region (ie. Greater Tokyo) tends to skew Japanese statistics - with a subnational HDI comparable to MA - but the rest of the subnational regions of Japan have HDIs comparable to Tennessee (0.890-0.900) or Florida (0.920-0.930).
What this highlights is that public service delivery is stronger in the Greater Tokyo region than the rest of Japan.
And this is unsurprisingly a major topic of discussion in Japanese policymaking as well, as the poorer regions have seen a massive youth flight to Tokyo.
Same with the less developed regions of the US as well.
When you do a similar spatial analysis of the US, you find the Deep South (MS, AL, AR, LA), Appalachia (WV, TN, KY), and MO continuing to lag. You also end up identifying rust belt states like MI and OH starting to lag.
The interest thing is, the Deep South and Appalachia didn't seem to lag in the early 1990s compared to the rest of the states, but remained stuck at 1990s levels while other states improved significantly in the 2000s and 2010s, and it was these states that regressed the most in the COVID years (2020-2022) [0]. My running theory is that these states were the kinds of states where low value single factory/industry towns (eg. Textiles) were most prominent, and were the worst hit by a mixture of NAFTA, China Shock, and the Great Recession.
This would also explain why GA, NC, and SC didn't see the same laggardness despite being comparable with the rest of the south in the 1990s - Atlanta, Charlotte, RTP, Greenville, and Columbia were industrialized enough in high value industries like automotive and power systems and had significant additional industries like Finance and Tech that allowed them to upskill and diversify.
> I do recognize that many parts of the US have weather/climate that is prohibitive for outdoor activity much of the year and these places tend to be fat.
Your comment doesn't make any sense. The South has terrible climate, suffocating heat and humidity much of the year. It is at the same latitude as North Africa. Why would anyone expect people to be outdoors in this environment? There is a reason they rely on air conditioning.
The populated parts of Alaska have mild climates similar to the Pacific Northwest, certainly more pleasant than the Midwest and not nearly as cold in winter. The high desert (e.g. Utah, Colorado) similarly has a pleasant low-humidity climate most of the year that is conducive to outdoor activity.
> The South has terrible climate, suffocating heat and humidity much of the year.
I just have to laugh at this. Have you lived in the Midwest? We have suffocating heat and humidity too, in fact the past several days. In the winter, we have biting cold windchills. And guess what, we also rely on air conditioning!
Two other factors worth noting: exercise does not depend on the outdoors. There are gyms, etc. Moreover, obesity does not depend entirely on lack of exercise; diet is a major factor too. Indeed, many would argue that diet is the more important factor.
I'd interpreted GP's comment "parts of the US have weather/climate that is prohibitive for outdoor activity" as specifically referring to the South, much of which is extremely unpleasant and borderline uninhabitable without air conditioning.
I don't know much about the Midwest but I grew up in Massachusetts (one of those northern states with good health & life expectancy but a reputation for bad weather) and my sister lived in Houston for a decade (which has mediocre life expectancy and bad weather). In Massachusetts, the winters were cold and snowy, the summers are hot and humid, and you had about 3 weeks of good weather in the spring and 2 weeks in the fall, but you sucked it up and went outside anyway. The snow wasn't going to shovel itself. In Texas, you stay inside in your nice air conditioned home all the time, unless you're getting into your nice air conditioned car to drive to a nice air conditioned indoor place. Nobody goes outside.
I'm in California now, in a town that is both hilly and walkable, and a lot of the residents here live to 95. When you're climbing the equivalent of 200 stairs each time you drop your kid off at school, you get a lot of background exercise without really trying.
I'm fairly convinced that exercise or the lack thereof and relatedly the rate at which people go outside is a major predictor of health outcomes.
> I'd interpreted GP's comment "parts of the US have weather/climate that is prohibitive for outdoor activity" as specifically referring to the South
To each their own, I guess, but I immediately thought of Midwest winters.
> borderline uninhabitable without air conditioning
The south was inhabited long before air conditioning was invented.
> In Massachusetts, the winters were cold and snowy, the summers are hot and humid, and you had about 3 weeks of good weather in the spring and 2 weeks in the fall
Minnesota is like that too, except the winters are colder and the summers hotter.
> you sucked it up and went outside anyway
Indeed, it's a choice. People exercise in all types of weather, hot and humid or cold and bitter.
> unless you're getting into your nice air conditioned car to drive to a nice air conditioned indoor place
Like the gym, for example?
> Nobody goes outside.
That's false, but in any case it's a choice.
> I'm fairly convinced that exercise or the lack thereof... is a major predictor of health outcomes.
Of course it is. But you completely ignored my statements about diet.
> and relatedly the rate at which people go outside
This is a different matter. Speaking personally, I almost always exercise indoors nowadays.
Your AC argument is weak. The south was quite miserable before AC. And we don't know anything about relative obesity back in the day between the South now, AFAIK. You can argue that not exercising is a choice, but either they consistently make that choice because are inherently lazy compared to others (dubious), it's all down to diet (possible) or because there actually is something different about physical activity in the South. I think extreme temps negatively impacting desire to exercise is an interesting theory. I know it's trivial to dress well for outdoor activities down to 40 degrees and quite manageable down to 30. 90+ on the other hand is not manageable, even in low humidity. So your comparison between hot and cold is a false equivalence.
Also the gym fucking sucks so I don't know why we are pretending it's a viable replacement for liveable climate. I don't go to the gym, but I ride my bike. I even ride it in extreme heat, like yesterday the heat index was over 100. Still won't catch me wasting my life doing boring exercise I hate in a gym.
> Did I say every day? Did you say every day was sub zero in the Midwest?
No, and no. Because both would be gross exaggerations.
My point is that both Minnesota and Mississippi, for example, have many days a year that are good for outdoor activites and many days a year that are not good for outdoor activities. The climate of Minnesota is no less hostile than the climate of Mississippi. Thus, differences in climate do not explain why Minnesota is one of the fittest states and Mississippi one of the fattest.
Needless to say, these are only relative differences. There are many fit people in both states, and many fat people in both states. When commenters say crap like, "Nobody goes outside", it's an absurd hyperbole, and it undermines the argument.
This all sounds valid, but isn't there a significant portion of people who deliberately avoid treatment of their illnesses because they can't afford it?
Can a worker who does not earn six figures and who does not have large savings afford treatment for diabetes, cancer, heart disease, or proper time to heal after an accident?
Go to the dentist when they have a toothache, or to the general physician when they have a flu or even a severe cold?
There is no paid sick leave, right?
I'm asking this in earnest, because it is not clear to me what the minimum public healthcare currently covers in the US?
Being sick or even chronically ill when you are not wealthy is already likely to make you poor even in places with broad public healthcare in Europe, if you are in bad luck.
But if you aren't given a minimum life support when sick (1-room flat, money for food) and no treatment in such a situation, you'll likely to end up homeless or die from your disease while grinding in your low-paid job until the end, no?
While the lifestyle of many Americans leaves a lot to be desired, I do recognize that many parts of the US have weather/climate that is prohibitive for outdoor activity much of the year and these places tend to be fat. If you look at the life expectancies in parts of the US that are known for having human friendly weather and outdoor activity, they tend to be among the highest in the country with low obesity rates to match, but this is confounded by geography and genetics.
It is complicated. The causes are sufficiently diverse and regional that the solutions need to be local.