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Working Through CRAAP: Healthcare Statistics

Note: This is NOT a fact check, it is a display of my own thought process. It is up to YOU to decide whether something is true or not.

It’s time to once again work through to  the CRAAP (Currency, Relevance, Authority, Accuracy, Purpose) Test – a tool that can be used against information items from across the political spectrum. It’s time to provide another example.

I recently collected this image on Facebook:

Picture of uncited statistics relating to US healthcare.

Collected on Facebook 12/18/2016

Here’s how I worked through the CRAAP Test.

Currency: The timeliness of the information.  When was the information published or posted?

Because of the creator note in the lower-right corner (FBDavidAvocadoWolfe), we know it was posted to Facebook by David Wolfe on November 22, 2016. In his post, he does not offer any context or data sources. There are 459 comments as of 12/18/2016 and it is possible he commented further, but I am analyzing the picture itself.

That’s the timeliness of the picture. We know NOTHING of the timeliness of the statistics. When were we 60th in life expectancy? And so on. Mr. Wolfe doesn’t tell us that.

Timeless stats are usually a red flag for me in sharing. I know that statistics change over time, so if I want to comment on current policies, I want the latest stats. If I’m having a conversation about historical circumstances, I’d want the stats of the time. Statistics without dates don’t help either circumstance.

Relevance: The importance of the information for your needs.  Does the information relate to your topic or answer your question?

It’s relevant to me as a citizen and that if we’re paying top dollar for care, I want top quality or a detailed explanation of why higher spending is required for the measures we achieve.

Authority: The source of the information.  What are the author’s credentials or organizational affiliations?  Is the author qualified to write on the topic?

For me, this one is a little bit tricky. While Mr. Wolfe is a health and nutrition author (Facebook, Website) who does not document formal education in his about pages, a discussion of his exact qualifications doesn’t feel right to me in this context. With this picture, Mr. Wolfe isn’t doing anything besides quoting statistics, and anyone is qualified to do that. If I were analyzing an article on his findings on cancer or aids treatment, a deeper look at his qualifications would be needed.

Accuracy: The reliability, truthfulness and correctness of the content.  Is the information supported by evidence?  Can you verify any of the information in another source or from personal knowledge?  Does the language or tone seem unbiased and free of emotion?  Are there spelling, grammar or typographical errors?

As I said above, none of the statistics/rankings have dates. So if Mr. Wolfe is talking about some other point in time than “Latest available statistics in December 2016”, that would be a different analysis.

Let’s look at each of Mr. Wolfe’s claim’s in turn:

The USA spends more on healthcare than any other country in the world but is …

The claim that the United States spends the most on healthcare than any other nation in the world is very common, and true as recently as 2012 as documented in this PBS interview with Mark Pearson, head of Division on Health Policy at the Organization for Economic Co-operation and Development (OECD). OECD is an international organization respected for its statistics gathering.

Health Costs: How the U.S. Compares With Other Countries
BY JASON KANE (PBS Newshour) October 22, 2012 at 10:30 AM EST

When I searched this claim on Google, I was careful to search for [health care costs by country] rather than something like [US spends more on health care than anyone else in the world]. That’s because I was interested in the accuracy of this claim and not trying to search for its source.

60th in life expectancy

In my searching, I found a table in Information Please Almanac titled Life Expectancy for Countries, 2015. This table listed the United States at 43rd place, with a life expectancy of 79.68 years. This is well below many first world countries (Japan 84.74, Sweden 81.98) but ahead of the actual #60, Albana (78.13 years).

Unlike Mr. Wolfe, Information Please Almanac cites its source, the 2015 CIA World Factbook. While the Factbook has traditionally come out in print, the CIA only maintains the latest version at https://www.cia.gov/library/publications/the-world-factbook/. As of 2016, it has the US ranked at 42nd in life expectancy.

While I accept publicly accessible statistics from the CIA at face value, I won’t judge you if you do not. One thing that makes me have faith in the accuracy of CIA’s number is that the US ranking is very low for industrialized countries. You’d think that if the Factbook were a propaganda tool, the US would always be in the top five of every country comparison.

If you don’t accept the CIA’s numbers, the next step would be to search for a country government’s home page and search for their health statistics. Make sure you get the same year for a given stat as the CIA World Factbook and compare the two. If you find discrepancies, leave a comment with the URL of your source.

1st in cancer

For cancer statistics by country, I located a 2012 table from the World Cancer Research Fund International (WCRF), an organization representing cancer prevention groups in a number of countries. Their staff appears to consist of health professionals with documented educational histories.

WCRF’s table shows the following cancer rankings for the United States using 2012 data:

  • Both Sexes – 6th (between Norway and Ireland)
  • Men – 9th (between Denmark and the Czech Republic)
  • Women – 2nd (Between Denmark and South Korea

So, close to true for women, but no #1 ranking.

41st in infant mortality

My search for [country rankings infant mortality] led me to the CIA World Factbook. Its 2016 country comparison table for infant mortality (where #1 highest) gave the US a ranking of 169 and an infant mortality of 5.8 deaths per 1000 births. The actual #41 for 2016 is Sao Tome and Principe, an African island nation, with 46.6 deaths per 1000 births.

If you don’t trust the CIA, see my suggestions under life expectancy above for fact checking them.

1st in obesity

I found two tables I found relevant in checking this claim:

Obesity – Adult Prevalance Rate (CIA World Factbook, data from 2008)

Fattest Countries in the World (Information Please Almanac, Citing World Health Organization (WHO) Data for Overweight and Obese, data from 2014)

The CIA ranked the US at 18th and WHO ranked the US at 8th. They weren’t exactly comparing the same thing. The CIA only looked at obesity, while WHO added in people who were overweight but not obese. But even with that help, the US can only get to 8th highest.

33% of Americans are diabetic and

When I want US health data, I go to the Centers for Disease Control and Prevention (CDC) if I want national data and to individual US state health departments if I want to verify state level data.

As of this writing, the latest full diabetes statistics report from the CDC is:

2014 National Diabetes Statistics Report

According to this report, 29.1 million people or 9.3% of the population have diabetes. This figure is accepted by the American Diabetes Association, a group with no interest in under-reporting.

Autism is up from 1 in 10,000 to 1 in 88.

Interestingly, this is the one place where current reality is more grim that Mr. Wolfe makes it out to be. The CDC has a page on Autism Spectrum Disorder (ASD), the current term for autism and related conditions. This page has these stats (2012) on prevalence:

  • About 1 in 68 children has been identified with autism spectrum disorder (ASD) according to estimates from CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network. [Read summary] [Read article]
  • ASD is about 4.5 times more common among boys (1 in 42) than among girls (1 in 189). [Read article]

I could not find support for the claim that the autism/ASD rate has ever been 1 in 10,000. But there are more diagnosed cases now than Mr. Wolfe’s number, which CDC gives as being the rate of ASD in 2008, in a table on the CDC ASD page.

Purpose: The reason the information exists.  Is its purpose to inform, teach, sell, entertain or persuade?  Is the information fact, opinion or propaganda?  Are there political, ideological, cultural, religious, institutional or personal biases?

While Mr. Wolfe offered no commentary when he first posted his picture, it seems like he’s trying to persuade people that the US needs to do something different about health care.

Because most of the claims are somewhat inflammatory and were unsupported assertions, I’d lean towards calling it propaganda, particularly the claim about diabetes which is more than three times its actual value.

In my view, Mr. Wolfe’s Facebook page and author website appear to have a bias against Western medicine, but I have no way of knowing if that affected his choice of statistics. Misleading statistics about the US health care system are thrown about by adherents of Western medicine as well.

After running this CRAAP test, this is not an image that I would share on social media if I were making a point in the US health care debate.

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