Published April 8, 2021
Updated May 4, 2021
Students in U.S. high schools can get free digital access to The New York Times until Sept. 1, 2021.
One would expect that when health care expenditures increase, life expectancy would increase too. But, for 2000 to 2017, this relationship has not been consistent globally.
After looking closely at the graph above (or at this full-size image), answer these four questions:
What do you notice?
What do you wonder?
What impact does this have on you and your community?
What’s going on in this graph? Write a catchy headline that captures the graph’s main idea.
The questions are intended to build on one another, so try to answer them in order.
2. Next, join the conversation online by clicking on the comment button and posting in the box. (Teachers of students younger than 13 are welcome to post their students’ responses.)
3. Below the response box, there is an option for students to click on “Email me when my comment is published.” This sends the link to their response which they can share with their teacher.
4. After you have posted, read what others have said, then respond to someone else by posting a comment. Use the “Reply” button to address that student directly.
On Wednesday, April 14, teachers from our collaborator, the American Statistical Association, will facilitate this discussion from 9 a.m. to 2 p.m. Eastern time.
5. By Friday morning, April 16, we will reveal more information about the graph, including a free link to the article that included this graph, at the bottom of this post. We encourage you to post additional comments based on the article, possibly using statistical terms defined in the Stat Nuggets.
UPDATED: APRIL 15, 2021
The Reveal
This is the second graph we have featured from the April 10, 2020 New York Times article “America Will Struggle After Coronavirus. These Charts Show Why.” The first graph was about the incidence of smoking in the United States by income level. The article includes 22 graphs that show how U.S. income, health, education, employment and family structure have changed over time.
This connected scatterplot graph uses data from 2000 – 2017. The article states that “no other country (than the United States) has suffered such slow growth in life expectancy.” According to the Center for Disease Control and Prevention National Vital Statistics System report, life expectancy at birth for the total U.S. population declined 1 year from 78.8 years in 2019 to 77.8 years in the first half of 2020 (the most recent data). This is despite the fact that health expenditures have been increasing for decades.
The health expenditures and life expectancy statistics preceded the Covid-19 pandemic. You cannot determine a causal relationship between health expenditures and life expectancy because this can only be done if there is an appropriately designed experiment. But, you can observe a relationship between life expectancy and health expenditures. What is the relationship between health expenditures and life expectancy in most countries? What is the relationship for the U.S.? Why is U.S. life expectancy declining while increasing in other comparable countries? How can this happen when health expenditures per capita are increasing? What could we do to change this trend?
Here are some of the student headlines we received online that capture the story of this graph: “Money Can’t Buy Health” by Princess of Tennessee, “Does Paying More for Healthcare Result in a Longer Life?” by Sukhpreet of Valley Stream North in New York, “How Much Does a Long Life Cost?” by Diane of the USA, “Are the Wealthiest the Healthiest?” by Paul of Memphis and “The Cost of Living” by Owen, Kate, Gabe and Halimo of Eden Prairie, Minnesota.
You may want to think critically about these questions:
Notice and wonder about the United States in this graph. What do the countries vertically located above the U.S. have in common? What do the countries horizontally located to the left of the U.S. have in common? What in the graph surprises you?
Notice the trend for Saudi Arabia. Interpret the “zig-zag.”
Our World in Data has many interactive graphs plus maps and tables about global life expectancy. Go to the graphs on Healthy life expectancy vs. Health expenditure per capita. Compare The New York Times’ graph to this graph. How do they show the data differently? Which question does each graph answer better?
Stat Nuggets for ““America Will Struggle After Coronavirus. These Charts Show Why.”
To see the archives of all Stat Nuggets with links to their graphs, go to this index.
CONNECTED SCATTERPLOT
A connected scatterplot shows the trend over time for the relationship of two quantitative variables. With a connected scatterplot, the values from two time series are shown simultaneously – one on the horizontal axis and one on the vertical axis. Their ordered pairs values for the time period are connected chronologically by a line.
In the Global Life Expectancy graph, the two quantitative variables are health expenditures per capita, shown on the horizontal axis, and life expectancy, shown on the vertical axis. There is data for many countries for the years 2000-2017. To construct each country’s line, the values for each year are plotted as an ordered pair (health expenditures followed by life expectancy) and the points are connected based on their order in time. Note that for most countries, both health expenditures per capita and life expectancy increase over the time period.
DIRECT vs. INVERSE RELATIONSHIP
Two variables are directly related if their values change in the same direction; that is, as one increases, the other tends to increase. Conversely, two variables are inversely related if their values tend to change in opposite directions; that is, as one increases, the other tends to decrease.
In the Global Life Expectancy graph, the two variables (health expenditures per capita and life expectancy) are directly related for most countries for the entire time period 2000 - 2017. For each country, the connected scatterplot left end point is for the year 2000 and the right end point is 2017. In general, the graph shows both health expenditures and life expectancy increasing together throughout the time period. When there is a health expenditure decrease and then increase from one year to the next, the lines “zig-zag,” such as Saudi Arabia.
TOTAL vs. PER CAPITA DATA
Some quantitative variables count the total number of times something occurs for a group. To calculate a per capita (“per person”) rate, simply divide the total number by the number of people in the group.
In the Global Life Expectancy graph, the health expenditures per capita equals the country’s total health expenditures divided by the country’s population.
________
The graphs for “What’s Going On in This Graph?” are selected in partnership with Sharon Hessney. Ms. Hessney wrote the “reveal” and Stat Nuggets with Erica Chauvet, mathematics professor at Waynesburg University in Pennsylvania, and moderates online with David Wilcox, statistics teacher at the Lawrenceville School in Lawrenceville, New Jersey.
3 answers
Responses to the Questions
What do you notice?
Many countries exhibit a positive correlation between health expenditures and life expectancy, with most nations showing an upward trend from 2000 to 2017. However, the United States stands out as a deviation from this trend, highlighting an increase in health expenditures without a corresponding increase in life expectancy.
What do you wonder?
I wonder why the U.S. is an outlier in this data. What factors contribute to the stagnation or decline in life expectancy despite rising health care costs? Are there underlying social determinants of health or systemic issues in the U.S. health care system that are not reflected in the expenditure data?
What impact does this have on you and your community?
This trend raises significant concerns about the effectiveness and efficiency of health care spending in my community and the broader context in the U.S. It suggests that increasing financial investment in healthcare does not automatically translate to better health outcomes. Community health initiatives may need to address factors beyond expenditure, such as access to preventive care, socioeconomic disparities, and lifestyle choices.
What’s going on in this graph? Write a catchy headline that captures the graph’s main idea.
"America's Health Paradox: Spending More Yet Living Less."
Engaging in Further Discussion
I would encourage everyone participating to engage with others' comments, noting how this issue resonates in different communities and drawing connections to broader public policy discussions surrounding healthcare reform. The trends shown in the graph call for critical thinking about how we can drive positive change in a system that seems fundamentally flawed despite its high levels of investment.
3. What does the data show? What do you notice
(what story does it tell?)
4. Why is it telling the story you wrote in 4? What
do you wonder?
3. What does the data show? What do you notice (what story does it tell?)
The data reveals a concerning narrative about the relationship between health care expenditures and life expectancy, particularly highlighting the United States as an outlier.
Observations:
General Trend: For many countries, as health expenditures per capita increase, life expectancy also rises. This suggests that higher investment in healthcare can lead to better health outcomes in most cases.
U.S. Anomaly: The United States showcases increasing health expenditures without a corresponding increase in life expectancy, and in fact, a recent decline in life expectancy at birth illustrates a significant outlier compared to other nations.
Potential Factors: This discrepancy might suggest systemic inefficiencies, such as high rates of chronic illness, inadequate preventive care, disparities in access to healthcare, or other social determinants affecting health that are not adequately addressed by mere financial input.
4. Why is it telling the story you wrote in 4? What do you wonder?
The story is shaped by broader societal and systemic factors that impact health outcomes far beyond just financial commitments. The U.S. spends more on healthcare than any other country, yet this spending does not translate to better health outcomes as demonstrated by stagnating or declining life expectancy figures.
Questions I Wonder:
What specific barriers exist in the U.S. healthcare system that prevent effective outcomes despite high expenditures?
How do social determinants such as income inequality, education, and lifestyle choices play a role in the health outcomes of individuals in the U.S.?
Are there particular health policies or practices in other countries that contribute to their success in achieving higher life expectancy with lower expenditures?
How can communities and policymakers address these underlying issues effectively to ensure that healthcare spending translates into genuine health improvements for the population?
This narrative begs for a closer examination of healthcare policies and practices, encouraging discussions about the effectiveness of resource allocation, public health initiatives, and the importance of addressing disparities in health access and quality.
1 answer