How we die in the US versus how people die abroad

In the past few years, there’s been a lot of talk about how we die in America. There’s been a lot less talk about how we don’t.

We don’t die from diarrhea. We don’t die from malnutrition. We don’t die from tuberculosis.

The rest of the world isn’t so lucky. I was looking at World Health Organization statistics last week and was struck by the huge gap between the richest and poorest nations. In countries like Afghanistan and Ethiopia, communicable and conquerable illnesses like TB kill people at hundreds of times the rate of death as in the United States.

Organizations like the Gates Foundation are working to disseminate simple, replicable interventions like encouraging mothers to dry their newborns and breastfeed them. But the problems are still huge, and the public health challenge remains enormous.

“There are still 6 million children who die every year before their fifth birthday from causes that are almost entirely preventable,” William Heisel told me. Heisel is the director of global engagement for the Institute for Health Metrics and Evaluation. (He was emailing with me from Rwanda, one of the world’s poorest and sickest nations.) “We know what strategies work, and yet those strategies are not available equally around the world,” he added.

As epidemiologists and analysts know well, a nation’s disease patterns vary dramatically based on underlying public health, as do the risk factors for mortality. For an especially stark comparison, I’ll hold the United States up to one of the world’s largest low-income countries, the Democratic Republic of Congo, and contrast four important factors.

Of course, high-income nations have plenty of serious health-care challenges, too. But many of our afflictions are first-world afflictions.

Alzheimer’s is horrible, and we desperately need a cure — but it almost always strikes the elderly, after they’ve lived a reasonably full life. (More than 96 percent of the 5 million-plus Americans with Alzheimer’s are over age 65.) Heart disease, stroke, and other top causes of death in the United States also tend to afflict Americans later in life.

In comparison, many residents of low-income nations don’t live long enough to die from these chronic diseases. The average life expectancy in the world’s 31 poorest countries is just 59 years.

And while Americans might realize just how good we have it — broken health system and all — I’d bet most of us don’t grasp just how fixable the world’s public health problems could be.

“On average, it costs just $4,000 to save a child under 5 from dying, and it costs even less in the poorest countries,” Heisel told me.

“If you look at the scale-up in health assistance that began in the 1990s, which funded things like medicine for HIV patients, bednets to prevent malaria, and vaccine programs, and you look at the declines in death and suffering around the same countries that received that funding, it’s hard not to see the linkage.”