A 30-year-old American is three times more likely to die at that age than his or her European peers. In fact, Americans do worse at just about every age. To make matters more grim, the American disadvantage is growing over time.
In 2017, for example, higher American mortality translated into roughly 401,000 excess deaths – deaths that would not have occurred if the US had Europe’s lower age-specific death rates. Pre-pandemic, that 401,000 is about 12% of all American deaths. The percentage is even higher below age 85, where one in four Americans die simply because they do not live in Europe.
There have been many efforts to account for the US mortality disadvantage. There is no single answer, but three factors stand out. First, death rates from drug overdose are much higher in the US than in Europe and have risen sharply in the 21st century. Second is the rapid rise in the proportion of American adults who are obese. In 2016, 40% of American adults were obese, a larger proportion than in Europe. Higher levels of obesity in the US may account for 55% of its shortfall in life expectancy relative to other rich countries. Third, the US stands out among wealthy countries for not offering universal healthcare insurance. One analysis suggests that the absence of universal healthcare resulted in 45,000 excess deaths at ages 18-64 in 2005. That number represents about a quarter of excess deaths in that age range.
Above age 65, healthcare insurance coverage is nearly universal via Medicare. An international review of medical practice by the National Academy of Sciences suggested that the US does comparatively well in identifying and treating cardiovascular diseases and many cancers. But the prevalence of these diseases, the principal killers in wealthy countries, is unusually high in the US. Heart disease, a type of cardiovascular disease and America’s number one cause of death for decades, is strongly linked to lifestyle factors such as obesity. Although the connection between obesity and health risks is well known, consumer preferences for unhealthy food are strong. Not just because humans are biologically vulnerable to sweets and fats, but because major food producers and distributors are incentivized to turn this weakness into profit.
Since the 1990s, Italian leaders have tried to overhaul the sclerotic economy while also running tight budgets. Mr. Draghi is the first in decades who can deploy massive fiscal firepower to help.
Italy’s economy has rarely grown by more than 1% annually over the past quarter-century. The economy has never fully recovered from the global financial crisis and subsequent eurozone crisis, and slumped by another 9% in 2020 amid the pandemic and strict lockdowns.
Germany, France and other EU countries backed the recovery fund mainly for fear that Italy and Southern Europe could get stuck in another deep economic slump that once again tests the cohesion and survival of the eurozone.
Most of Greece’s debt is in bailout loans from the rest of the eurozone, with no repayments due for many years, making another Greek debt crisis unlikely for a long time.
Those developments are infuriating, and also enlightening as to how the system of the world functions these days, but the main event remains the race between new strains and vaccinations.
In America the race is plausibly close. Cases are rising, and likely will continue to rise for several more weeks, especially if vaccination rates continue to stagnate. But that acceleration should start soon, and at an additional 3% protection per week that grows and compounds, the vaccinations won’t take that long to turn the tide even if they don’t accelerate much.
In Europe the race is not so close. Vaccinations are running far slower, with no short term hope for things to get much better. The recent own goals only made a bad situation worse, and in many European countries things are looking quite bad. Lockdowns are once again the order of the day in many places, most notably Germany, and yet the situation is getting rapidly worse, in some places reaching crisis proportions.
The US can look to Europe for how this played out: European countries tried in-person learning last fall but began closing schools as B.1.1.7 swept through the continent. By December, countries including the Netherlands and Germany had shut down their schools in the face of rising case numbers. The CDC says it may need to update school reopening guidelines in light of new information about variants.
This task is made more difficult because tracking the spread of variants in the US is tough right now. Compared with other countries, it has very few labs doing this work, and while more funding will help, Friedrich says there will still be a gap.
Italy’s Enel SpA, one of Europe’s biggest electricity producers, has short-term commercial paper that recently offered an annualized yield of minus 0.61%, according to FactSet: That is 0.11 percentage point lower than the ECB’s deposit rate of minus 0.5%.
When interest rates are negative, borrowers pay back less than they were lent when their debt comes due. At Enel’s rate, if it borrowed $100 for a year, it would pay back $99.39. For the lender, in this case the money-market funds that buy commercial paper, the opposite is true. They get back less money.
“It took a couple of years for clients to get their heads around the idea that they’d have to pay to leave money in a safe spot,” said Kim Hochfeld, global head of State Street’s cash business. State Street’s EUR Liquidity LVNAV Fund — worth 6.6 billion euros, equivalent to $7.9 billion — yields minus 0.68% after fees, but that compares with total costs on large bank deposits of up to 1%, she added.
A recent report on tax revenue sources shows that social insurance taxes—also referred to as social security contributions or payroll taxes—are an important revenue source for European governments. Social insurance taxes, as opposed to individual income taxes, are usually levied at a flat rate. The revenue is generally used to fund specific social programs, such as unemployment insurance, health insurance, and old age insurance.
In 2019 (the most recent data available), social insurance taxes were the second largest tax revenue source in European OECD countries, at an average of 29.5 percent of total tax revenue. Only consumption taxes were on average a larger source of tax revenue, at 32.4 percent.
In the spring, as the virus ravaged western Europe, countries in the former eastern bloc quickly introduced border controls and lockdowns, and were largely spared. Belgium, Britain, France, Italy, the Netherlands, Spain and Sweden accounted for almost all of the continent’s deaths. Each suffered a monthly excess-mortality rate of at least 12 people per 100,000 (averaged from March to May). The country in eastern Europe that got closest was Belarus, which recorded a monthly rate of 8 per 100,000, after imposing almost no restrictions on daily life. Others were markedly lower.
At the same time that covid-19 was devastating New York, cities in western Europe were also suffering severe outbreaks. Britain, Spain, Italy and Belgium have some of the highest national excess-death rates in the world, after adjusting for the size of their populations. France and Portugal locked down comparatively early, given the number of positive tests at the time. However, a second wave of covid-19 in winter has caused excess mortality to rise again across the region. (Some countries also recorded a small spike of non-covid fatalities during a heat wave in August.)
When governments realized death tolls were too low, they revamped the way they counted them
Weeks after the virus hit Italy last year, doctors, funeral homes and officials realized that government Covid-19 death tolls were too low and many victims weren’t getting included. Informal tallies quickly revealed that thousands of deaths most likely caused by the virus had been omitted. Limited testing left the number of infections unknown, and many people had died outside hospitals, which were the initial source of fatality figures.
Italy’s statistical agency, Istat, scrambled to assemble more reliable information, collecting data from towns and cities faster than ever before. In May, it revealed what people at the front lines had suspected: a 39% jump in nationwide deaths between Feb. 21 and March 31 compared with previous years.
“Normally, they [the data] would have arrived six months later,” said Istat President Gian Carlo Blangiardo in May. “We made an extraordinary effort.”