Written by Leland Faust
Even at Harvard University, one of the most respected research universities in the world, faculty can put out drivel. I was appalled after reading the article “Putting Social Progress on Par with Prosperity” in a recent issue of Harvard Magazine. A Harvard Business School professor had issued his Social Progress Index which included a ranking of 133 countries on health and wellness. Do people live long and healthy lives? The United States ranked 68th on that list trailing, among others, Peru (1), Ethiopia (30), Cambodia (40), and Ghana (60). How does the average person in poor countries like Ethiopia, Cambodia, and Ghana live longer and healthier than the average American?
Let’s start with life expectancy: United States (80 years), Cambodia (71 years), Ethiopia (68 years), and Ghana (60 years). No surprises so far. Longevity must be less important than other criteria.
Let’s take a look at each of the four other factors used by the professor to determine health and wellness.
1. Premature deaths from non– communicable diseases. What is the probability of dying between the ages of 30 and 70 from cardiovascular disease, cancer, diabetes, or chronic respiratory diseases. These are first world problems. But why ignore communicable diseases? These are the leading cause of death in many poor countries. Why eliminate from consideration death from HIV (AIDS), malaria, and diarrheal diseases, among others? In many low income countries respiratory infections are a leading cause of death, but those were not included in the “chronic respiratory disease” category. One other question: if life expectancy is 60, how can deaths prior to 70 but after 60 be considered premature?
2. Obesity rates. This measures the percentage of the population with a body mass index of 30 kilograms of weight per meter of height squared, or higher. Here comes another first world problem. Even though the US and most developed countries have significantly higher obesity rates than those in the low income countries, a lack of obesity may not necessarily be a good sign. Starving populations are not obese. The obesity rate in the US is a whopping 33%, while in Cambodia, India, Nepal and Vietnam it averages about 2%. True, fewer overweight folks, but that doesn’t necessarily mean healthier. Malnutrition is a pervasive problem in many Third World countries. Starving people are usually not healthy.
3. Outdoor air pollution attributable deaths. This measures the number of deaths resulting from emissions from industrial activity, households, cars and trucks. Talk about self-fulfilling. The death rate using this measure must by definition be lower in non — industrialized countries than in highly industrialized ones. In Ethiopia there are 3 motor vehicles per 1,000 residents, in Cambodia 14, and in Ghana 30. The US, which strange but true does not lead the world, has about 800 vehicles per 1,000 residents. Air pollution, although a real health issue, is not a leading cause of death even in high-income countries. We can also assume that industrialized farming in the United States adds more to air pollution more than farming in Africa. Whose farm productions do you think leads to healthier outcomes?
4. Suicide rate. This is the age — adjusted mortality rate due to self — inflicted injury. Arguably the members of a country with a significantly higher suicide rate may be suffering more mental anguish than those in a country with a lower rate, or maybe they just kill themselves more often. But how important is the suicide rate to the overall death rates? The suicide rate in Ghana is about 3 per 100,000, while in the US it’s about 12 per 100,000. So our suicide rate is four times that in Ghana. But suicide in the US accounts for less than 1.5% of all deaths. So reducing it to Ghana’s much lower rate would save about 1.1% of the deaths in the U.S. (until they die of some other cause). The suicide rate is a small factor in the overall death rates everywhere. If the US suicide rate is four times that of Ghana but life expectancy in Ghana is about 20 years less than in the United States, how important can it be? Perhaps a high suicide rate means the population is otherwise healthy.
Peru was rated number one for long and healthy lives, while the lowly US checked in at number 68. Life expectancy in Peru is reported at 74 years, while in the US it’s 80 years. The other 4 criteria must give the edge to Peru.
1. In considering premature deaths from non — communicable diseases, the index didn’t include viral or bacterial infectious diseases, but these are the leading causes of death in Peru. Influenza and pneumonia occur there at about 4 to 5 times the rate as in the US. These are ignored by the Harvard professor. Does death from infection lead to healthy lives?
2. The obesity rate in Peru is approximately 16%, compared to about 33% in the US. But how healthy are the Peruvians who live in the Amazon basin, look excruciatingly under-fed, and struggle each day to catch fish from the rivers with hand-held spears?
3. I’m sure there are fewer deaths attributable to outdoor air pollution in Peru than in the US. Less industrialization equals less pollution. Peru has about 73 motor vehicles per 1000 residents while in the US it’s about 800.
4. The suicide rate in the US is about 12 per 100,000, while in Peru it’s about 9 per 100,000. The difference of 3 per 100,000 gives Peru the nod here. But I can think of many more significant factors which the index ignores.
Summary: Peru beats the US four to zip.
Gender equality is another criteria used in this Social Progress Index. But one needs to look at reality rather than appearances. The article indicates that Rwanda “ranks high for gender equity, as women constitute a majority of the parliament.” My quick research indicates that Rwanda is the only country in the world where women have a majority of seats in the national legislative body. But before we get too excited, let’s consider that in the last national election the current President of Rwanda was reelected with 93% of the votes cast. Where I come from, this tells us something rather important. Have you ever seen a system even approaching a democracy where the presidential candidate receives 93% of the vote? The President, whose net worth is estimated at $500 million and who has been serving since 2000, would have seen his last term expire in 2017. Not to worry. He is so popular that in a very recent election 98% of the citizens voted to extend his ability to rule until 2034 when he will be 75. So I’m not quite sure what real power the women who constitute a majority of the parliament have. But my guess is not too much. Also, how much economic clout do women yield in Rwanda? Are they running the business and industry of the country?
The social progress index reminds me far too much of a survey done years ago by the San Francisco Chronicle. It ranked the best suburbs of San Francisco, and ranked Antioch came in ahead of Hillsborough. One of the main reasons was Antioch’s more affordable housing. In 2015 the average price of a home sold in Antioch was about $350,000, while in Hillsborough it was about $3,500,000. In which of these two cities do you think the residents have a better life? Where would you prefer to live?
There’s a population that Harvard professor failed to include in his survey which would almost certainly have ranked right at the top based on his criteria. The residents have very low rates of premature death from non-communicable diseases, obesity is extremely rare, and deaths from industrial air pollution are unheard of. We do not have good records for the suicide rate for this group, but I think we can be reasonably certain it is low. This omitted population is Cro-Magnon man, who lived about 25,000 years ago. Their life expectancy has been estimated at 30 years despite the fact that they got plenty of exercise, drank pure water, and ate only locally grown organic food which contained no GMOs, antibiotics or transfats.
As for me, I’ll take the health and wellness in the United States over that in Ethiopia, Cambodia, Ghana, and even in number one Peru. Apparently my view doesn’t square with that of the Harvard professor. But as they say: that is why we have horse races.