High Life (2020)
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High Life (2020)
A group of criminals serving death sentences are sent on a mission in space to extract alternative energy from a black hole. Each prisoner is treated as a guinea pig by Dr. Dibs for her experiments. She is fixated on trying to create a child in space through artificial insemination, but has yet to succeed. Sexual activity between prisoners is prohibited. The ship is equipped with "The Box," a device in a small room that is obsessively used by the crew to masturbate. Dr Dibs administers sedatives to the passengers. Dibs is on the ship because she murdered her own children and husband before attempting suicide. Monte, the only celibate prisoner, rejects Dibs' sexual advances. Monte is serving a life sentence for murdering a friend for killing his dog as a child. Monte's only friend on the ship is Tcherny, who is drawn to the onboard garden because it reminds him of Earth.
The short summary of what I will discuss below is that Americans suffer higher death rates from smoking, obesity, homicides, opioid overdoses, suicides, road accidents, and infant deaths. In addition to this, deeper poverty and less access to healthcare mean Americans at lower incomes die at a younger age than poor people in other rich countries.
The US clearly stands out as the chart shows: Americans spend far more on health than any other country in the world, yet the life expectancy of the American population is shorter than in other rich countries that spend far less.
The unequal development over recent decades led to an inequality between the US and other rich countries. In the US health spending per capita is up to four times higher, yet life expectancy is lower than in all of these countries.
One could write an entire book on what this chart shows us. Here I want to look at one key question: why is life expectancy in the US shorter? Which causes of death are more common in the US than in other rich countries?
Obesity is a key risk factor for many of the leading causes of death in rich countries, including heart disease, diabetes, some cancers, and stroke.3 Estimates of the death rate from obesity-related factors in the US are higher than for other countries as the chart shows. To improve population health it will be key for all countries to make progress against obesity, for the US it is especially important.
This is of course important but it cannot explain the growing inequality in life expectancy between the US and other countries over time. Over the last few decades, homicide rates have declined more in the US than in other rich countries. In relative terms, the faster decline of homicide rates in the US has reduced the relative difference in life expectancy between countries.
In the US the death rate has increased more than 10-fold since 1990, while opioid overdoses have remained an extremely rare cause of death in other countries. No other country in the world has seen a surge in opioid overdose deaths as large as the US. Today the US has by far the highest opioid overdose death rate.
Opioid overdoses are still thankfully a relatively rare cause of death overall (it is the cause of death of 1.6% of Americans), but these deaths affect life expectancy because many victims are relatively young.
Ruhm (2017) carefully studied opioid mortality in the US on a local level and found that the availability and the prescription of opioid-based painkillers is the main driver of the opioid mortality surge in the US.4 This contributes to an explanation of both aspects that the first chart above highlights: lower life expectancy and higher healthcare costs.
Suicides are also among the few causes of death that are a high risk for younger people. The age distribution of suicides and the fact that suicides are rising in the US and falling in many other rich countries explain why this is another cause of death that contributes to the divergence in life expectancy that we are trying to explain.
Not just the mortality of infants is higher in the