Vol. 23, Issue 2: Spring 2016

Why Costa Ricans Outlive Americas

Sandeep Kaur

Why do some populations live longer than others? Many factors unquestionably influence the health indicators of a population. Researchers are attempting to understand why Costa Rica outperforms the United States in life expectancy, despite the United States having higher income and health care expenditures. For example, “mortality in the United States is 18% higher than in Costa Rica among adult men and 10% higher among middle-aged women” (Dow). The surprising factor lies in the fact that low-income citizens of Costa Rica have a better life expectancy than low-income citizens of equivalent position in the United States. It is important to explore the reasons for this disparity because Costa Rica’s impressive health of its underclass citizens exemplifies that high mortality rates are not solely the result of poor socioeconomic conditions.

It is well understood that higher life expectancy is correlated with higher economic development. Costa Rica is well known for its excellent health indicators - it is the oldest democracy in Latin America and its government strongly supports social redistributive programs. The United States delegates millions of dollars towards its health care system. Not surprisingly, “health expenditures per capita in the United States are about 10 times as high as in Costa Rica” (Dow). Another difference between the United States and Costa Rica is the way in which they distribute health resources. While the United States has a fragmented health care for low socioeconomic adults, Costa Rica has a national healthcare system that covers a majority of its citizens. Consider that “according to the 2011 census, 86% of Costa Ricans (96% of older adults) are covered by the public health insurance and care system known as the CCSS.” Whereas in the United States, healthcare coverage is only guaranteed to citizens over the age of 65, under Medicare.

According to National Longitudinal Mortality Studies samples, “the mortality disadvantage of US men is larger (22% higher mortality) after age 65 than before this age (11%).” Since the United States provides universal healthcare for residents over 65 years and Costa Ricans are eligible for coverage at all ages, this data indicates that health insurance does not adequately explain the mortality gap between these populations. Researchers concluded that the prevalent rates of heart disease and lung cancer are the driving forces that lower overall mortality rates in the United States. For example, statistics show that “US men have four times higher risk of dying of lung cancer and 54% higher risk of dying of heart diseases than Costa Rican men.” Nonetheless, Costa Ricans are more affected by cerebrovascular conditions and stroke compared to Americans. The overall lower rates of obesity, sedentariness, and dyslipidemia indicate that Costa Ricans typically live healthier lifestyles. “From a life expectancy standpoint, it is thus better to live in Costa Rica for low-SES individuals, whereas it is better to live in the United States for high-SES people younger than 65 y” (Dow). One hypothesis for why health inequality is lower in Costa Rica is that a lifetime of universal health insurance creates healthy habits that are carried throughout an individual’s lifetime, contrasting to the United States, which has high uninsurance rates before age 65 among the poor. “These results point to smoking as an important explanatory factor of low adult mortality of Costa Rica, as it has been in other international comparisons of mortality” (Dow). UC Berkeley Professor Dow comments that past research supports the claim that “decreased levels of smoking and morbid obesity would lead to increased life expectancy-- though of course, other factors are likely at play also.” Hence, if smoking were eradicated, cardiovascular mortality and chronic respiratory mortality would no longer be advantages compared to Costa Ricans. The higher mortality rates for residents over 65 and in SES in the United States can be explained by an intersection of these factors.

The lower prevalence of obesity in the male Costa Rican population suggests healthier lifestyles. However, this trend is less common in Costa Rican women, who have a higher risk of high blood pressure and diabetes, which could be a result of the high fertility levels. It is important to analyze these relationships because “from a life expectancy standpoint, it is thus better to live in Costa Rica for low-SES individuals” (Dow). Other research on the correlation between SES and health has also found that “adults with incomes four times or more above the poverty level were more than two times as likely as the adults below poverty level to engage in rigorous physical activity three to four times per week” (Center for Disease Control). A possible confounding variable that is leading to the differences in mortality rates and life expectancy between Costa Rica and the United States is the great amount of diversity in the United States.

This comparison of mortality rates between the United States and Costa Rica is vital because it could open doors that help improve our health throughout the United States - both in low and high-income brackets. By analyzing the Costa Rican health care model, the United States could potentially lower its costs and develop a more beneficial health care system that is more effective and cost-efficient. In other words, one could pay less for health insurance and live longer. The article concluded that “overall, an important part of the higher mortality of low-SES individuals existing in the US appears to be linked to unhealthy lifestyle factors, including smoking and obesity.” Other studies and literature suggest that social hierarchy and health may be linked factors such as stress, life control, anxiety, self-image, happiness, and depression. Hence, this data can be used to justify how universal healthcare coverage throughout one’s lifetime reinforces prevention of these habits and diseases, across all levels of socioeconomic status.

When asked what further research still needs to be conducted in order to figure out why certain populations live longer than others, Professor Dow responds that there are still many mysteries to unravel, for instance, “are there specific policies that have helped protect poorer Costa Ricans from the worse health that is commonly seen among poorer groups in other populations? Are the patterns in Costa Rica simply an outlier, or will we see the same patterns as we get similar adult mortality data from other low and middle-income countries? And why is it that Hispanics in the U.S. seem to have mortality patterns that are more similar to Costa Ricans than to non-Hispanic whites in the U.S.?” Whether one’s lifespan is determined by genes or other external factors, it is still important to make healthy decisions in order to avoid losing years off one’s life.