PLANETARY HEALTH WEEKLY

The winter games in Beijing are likely to be over by the time you read this.  The games originated in Greece millennia ago and coincided with a festival honoring Zeus.  They  were revived in Athens in 1896 with contestants from 12 nations.  World wars prevented holding them in 1916, 1940 and 1944.  The Tokyo 2020 event was postponed a year due to COVID-19.  Since 1994 there have been separate Summer and Winter Olympics alternating every two years. Countries compete with medals awarded to individuals and teams that represent their nation. What qualifies as an Olympic event has changed since the first tournament, from a 192 meter footrace in the first Games to now more than 400 events among 35 different sports and 53 disciplines in the Winter and Summer games combined.  Events such as golf, skateboarding, and surfing have been added, while others such as cricket retired.  Breakdancing and frisbee will likely debut in 2024. The Paralympic Games were added in 1960 in Rome featuring 400 athletes from 23 countries. 

What if health was a discipline in the Olympics?  What kind of races or events might be considered?  I began thinking this way over 20 years ago, coining the phrase “Health Olympics” in a paper in the Canadian Medical Association Journal titled: “Societal hierarchy and the health Olympics.” Alas, this hasn’t yet become a household phrase. That article has had few citations and bespeaks to a desire to not make country comparisons for meaningful health outcomes. That has not always been the case, as a Canadian prime minister once boasted that Canada was number two in life expectancy rankings a few decades ago, and Australia set the aim of being the healthiest country by 2020. Let’s explore the Health Olympics. 

A reasonable race in such events would be life expectancy, average length of life if mortality rates didn’t change from year to year.  There are various sources for this data.  I’ve been using the annual United Nations Human Development Report where Table 1 lists UN nations and their life expectancies.  Vital statistics refers to the recording of vital events such as births and deaths. All rich countries have been doing this for some time and reasonable estimates exist for the others.  For 2019 the UNDP ranking for the Gold Medal would go to Japan with a life expectancy of 84.6 years.  Canada ranked 13th with 82.4 years while the United States tied for 36th at 78.9 years.  

The United States Central Intelligence Agency (CIA) has a World Factbook where they rank nations on various indicators.  For the latest data (they used to report the year for the indicator but no longer do), Japan comes in at 84.65 while Canada is 83.62 and the U.S. is 80.43.  The U.S. ranks 46^th there.  The CIA includes tiny countries such as Monaco, San Marino and Taiwan (which is not a UN country) which explains the poorer U.S. ranking.   

As many know, there is current disagreement about numbers of COVID-19 deaths.  There is no UN report for 2020 COVID-19 outcomes. Nevertheless, the U.S. appears to have had more COVID-19 deaths than any other nation.  Some estimates for 2020 keep Japan at 84.4, while Canada is 81.7 while the U.S. drops to 77.3 years. Statistics Canada reported this as the largest decrease recorded since 1921, the year its vital statistics registration system was introduced. 

If health were an Olympic event and the race was how long you lived, then the U.S. would not appear in the event as it would have been disqualified in the trials.  Back in the early 1950s the U.S. would certainly have been in the finals although the times would be considerably shorter.  That is, measured by length of life, the United States was one of the leading nations in the early 1950s and might have won a medal.  The qualifier ‘might’ is necessary as good data were not then available for all countries.  Nonetheless, since then many other nations have seen much greater improvements in health than the United States. Why is this the case? 

Consider the 2019 5.7 year gap between Japan and America.  If the two leading causes of death in the U.S. that year were eliminated, heart disease and cancer, the United States would be very close to Japan’s life expectancy.  In other words if the United States eliminated its two leading killers as causes of death, they would be close to being the longest-lived country.  That represents a phenomenal health gap. While such figures are occasionally reported in the news, namely U.S. life expectancy numbers and those of longer-lived nations, the significance of those few years difference is never explained. 

What surprises me is how difficult it is to draw attention to U.S. health in comparison to other nations.  There is the belief that America is number one, the best, when it comes to anything and everything.   

In upcoming posts I will explore reasons for the U.S. relative health decline (and with COVID-19, an absolute health decline not seen in some other nations such as Japan).