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INTERNATIONAL HEALTH COMPARISONS - Healthy Life Expectancy

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First off - I want to thank the "Powers that Be" (Tim, Brian, random hacker :)xyz?) for creating this new forum! I'm going to post a link to this thread and this forum on the CR Practice and Chit Chat forums, many of whose threads would be more appropriate here.

 

http://www.worldlifeexpectancy.com/healthy-life-expectancy-by-gender

 

Astonishing how high Cyprus is on this ranking.  I wonder why.

 

Thanks Rodney. A very interesting resource. Regarding Cyprus, it doesn't look like they've escaped the obesity epidemic. In fact, they are some of the heaviest people in the EU, at least as of 2007:

 

Obesity.jpg

 

Although they used to eat a Mediterranean-style diet, like their neighbor Greece, their diet has really gone downhill over the last few decades [1].

 

Therefore, their unusually high longevity is likely to be at least in part explained by a well known selection effect called the Healthy Immigrant Effect (HEI) [2] [3]. 

 

From [3]:

 

The existence of a healthy immigrant effect – where immigrants are on average
healthier than the native-born – is now a well accepted phenomenon. There are many
competing explanations for this phenomenon including health screening by recipient
countries, healthy behaviour prior to migration followed by the steady adoption of
new country (less) healthy behaviours, and immigrant self-selection where healthier
and wealthier people tend to be migrants. We explore the last two of these
explanations for the healthy immigrant effect by examining the health outcomes,
health behaviours, and socio-economic characteristics of immigrants from a range of
source countries in the US, Canada, UK and Australia. We find evidence of strong
positive selection effects for immigrants from all regions of origin in terms of
education. However, we also find evidence that self-selection in terms of
unobservable factors is an important determinant of the better health of recent
immigrants. 
 

There are several factors at play in the HIE, but a large one is that the sick and infirm don't tend to immigrate - they just aren't robust enough to make the transition or are prevented from immigrating due to immigration laws. As a result, recent immigrants are on average healthier than the average person both in the country they are leaving, and in the country they are entering.

 

Cyprus is an small, affluent country with a large immigrants population (in the neighborhood of 44%), so the HEI may have had a large impact on its longevity statistics. By some accounts, Monaco has the longest life expectancy of any country in the world (89.7 years) and it too is likely the beneficial of the HEI. It is a very small country where very rich, healthy oldsters go to retire.

 

The HEI is one reason why studies of changes in health when people immigrate need to be considered with a certain degree of skepticism. You often hear "when people immigrate from country X to the US and adopt our poor diet/lifestyle practices their health goes downhill". Some of the negative effect is probably due to the US diet & lifestyle, but some of it is probably due to regression towards the mean - immigrants start out healthy because if they weren't they wouldn't have immigrated, but over time naturally tend towards an average health status, skewing the statistics.

 

--Dean

 

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[1] BMC Public Health. 2014 Jan 8;14:13. doi: 10.1186/1471-2458-14-13.

A study of the dietary intake of Cypriot children and adolescents aged 6-18 years
and the association of mother's educational status and children's weight status
on adherence to nutritional recommendations.

Tornaritis MJ(1), Philippou E, Hadjigeorgiou C, Kourides YA, Panayi A, Savva SC.

Author information:
(1)Research and Education Institute of Child Health, 138 Limassol Ave, 2015
Strovolos, Cyprus. tor.michael@cytanet.com.cy.

BACKGROUND: A balanced diet is fundamental for healthy growth and development of
children. The aim of this study was to document and evaluate the dietary intake
of Cypriot children aged 6-18 years (y) against recommendations, and to determine
whether maternal education and children's weight status are associated with
adherence to recommendations.
METHODS: The dietary intake of a random sample of 1414 Cypriot children was
assessed using a 3-day food diary. Adherence to recommendations was estimated and
the association of their mother's education and their own weight status on
adherence were explored.
RESULTS: A large percentage of children consumed less than the minimum of 45%
energy (en) of carbohydrate (18.4%-66.5% in different age groups) and exceeded
the recommended intakes of total fat (42.4%-83.8%), saturated fatty acids
(90.4%-97.1%) and protein (65.2%-82.7%), while almost all (94.7%-100%) failed to
meet the recommended fibre intake. Additionally, a large proportion of children
(27.0%-59.0%) consumed >300 mg/day cholesterol and exceeded the upper limit of
sodium (47.5%-78.5%).
In children aged 9.0-13.9y, there was a high prevalence of
inadequacy for magnesium (85.0%-89.9%), in girls aged 14.0-18.9y, of Vitamin A
(25.3%), Vitamin B6 (21.0%) and iron (25.3%) and in boys of the same group, of
Vitamin A (35.8%). Children whose mother was more educated were more likely to
consume >15%en from protein, Odds Ratio (OR) 1.85 (95% CI:1.13-3.03) for mothers
with tertiary education and exceed the consumption of 300 mg/day cholesterol (OR
2.13 (95% CI:1.29-3.50) and OR 1.84 (95% CI:1.09-3.09) for mothers with secondary
and tertiary education respectively). Children whose mothers were more educated,
were less likely to have Vitamin B1 (p<0.05) and Vitamin B6 intakes below the EAR
(p < 0.05 for secondary school and p < 0.001 for College/University) and iron
intake below the AI (p < 0.001). Overweight/obese children were more likely to
consume >15%en protein (OR 1.85 (95% CI:1.26-2.71) and have a < Adequate Intake
of calcium (OR 1.85 (95% CI:1.11-3.06)).
CONCLUSION: Cypriot children consume a low quality diet. Maternal education and
children's own weight status are associated with children's adherence to
recommendations. Public health policies need to be evaluated to improve dietary
quality and reduce disease burden.

PMCID: PMC3909376
PMID: 24400785

 

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[2] Minn Med. 2007 Mar;90(3):51-3.

The "healthy migrant" effect.

Fennelly K(1).

Author information:
(1)Hubert H Humphrey Institute of Public Affairs, University of Minnesota, USA.

In many ways, first-generation immigrants to the United States are healthier than
people of similar ethnic backgrounds who were born in this country. However,
overtime, the newcomers' health advantages diminish dramatically. This article
discusses factors that contribute to the deterioration of immigrants' health:
poverty, living in substandard housing, not having access to medical care,
adoption of an American diet, smoking, and substance abuse.

PMID: 17432759

 

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[3] http://carleton.ca/sppa/wp-content/uploads/chesg-mcdonald.pdf

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