LIFE IN THE END ZONE: A discussion of topical issues for anyone concerned with the final phase of life by Muriel R. Gillick, MD
October 06, 2013
Where in the World is the USA?
The widespread belief in American exceptionalism means that we tend to think we are unique. Often, being unique slips into being the best. But for a long time, I’ve had a sneaking suspicion that we might be able to learn something about how to improve life for older people by looking at other countries. A new study based on data from the UN, the World Health Organization, and the World Bank, suggests we could.
The report was released on October 1, the International Day of Older Persons, a day that will be celebrated at the UN this week but that I confess I wasn’t even aware existed. The authors created a “global age watch index,” made up of 4 domains: economics, employment and education, the environment, and health. Based on these measures, the best place to live if you’re over 65 is Sweden, which was in the top 10 in all 4 domains. The US placed 8th in the overall ranking (a geometric mean of the 4 domains). But if we look at the health status component, we find a bleaker picture.
Health status was measured based on life expectancy at age 60 (WHO data), healthy life expectancy at age 60 (data from the Global Burden of Disease Study, Institute of Health Metrics and Evaluation, Seattle), and psychological wellbeing (based on the Gallup WorldView, a subjective assessment of whether one’s life has an important purpose or meaning). Based on these indicators, the US ranking is an embarrassing 24.
Actually, the US didn’t do so well in the economic or environmental domains either—its overall score is respectable mainly because of relatively high employment and high educational attainment among American elders. In terms of income security, the ranking is #36, reflecting a marked income inequality. And on the “enabling environment” dimension, which measures things like social connections and access to public transportation, the US came in at 16.
So who are the role models? Three countries stand out as having high rankings across the board: Sweden, Norway, and Germany. The second tier is comprised of the Netherlands, Canada, Switzerland, and New Zealand. Maybe it’s time we explore what these other countries are doing right and have the humility to learn from their example.
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