Probably a combination of Universal Healthcare, Food Regulations (from what I understand, food quality regulations in the US are lacking compared to the EU), more balanced cultural attitudes towards work-life balance, less car-focused cities and more walkable cities.

These are all universal across the EU and yet there's big differences between EU countries.

Food regulations doesn't mean people have a healthy diet. A lot of the Eastern Europe countries have higher obesity rates: https://ec.europa.eu/eurostat/statistics-explained/index.php...

That is likely more due to epigenetic factors than individual diets.

A lot of Eastern Europe was doing very poorly a generation or two ago, and we know that living through a period of hunger will cause your children to be more likely to gain weight.

I'd say healthy food availability in the US generally sucks.

Less so than regulation, just the market making it difficult for a lot of people to eat healthily, less-processed, and fresh with regularity.

This is talking about places that don't have a Whole Foods nearby. (Or often any grocery store!)

> I get the feeling that Universal Healthcare (medicare for all) would probably level the difference?

Sometimes my wife convince me to try American candy/foods that we buy in these "foreign foods stores" locally, because she grew up eating some of them in her country.

And every time we check the contents by reading the nutrition-labels or checking with apps like Yuka, it turns out that the stuff Americans put in the mouth and stomach are filled with stuff that is outright illegal to put in foods here in Europe.

So if I were to guess, it would be related to what is legal to put in foods/consumables.

The US ranks 3rd in quality and safety, with scores pretty similar to pretty much every European country

https://impact.economist.com/sustainability/project/food-sec...

There's lots of stuff like that, the way chickens and eggs are cleaned etc.

It sometimes is annyoying though, especially around foods and medicine when something is not yet approved in Europe e.g. It's really hard to get Allulose (sugar alternative with similar properties benefitting baking); As far as I can tell it's not actually "illegal" in Europe, it's just not approved as a food, so no-one risks importing it..

... Such as?

Last time I checked, these were some of the substances I found in American food/drinks/candy that are outlawed in EU:

- Titanium dioxide (E171)

- Potassium bromate

- Azodicarbonamide

- Propylparaben

I'm sure there is more, and there is probably also stuff that is banned in the US but not in Europe.

> what is legal to put in foods/consumables.

Which is also indirectly related to universal healthcare: since sick people cost money to the state, the government is incentivized to regulate foods more closely.

It's not just the universal healthcare enables access to healthcare to more people. When healthcare is something being paid for by everyone, the state of other people's health matters to you too (not just your own).

Therefore, things like public smoking bans (as we have in the UK) as well as public health campaigns around alcohol consumption and healthy eating become palatable. Regulating harmful foodstuffs becomes more important. The cost of smokers' adverse health was (and still is) enormous, and reducing that burden benefits everyone.

Smokers actually cost less than non-smokers because they die a decade and a half sooner, and old age is where most expense happens.

The true issue is secondhand smoke. That for me is what it all is about: preventing unwilling people from being exposed to smoke, full stop.

About as many people die from smoking than from secondhand smoke. Think for a minute how horrifying that is.

> Smokers actually cost less than non-smokers because they die a decade and a half sooner, and old age is where most expense happens.

This is often mentioned, but it's simply not true. It's not old age itself that costs money, it's the part of your life where you need care and support. This is old age in otherwise healthy people, but smokers don't just drop dead one day, they go through as many if not more years of care and support as everyone else, they just do it younger (which costs in lost productive years too).

https://www.gov.uk/government/publications/cost-of-smoking-t...

I don’t think your link is showing what you want it to show - it’s showing costs, but not necessarily any sort of counterfactual delta AFAICT.

There’s been a number of studies on this, and they do seem to suggest that overall smoking saves society money. E.g. here’s one from Finland

https://bmjopen.bmj.com/content/2/6/e001678

Food, I believe it's obvious. France obesity rate is also lower than the US.

Large portion of americans eat like they have free healthcare.

This has got to be a massive factor.

What shocked me about the US when I went, was how much peptobismol people chugged down. There was not one meal in my 1 week stay there that I could digest without issue.

Annual sales of Pepto Bismol look to be well under $0.50 per person, so while the American diet and food quality is appallingly worse than Europe, I suspect your one week of stomach upset is not be a great source from which to extrapolate.

Fair enough, maybe it was just the amount and variety of peptobismol products that I noticed were for sale everywhere. For example just in the Hotel where I was staying, they had a bunch chewable peptobismol gummy bears + the ordinary bottles for sale.

> maybe it was just the amount and variety of peptobismol products that I noticed were for sale everywhere.

Just wait until you see the breakfast cereal aisle

Or the chips/pretzels aisle which is often different from the cookies aisle which is often different from the candy and chocolate aisle…

Eating food and drinking water in a strange place can upset your stomach even if the people who live there all the time are fine. This is a very well-known phenomenon.

This is why I cook at home a vast majority of the time. It also depends where in the country you are. You could easily eat healthy in LA, NYC, SF, Chicago, etc. but if you’re outside the major cities you can find it a lot harder.

There's more. Traffic accidents, Americans have more than twice as many fatal accidents as Europeans and 3-4 times as many as France/Finland/…, and the age of people dying in traffic pulls down the overall average. And of course crime. Americans shoot each other, and that's not just 95-year-olds, so that'll pull down the average as well.

Surely it is not just healthcare and air/water as for example Scotland has life expectancy that is worse by two years comparing to England: https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

My understanding for Scotland/England it is a question of alcohol/drugs to some degree. I suspect it is similar for the comparison to US.

Much of europe does have universal healthcare, but it is done internally to each european country.

That means poorer countries tend to have worse healthcare, and less good outcomes.

The divide you see in this map is more like Soviet infrastructure versus western infrastructure and Eastern approach to alcohol and nutrition.

It’s much more than money.

At best about half. Compared to UK, roughly other half of gap is drug overdoses, car crashes and firearm deaths

https://publichealth.jhu.edu/2024/americans-die-younger-than...

58% of firearm deaths in the US are suicide. It could be argued a percentage of drug overdoses are as well. While 5-7% of ODs are classified as suicide, even slower drawn out drug addictions leading to OD could be considered it as many use drugs to dull the pain of daily living. We Americans are deeply unhappy. Something is very very broken here.

I doubt you can free healthcare your way out of obesity. You can't even healthcare your way out of obesity when you make it really, really personally expensive to be obese. And obesity is almost certainly the mortality bottleneck these days.

Obesity is primarily caused by the 1-2000 micro-decisions we make each year about what to eat, when, and how much. A free visit to the doctor now and then is just not going to move the needle much on that one way or another for most people, most of the time. Even if it could we have to ask why a $0 doctor visit would be so much more effective than a $100 doctor visit.

No, the effects you're seeing what Europeans are more fit than Americans on average is coming from somewhere else. I think the real answer is the obvious one: Food here in Europe is simply worse tasting than in the US in general. I've been here for 5 years across twice as many countries; I've never had a pizza here that even matches Little Caesar's back at home, in terms of lighting up my little monkey neurons, to say nothing of Costco. If I ever go back home I will break and get one of the two within a week of reaching the airport.

Capitalism is an optimization process that has optimized the heck out of food reward signal. Your only real options are either to be poor enough that capitalism doesn't care about getting you the 'good stuff' - easier said than done when being poor sucks, and when the good stuff is constantly getting cheaper over time anyway - or you fight back with even harder optimization in the reverse direction. You could argue Europe is some mixture of both compared to the US.

I think free healthcare means government wants ppl to be healthy. Unhealthy people literally take money from government's pocket, so gov uses various regulation against unhealthy stuff and does healthy lifestyle promotion

I don't see why that would work better than having the unhealthy people literally take the money out of their own pocket.

Can you explain how you disagree? You mean ordinary people have as much money as the government and can introduce regulation against unhealthy stuff and run positive health promotions just like the government?

Alright, now imagine the government doesn't pay for healthcare. This is the literal cheapest thing for them, as it now costs $0, and they don't have to spend time worrying about law.

If the government isn't paying for your healthcare, then you have to pay it yourself. If you are fat, statistically, you will probably end up paying a lot more over time. This is not "wasted" money - no money you spend on your health is totally wasted. The good news is, you personally benefit from this money more than anyone else who could possibly spend it on your behalf - you reap the health benefits, the extra Christmases with the family, the bigger smiles from strangers.

Now how much does being fat cost over a lifetime? Frequently in the range of tens or even hundreds of thousands of dollars. That's pure medical costs, before we even consider how much the intangibles are worth.

The thing is: Most people understand this. If you understand this, and are still fat, then on some level you are indeed saying that the money isn't worth the trade-off of changing your whole lifestyle to (a) fix this and then (b) ensure you don't end up there again.

To me that's proof that being fat is a very hard thing to change just by throwing money at it. The literal best, most incentivized person, the fat person themselves, can't even figure out how to change it, not even with at minimum tens of thousands of dollars on the line. There are probably government interventions that probably could move the needle at scale, but they are probably not "let's subsidize spinach farmers" or whatever, because an extra $2 per week for spinach is just not that much money compared to even a single $50,000 gastric bypass. They probably look more like "If your BMI drifts above 27 we send you to weight loss prison and you can come out when you're below 22 again", which sounds insane, because it is. It is simply a very hard problem to solve by throwing money at it.

> Alright, now imagine the government doesn't pay for healthcare. This is the literal cheapest thing for them, as it now costs $0, and they don't have to spend time worrying about law.

I mean a government that already chose to implement free healthcare. THEN it is cheaper for them to keep people healthy.

Of course it would be cheapest to not care at all. But if you already locked into caring then it is cheaper to prevent than to treat

That isn't actually the argument I'm making, but for what it's worth that's both false and begging the question. A government can choose to stop implementing universal healthcare, just like it can choose to implement it.

What is false in what I wrote can you be specific? Thanks

> government can choose to stop implementing universal healthcare, just like it can choose to implement it.

FYI in a democracy it doesn't really work like that

This exchange is going nowhere. Safe travels.

American baby boomers hobby in retirement is going out to eat as much as possible and drinking beer/wine. Or they travel to other countries to go out to eat as much as possible and drink beer/wine/cocktails.

All the baby boomer men in my family would be dead if it wasn't for the American health care system.

Even suffering heart attacks, they didn't miss a beat to get back to going out to eat, drinking beer/wine and being massively overweight.

If you go to any restaurant at night it will be packed with fat old people stuffing their face. Most on medications so that they don't have to change their lifestyle.

No country has ever had the BMI of old people that America has right now. It is a wealth curse.

Would probably level the difference of what? This is rich countries vs poor countries. You can get an identical result over a US map:

https://www.nationhoodlab.org/the-regional-geography-of-u-s-...

Terrible Maps “Literally every US statistic ever”:

https://x.com/TerribleMaps/status/1933586469207036321

Universal Healthcare payed for by taxes gives the government an incentive to regulate and ban the worse public health hazards.

It's wild what you guys can find in your food. An example that keep baffling me is the near-impossibility of finding bread that isn't sweet in the US.