Although the rate of sugar consumption may seem a less important health factor than these other factors mentioned, its modestly negative longevity correlation is at least as comparable to those from smoking, obesity, and alcohol. Using data from the Organization for Economic Cooperation and Development (OECD), Euromonitor and other sources, with sugar consumption data among about 50 nations, higher sugar consuming countries are slightly more likely to underperform than lower sugar consumers. On average, and after adjusting for the fact that higher-spending countries tend to consume more sugar than poorer ones, countries with higher sugar consumption have somewhat worse longevity outcomes based on healthcare spending (see chart below). And since the increase in sugar consumption for many countries has been a relatively recent trend, this may be another factor that will more fully impact longevity in the coming years. Research shows that increased sugar intake is highly correlated with increased diabetes prevalence, as is obesity, which has also been sharply rising in recent years. This will have an increasingly negative impact on mortality over the longer term (in many countries, not just, the U.S., though Americans already rank high in diabetes prevalence (see 2nd graph).
A compounding difficulty when studying sugar consumption is that of other sweeteners, particularly high-fructose corn syrup (HFCS). The fact that the U.S. leads the world in HFCS consumption may also be a proximate cause of some of its health issues, both current ones and those in the future. A 2012 study of 42 countries by researchers from Oxford and USC found that countries that used HFCS (to any extent) had 20% higher rates of type-2 diabetes compared to countries where HFCS was not allowed. Those higher rates of diabetes were independent of obesity levels, BMI, economic output and even total calories and sugar consumption. And given that the U.S. consumes the most high-fructose corn syrup of any country, it seems reasonable to assume that the health of Americans are more negatively affected than other countries from this consumption. It is possible that since the U.S. is an outlier in terms of HFCS consumption, it contributes to the U.S. being a highly negative outlier in terms of longevity and health. (Although Americans have reduced their consumption of HCFS by about a third since peaking around the year 2000, U.S. consumption - averaging about 25 pounds per person per year - still leads the world.)
While the correlations between sugar consumption, alcohol consumption, and smoking rates to longevity are rather weak, their modest correlations might explain some of the over and under-performance among individual countries (compared to their healthcare spending, the dominant variable). Using these modest correlations and putting together a regression equation for these three additional factors – smoking rates, alcohol consumption, sugar consumption (the latter, when available, about half of the countries) – I improved the overall correlation between longevity to healthcare spending slightly (the R-squared rising from .74 to .76) (see graph below). A little better, but underscoring the weakly predictive effect from these health factors.
The sunshine vitamin
An even more significant health variable explaining some of the remaining differences in health and longevity might be the variation in sunshine and vitamin D levels across populations. While unfortunately, the research into vitamin D levels across countries is more limited, tens of thousands of smaller studies have shown strongly negative health outcomes when vitamin D deficiency has been present. While one might assume that sun exposure and corresponding vitamin D levels would be highest in countries near the equator, that often isn't the case. Sometimes populations in very hot countries such as India and those in the Middle East are also often deficient in vitamin D levels, often because many try to avoid the hot sun for much of the year. The research across countries has shown high and widespread rates of vitamin D deficiency in the Middle East, China, Mongolia, Philippines, Malaysia, and Indonesia and others. These same countries and areas also tend to be underperformers in terms health spending-adjusted longevity.
In addition, in many countries with large Muslim populations, such as those in the Middle East, vitamin D levels (and thus, health) are further negatively impacted because of the clothing often worn there that covers most of the body, particularly that worn by the women. Available research shows that in many of these areas females are particularly impacted by this sunshine/vitamin D deficiency, and being female is found to reliably predict greater vitamin D deficiency in many countries. Research that has been done within populations in many of these countries shows a clear correlation between sex or “ethnicity” (specifically, Muslim or not) and vitamin D deficiency. For example, a population studied in Saudi Arabia found that women were three times as likely to be vitamin D deficient than the men in the same area. Other countries found with similar vitamin D disparities include Indonesia, Malaysia, Iran, Morocco, Lebanon, Jordan, Egypt, Bahrain, Qatar and Kuwait. It is likely that low levels of sun exposure and vitamin D is the primary reason not only for overall under-longevity (and likely, poorer health), but women's in particular, in these countries.
It is in these countries that women's relative longevity compared to men's is generally the worst of all regions of the world. When I compared female to male longevity gaps among the 120 longest-living countries, I found that of the 21 countries in which the female longevity gap was reduced by 2 or more years (men outliving women by at least two years compared to global averages), the majority were from Middle Eastern countries and/or countries that have large Muslim populations.
Similarly, it is also possible that some of the problems with longevity in Russia and former Soviet-bloc countries is due to their high latitude, and low sunlight for most of the year. While in these countries men generally terribly underperform women in terms of longevity compared to averages (possibly due to their very high intake of alcohol), the women in these countries also generally underperform longevity expectations compared to women from other regions.
In the graph below we see that vitamin D deficiency levels are particularly widespread across the Middle East and Northern Europe, which likely explains much of the longevity underperformance in those areas. We also see that while these vitamin D levels might significantly explain the underperformance in some of these other regions, low vitamin D levels cannot explain the very weak health and longevity performance of the U.S. compared to other developed nations. Based on this data, overall, the U.S. has some of the lowest vitamin D deficiency levels in the world (though is still a serious health issue with much of the population, especially in northern states in the U.S. and among elderly populations, the obese, and people with darker skin - all groups that absorb vitamin D at a lower rate).
Although it's nearly impossible at this point to quantify the health and longevity consequences of low sun exposure, it seems likely that sunlight and vitamin D differences alone account for much of the longevity underperformance in the Middle East and Eastern European countries. Accounting for that significant health factor essentially leaves the U.S. as the sole significant negative outlier, especially among higher-spending populations.
“We're #1!” For better or worse.
It's important to remember that the countries we are comparing the U.S. to, that are outliving the U.S. by an average of 5 years or more in terms of spending-adjusted longevity are not utopias of health and lifestyle. Many of these countries have high rates of smoking or alcohol, polluted air and water, poor sanitation, high drug use, fast food and sugar consumption, and other obstacles to health. In spite of those problems, they are generally far surpassing the U.S., not just in terms of longevity for their spending, but overall healthcare (the World Health Organization has ranked the U.S., the highest-spending country on healthcare in the world, 37th in terms of its overall health).
There are things these countries do better than the U.S., and they often center around their diet. For example, many of the outperforming European countries in terms of longevity, such as Greece, Italy, Spain, Portugal, France, Cyprus and Croatia, are in areas where the Mediterranean diet is common. Many studies have shown lower incidence of cardiovascular disease, cancer, diabetes and other health conditions, in areas where this diet – generally high in fruits, vegetables, fish, whole grain, and olive oil along with low intake of non-fish meat – is prevalent. Asian overperformers such as Japan, South Korea, Vietnam and Bangladesh, have dietary differences (an obvious differences is their higher average consumption of rice), but tend to have similarities to the Mediterranean in terms of high seafood and vegetable consumption, low red meat consumption, and low to modest sugar consumption. In contrast, on average, Americans have lower levels of seafood consumption, eat very high levels of non-fish meat, generally ranked near the highest in the world (see graph below), high sugar consumption (also generally ranked highest in average consumption globally), modest vegetable and fruit consumption, and a high percentage of their meals from processed food (likely the highest in the world).
Government “Watchdogs” part of the problem
At the same time, some populations in other (generally non-Asian) countries such as Australia, New Zealand, Israel, Argentina and others have high meat consumption and still have better health outcomes than in the U.S. A more significant food variable affecting populations might be the extent that food, regardless of the kind, is processed, and the extent that it contain toxins and other artificial ingredients, pesticides, and preservatives. It is estimated that at least 60%-70% of the average American diet is made up of processed foods, and half of total calories comes from “ultra-processed” food, which include chemicals not generally used in cooking, such as flavorings, emulsifiers and other additives used to mimic real food (an estimated 5,000 additives are allowed in U.S. food, which the FDA does not regulate). The use of many toxic food additives and food colorings have also been sharply limited in many of these other countries, while in the U.S. they are allowed and used excessively. Similarly, the dangers of high-fructose corn syrup have been known for decades, yet the FDA has continued to deny their harm. Even today the FDA claims HFCS is no more dangerous than cane sugar.
It is a similar story with all artificial sweeteners in the U.S. Both the US National Cancer Institute and the National Institute of Health claims that there is no “clear evidence” that artificial sweeteners – “regulated” by the FDA - cause cancer or other serious health problems in humans. Likewise, partially-hydrogenated oils or “trans-fats) has also been known for decades as a probable health hazard in the areas of cancer, Alzheimer's, coronary artery disease, depression, and diabetes, but it was not until 2006 that trans-fats were required by the FDA to be on nutrition labels in the U.S., not until 2013 when the FDA finally determined that trans-fats were “generally not recognized as safe”, and not until 2018 that food manufacturers were required by the FDA to eliminate its use. Such changes come decades after other countries have restricted or eliminated their use, with the health of the citizens in those nations the better for it, and Americans' health the worse.
Likewise, genetically-modified crops and food (GMO) has been banned or severely restricted in much of the world. While it's difficult to know exactly how much GMOs are consumed across nations, we know that the U.S. is far and away the leader in GMO production, accounting for more than half the world's production (see graph below). And with more 90% of the corn, sugar beet, soy, canola and cotton in the U.S. being of the GMO variety, we know Americans are consuming a lot of, easily more than any other country. The FDA says that GMO foods are safe for human consumption, and are no more likely to lead to serious disease than non-modified food. But if the regulators are in fact, wrong, and GMO food has been negatively impacting the health of Americans for decades. We can lay the blame at the feet of the “regulators”, who willfully resist preventing the sale and distribution of potentially harmful or dangerous food, their stated purpose.
Over the longer term, we will see more fallout from unnecessarily taking prescription drugs to control symptoms (and sometimes no symptoms, but simply as “preventative” measures) resulting from nutrition and lifestyle deficiencies. Since synthetic drugs build up toxins in the body, and disrupt the body's normal responses and pathways to health, the negative health effects from high prescription drug use will show up in greater amounts in the future. This will then result in even more drugs required to treat the deficiencies and symptoms resulting from the previous drugs, and the cycle will continue. (Another problem with prescription drugs is that many lead to weight gain, further adding to the health problems of Americans, and necessitating still further medical treatment or medication.)
This cycle converts short-term medication users to lifelong drug industry customers. Drugs are generally tested short-term, taken long-term, with users the guinea pigs (for example, according to the CDC, one in five anti-depressant users have been on them for more than a decade). This is great for drug company profits, terrible for the long-term financial and physical health of the population. As Americans collectively already spend more than three times what they should compared to other countries with similar health and longevity outcomes, we should not expect that still more spending on synthetic medicine and surgery - traditional “healthcare” - will improve the aggregate health of Americans.
After wealth of a population, the most important variable for health, appears to be access to quality food and good nutrition. We can trace much of the excellence or deficiencies of individual countries to their diets. In a previous article I showed that the U.S. spends the most of any country on healthcare, and an even higher percentage on its older citizens. Yet, from age 65, U.S. life expectancy is ranked 28th in the world, despite spending at levels more than four times per capita than other developed nations. From age 75, compared to the U.S., life expectancy is higher in the countries of Panama, Cuba, Dominican Republic, Costa Rica and Chile, all of which spend about a tenth to a fifth per person on healthcare of what the U.S. does, and an even lower percentage of its older citizens. Instead of spending tens of thousands of dollars per older citizens on drugs and medical intervention as the U.S. does, in these other countries, the focus is on truly preventative healthcare, which starts and ends with healthy food and good nutrition, and a healthy lifestyle.
In these other countries, and most of the countries of the world, citizens generally eat real food, instead of the processed and toxin-full “food” found on much of the grocery store shelves and restaurants in the U.S. Americans may truly have the worst diet in the world, and if so, likely accounts for most of the health problems impacting its population. And while much of their diet and health problems in the U.S. are self-inflicted, much also reflects the nature of its food establishment. It is very hard to avoid processed food in the U.S. Its large food corporations have fought hard against laws that would limit potentially (or known to be) dangerous ingredients in its products, or even prevent accurate food labeling, to even tell you what is in the products they make. A consumer in the U.S. who wishes to avoid things like high-fructose corn syrup, GMOs, toxins, pesticides, growth hormones, trans-fats and other things, will have to work very hard. By contrast, in most other countries, avoiding such things is much easier, since they hardly exist.
And this is not a case where the “free market” in the U.S. has led Americans to demand these these things, and because of that, the government should just leave these things alone. These things were created by government intervention, not consumer demand. – GMOs, high-fructose corn syrup, heavily preservatized and processed foods. It was because of government subsidies to the corn industry that artificially pushed down the price of corn low enough that it became profitable to replace sugar with “refined” corn. If high-fructose corn syrup has led to the death of millions of Americans and poor health for tens of millions others, it was because of unnatural intervention into the marketplace by the government. The population did not ask for these, but were foisted on the U.S. population, without their consent and often their knowledge. And all along, government “regulators”, such as the USDA and the FDA ignored evidence of their harm, and told Americans that their food was safe.
Along the way too, terrible health and diet advice was given (and is still given) by those in regulator agencies, such as to avoid butter and fats, cholesterol, and salt, in favor of synthetic margarine, high sugar and carbohydrate diets. Aphorisms such as “a calorie is a calorie” and “fat makes you fat”, and other myths have led to poor health for so many. Americans are told to slather on toxin sunscreen on themselves and in the process artificially decrease natural and necessary vitamin D. The nutritional guidelines from governments are terrible, with suggested nutrient levels far too low to ensure proper health, particularly given the generally highly-processed and toxic nature of American food, the toxins in prescription drugs, vaccines, soil, and water. In fact, the FDA and other regulator agencies have used much of their taxpayer resources to limit or marginalize critical nutritional disease research, as well as natural food and medicine.
The general premise of this series of articles was that the underperformance of health in the U.S. compared to other countries (or put another way, massive overspending on “healthcare”) was in large part due to corruption. If so, it's a joint corrupting effort from large corporations, including those in agriculture and food production, insurance companies, government, lobbyists, regulatory agencies, and others. The U.S. is not only an outlier in terms of negative health, it is an outlier in the extent of “healthcare” corruption among countries.
The U.S. leads the world in health and medical care, by far, in absolute terms, and after adjusting for cost of living. Based on the correlation between medical spending and longevity, the U.S. is spending three or four times what you would expect for its average longevity compared to other countries. Much of this is simply wasted, to unnecessary treatments, drugs, regulations, inflated prices, and other. Some of this spending has become counter-productive, whereby natural, healthier treatments and prevention by way of proper nutrition have been ignored or worse, vilified and restricted by regulatory agencies. Too much overtreating for non-existing “diseases” or “conditions”, physical and mental, too much medication, and too much corrupted “regulating” (i.e., government agencies connected to and bought off by drug, insurance, and “healthcare” companies), and too little in the way of uncorrupted, science-based regulations.
Daily in the U.S., individuals are put on dangerous mental health drugs without counseling. (The CDC says the majority of individuals taking anti-depressants had not been to a mental-health professional even once in the prior year. For more on America's deplorable historical and current state of mental health, I highly recommend Robert Whitaker's, Mad in America). In traditional medicine in the U.S., individuals with “high” cholesterol and blood pressure (based on arbitrary and changing standards), and nearly every other health condition, are given drugs without looking at the underlying causes of health deficiency (75% of doctors visits result in a prescription for medication), and generally without even checking for basic vitamin deficiency).
The worst part is that many of these problems have only become worse in relatively recent years. That means the worst is yet to come. I have commented that average longevity in the U.S. has flattened in the last few years, while it continues to improve in just about every other country on the planet. At a certain point, officials who are actually concerned about the health of Americans will need to take a serious look at what other countries are doing right and what the U.S. is doing wrong.