Why death comes sooner in America

A report finds that Americans have "shorter lives and poorer health," coming in last in key areas behind 16 other rich nations

STORY HIGHLIGHTS

• Aaron Carroll: New study shows U.S. health and lifespan worst of 17 rich countries


• He says it's because of personal choices, systemic woes. Poverty high, health care uneven


• He says this particularly affects youth, plagued by sickness, violence, high mortality


• Carroll: Don't make it political. The richest country in the world must improve public health

Editor's note: Dr. Aaron E. Carroll is an associate professor of pediatrics at the Indiana University School of Medicine and the director of the university's Center for Health Policy and Professionalism Research. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

(CNN) -- A just-released report from the Institute of Medicine and National Research Council is making news by clearly illustrating that Americans have "shorter lives and poorer health." This is somewhat shocking, given how much we spend on health care each year — more than any of the 16 other rich countries surveyed in the study. What's even more upsetting is that this report focused quite heavily on people who are young. In the United States, even that group fared poorly.

Aaron Carroll

Why is this?

Some of the reasons involve choices make at a personal level. We eat too much, abuse drugs too often, wear seat belts too rarely and commit violence against each other to often.

Systemic issues are also to blame. We have higher levels of poverty than comparable countries, and our safety net programs are less capable of catching people when they fall. And too many also have too much trouble accessing the health care system, resulting in inefficient, ineffective and often absent care.

It's far too easy to let these dreadful statistics become obscured in a politically charged argument. Let's avoid that. This report is so stark that it's going to take a concerted effort on the part of the government, the media, the health care system and everyday citizens to turn things around. Our personal choices are bad. Our safety nets are bad. Our health care system is bad. It's all bad. How bad?

When compared with peer countries, the United States was the absolute worst with respect to still births, infant mortality and low birth weight. Some have tried to blame this on "coding" differences. In other words, they will claim that other countries will refuse to define a premature birth as we do, resulting in artificially high numbers in the United States. But when this report recalculated the rates to exclude such births equally in all countries, we still ranked last.

Things don't get better after birth. The chance that a child in the United States will die before age 5 is higher than in any of the other 16 peer countries. Injuries are the most common cause of death, but the United States also has the highest rate of deaths caused by negligence or abuse.

And violence is decidedly an American problem. Homicide is the third most common cause of death in children age 1-4.

From age 5-19, the trend continues. Kids this age in the United States have the worst health ranking of the 17 studied countries. More than one-third of U.S. children age 5-17 are obese or overweight, the highest of any peer country. The adolescent pregnancy rate in the United States is about 3.5 times the average of others. Additionally, the rates of sexually transmitted infections, including syphilis, gonorrhea and chlamydia are the worst compared to peer countries.

Nor are these children exempt from death. Injury deaths are more common in 15- to 19-year-olds in the United States than in any other studied country. Homicide claims the second highest number of lives in 15- to -24-year-olds, and 4 in 5 of those deaths involve guns. Males between the ages of 15 and 19 are five times as likely to die from violence in the United States than in other countries.

Even as young adults, ages 25-34, mortality remains consistently upsetting and preventable. Unintentional injuries remain the No. 1 cause of death. The risk of dying by violence remains seven times higher for males in the United States ages 20-24 than in other countries.

We have to work together to make these numbers better. Some of them can be improved with public health measures. We need to help Americans be less obese, to have fewer accidents and to commit less violence. There are lots of local studies and initiatives that propose ways to fix these things, but our public health system is woefully underfunded, and translating any promising findings to meaningful societal change poses a huge challenge.

We also need to improve our safety nets to help children at the lowest end of the socioeconomic ladder do better, even before they are born. Pregnant women, babies and children suffer from hunger and malnutrition far too often in the richest country in the world. Yet we still debate the merits of the federally funded WIC (Womens, Infants and Children) program, school lunches and food assistance to needy families.

Finally, we need to find a way to improve access to the health care system. The Medicaid program covers one in every three births and one in every three children in the United States, and it's still not enough. As some states balk at expanding Medicaid to cover many of the poorest uninsured, some are still talking about reducing funding to the already stretched program. There's no question that we have the capability, the knowledge and the resources to care for people. It's just a matter of doing it better.

There will be some who deny these results. Others will try to use them for political gain. That would be a mistake. We have to accept these findings and begin to work holistically to improve them. Being last just isn't the American way.

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The opinions expressed in this commentary are solely those of Aaron Carroll.

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U.S. tells computer users to disable Java software

Updated 9:00 p.m. ET

WASHINGTON The U.S. Department of Homeland Security is advising people to temporarily disable the Java software on their computers to avoid potential hacking attacks.

The recommendation came in an advisory issued late Thursday, following up on concerns raised by computer security experts.

Experts believe hackers have found a flaw in Java's coding that creates an opening for criminal activity and other high-tech mischief.

CNET's Topher Kessler writes:

"The malware has currently been seen attacking Windows, Linux and Unix systems, and while so far has not focused on OS X, may be able to do so given OS X is largely similar to Unix and Java is cross-platform.

Even though the exploit has not been seen in OS X, Apple has taken steps to block it by issuing an update to its built-in XProtect system to block the current version of the Java 7 runtime and require users install an as of yet unreleased version of the Java runtime.

Luckily with the latest versions of Java, users who need to keep it active can change a couple of settings to help secure their systems. Go to the Java Control Panel that is installed along with the runtime, and in the Security section uncheck the option to "Enable Java content in the browser," which will disable the browser plug-in. This will prevent the inadvertent execution of exploits that may be stumbled upon when browsing the Web, and is a recommended setting for most people to do. If you need to see a Java applet on the Web, then you can always temporarily re-enable the plug-in.

The second setting is to increase the security level of the Java runtime, which can also be done in the same Security section of the Java Control Panel. The default security level is Medium, but you can increase this to High or Very High. At the High level, Java will prompt you for approval before running any unsigned Java code, and at the Very High level all Java code will require such approval, regardless of whether or not it is signed."

Java is a widely used technical language that allows computer programmers to write a wide variety of Internet applications and other software programs that can run on just about any computer's operating system.

Oracle Corp. bought Java as part of a $7.3 billion acquisition of the software's creator, Sun Microsystems, in 2010.

Oracle, which is based in Redwood Shores, Calif., had no immediate comment late Friday.

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CDC: Flu Outbreak Could Be Waning

The flu season appears to be waning in some parts of the country, but that doesn't mean it won't make a comeback in the next few weeks, according to the Centers for Disease Control and Prevention.

Five fewer states reported high flu activity levels in the first week of January than the 29 that reported high activity levels in the last week of December, according to the CDC's weekly flu report. This week, 24 states reported high illness levels, 16 reported moderate levels, five reported low levels and one reported minimal levels, suggesting that the flu season peaked in the last week of December.

"It may be decreasing in some areas, but that's hard to predict," CDC Director Dr. Thomas Frieden said in a Friday morning teleconference. "Trends only in the next week or two will show whether we have in fact crossed the peak."

The flu season usually peaks in February or March, not December, said Dr. Jon Abramson, who specializes in pediatric infectious diseases at Wake Forest Baptist Health in North Carolina. He said the season started early with a dominant H3N2 strain, which was last seen a decade ago, in 2002-03. That year, the flu season also ended early.

Click here to see how this flu season stacks up against other years.

Cheryl Evans/The Arizona Republic/AP Photo

Increasing Flu Cases: Best Measures to Ensure Your Family's Health Watch Video

Because of the holiday season, Frieden said the data may have been skewed.

For instance, Connecticut appeared to be having a lighter flu season than other northeastern states at the end of December, but the state said it could have been a result of college winter break. College student health centers account for a large percentage of flu reports in Connecticut, but they've been closed since the fall semester ended, said William Gerrish, a spokesman for the state's department of public health.

The flu season arrived about a month early this year in parts of the South and the East, but it may only just be starting to take hold of states in the West, Frieden said. California is still showing "minimal" flu on the CDC's map, but that doesn't mean it will stay that way.

Click here to read about how flu has little to do with cold weather.

"It's not surprising. Influenza ebbs and flows during the flu season," Frieden said. "The only thing predictable about the flu is that it is unpredictable."

Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center in Nashville, Tenn., said he was expecting California's seeming good luck with the flu to be over this week.

"Flu is fickle, we say," Schaffner said. "Influenza can be spotty. It can be more severe in one community than another for reasons incompletely understood."

Early CDC estimates indicate that this year's flu vaccine is 62 percent effective, meaning people who have been vaccinated are 62 percent less likely to need to see a doctor for flu treatment, Frieden said.

Although the shot has been generally believed to be more effective for children than adults, there's not enough data this year to draw conclusions yet.

"The flu vaccine is far from perfect, but it's still by far the best tool we have to prevent flu," Frieden said, adding that most of the 130 million vaccine doses have already been administered. "We're hearing of shortages of the vaccine, so if you haven't been vaccinated and want to be, it's better late than never."

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Physics not biology may be key to beating cancer

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SIA firms up order for another 25 widebody aircraft from Airbus

SINGAPORE : Singapore Airlines (SIA) has firmed up an order for 25 more widebody aircraft from Airbus.

Five of the aircraft are the A380.

SIA has placed three consecutive orders for the A380, making it the second largest customer of the A380, and now has 19 such aircraft in service.

The remaining 20 aircraft are in the mid-size category - the A350-900s, which will be used on medium- and long-haul routes.

- CNA/ms

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Beheading exposes exploitation

STORY HIGHLIGHTS

• Saudi authorities beheaded Rizana Nafeek, a Sri Lankan woman


• She was convicted of killing a baby of the family employing her as a housemaid


• This was despite Nafeek's claims that the baby died in a choking accident


• Becker says her fate "should spotlight the precarious existence of domestic workers"

Jo Becker is the Children's Rights Advocacy Director for Human Rights Watch and author of 'Campaigning for Justice: Human Rights Advocacy in Practice.' Follow Jo Becker on Twitter.

(CNN) -- Rizana Nafeek was a child herself -- 17 years old, according to her birth certificate -- when a four-month-old baby died in her care in Saudi Arabia. She had migrated from Sri Lanka only weeks earlier to be a domestic worker for a Saudi family.

Although Rizana said the baby died in a choking accident, Saudi courts convicted her of murder and sentenced her to death. On Wednesday, the Saudi government carried out the sentence in a gruesome fashion, by beheading Rizana.

Jo Becker

Read more: Outrage over beheading of Sri Lankan woman by Saudi Arabia

Rizana's case was rife with problems from the beginning. A recruitment agency in Sri Lanka knew she was legally too young to migrate, but she had falsified papers to say she was 23. After the baby died, Rizana gave a confession that she said was made under duress -- she later retracted it. She had no lawyer to defend her until after she was sentenced to death and no competent interpreter during her trial. Her sentence violated international law, which prohibits the death penalty for crimes committed before age 18.

Rizana's fate should arouse international outrage. But it should also spotlight the precarious existence of other domestic workers. At least 1.5 million work in Saudi Arabia alone and more than 50 million -- mainly women and girls -- are employed worldwide according to the International Labour Organization (ILO).

Read more: Indonesian maid escapes execution in Saudi Arabia

Again according to the ILO, the number of domestic workers worldwide has grown by more than 50% since the mid-1990s. Many, like Rizana, seek employment in foreign countries where they may be unfamiliar with the language and legal system and have few rights.

When Rizana traveled to Saudi Arabia, for example, she may not have known that many Saudi employers confiscate domestic workers' passports and confine them inside their home, cutting them off from the outside world and sources of help.

It is unlikely that anyone ever told her about Saudi Arabia's flawed criminal justice system or that while many domestic workers find kind employers who treat them well, others are forced to work for months or even years without pay and subjected to physical or sexual abuse.

Passport photo of Rizana Nafeek

Read more: Saudi woman beheaded for 'witchcraft and sorcery'

Conditions for migrant domestic workers in Saudi Arabia are among some of the worst, but domestic workers in other countries rarely enjoy the same rights as other workers. In a new report this week, the International Labour Organization says that nearly 30% of the world's domestic workers are completely excluded from national labor laws. They typically earn only 40% of the average wage of other workers. Forty-five percent aren't even entitled by law to a weekly day off.

Last year, I interviewed young girls in Morocco who worked 12 hours a day, 7 days a week for a fraction of the minimum wage. One girl began working at age 12 and told me: "I don't mind working, but to be beaten and not to have enough food, this is the hardest part."

Many governments have finally begun to recognize the risks and exploitation domestic workers face. During 2012, dozens of countries took action to strengthen protections for domestic workers. Thailand, and Singapore approved measures to give domestic workers a weekly day off, while Venezuela and the Philippines adopted broad laws for domestic workers ensuring a minimum wage, paid holidays, and limits to their working hours. Brazil is amending its constitution to state that domestic workers have all the same rights as other workers. Bahrain codified access to mediation of labor disputes.

Read more: Convicted killer beheaded, put on display in Saudi Arabia

Perhaps most significantly, eight countries acted in 2012 to ratify -- and therefore be legally bound by -- the Domestic Workers Convention, with more poised to follow suit this year. The convention is a groundbreaking treaty adopted in 2011 to guarantee domestic workers the same protections available to other workers, including weekly days off, effective complaints procedures and protection from violence.

The Convention also has specific protections for domestic workers under the age of 18 and provisions for regulating and monitoring recruitment agencies. All governments should ratify the convention.

Many reforms are needed to prevent another tragic case like that of Rizana Nafeek. The obvious one is for Saudi Arabia to stop its use of the death penalty and end its outlier status as one of only three countries worldwide to execute people for crimes committed while a child.

Labor reforms are also critically important. They may have prevented the recruitment of a 17 year old for migration abroad in the first place. And they can protect millions of other domestic workers who labor with precariously few guarantees for their safety and rights.

Read more: Malala, others on front lines in fight for women

The opinions expressed in this commentary are solely those of Jo Becker.

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Sheriff: High school gunman felt he'd been bullied

TAFT, Calif. Authorities say a teen who fired on classmates and critically wounded one at a rural California high school had planned the attack and targeted students he felt had bullied him for more than a year.

Kern County sheriff Donny Youngblood said at a news conference Thursday night that the 16-year-old used a shotgun that belonged to his brother and went to bed Wednesday night with a plan to shoot two fellow students.

"He believed that the two people he targeted had bullied him, in his mind. Whether that occurred or not, we don't know yet," Youngblood said.

Youngblood added that the suspect came to Taft Union High School with ammunition stuffed in his pockets.

According to Youngblood, surveillance video shows the teen trying to conceal the gun as he nervously enters the building through a side entrance after school had started Thursday morning.

The boy went into a classroom, shot one student, then fired on but missed others before a teacher and another staff member talked him into surrendering, Youngblood told reporters.

Morgan Allredge, 16, calmly described what happened to CBS Los Angeles station KCBS. To see the interview, click on the video at left.

The wounded student was flown to a hospital in Bakersfield and was listed in stable but critical condition. He is also 16, reports CBS Bakersfield, Calif. affiliate KBAK-TV.

When the shots were fired, teacher Ryan Heber tried to get the 28 students out a back door and engaged the shooter in conversation to distract him, Youngblood said.

Some students got out the back door, while some barricaded themselves in a classroom storage closet, KBAK says.

A third and final shotgun blast was directed to the windows of the classroom, KBAK reports.

Campus supervisor Kim Lee Fields responded to a call of shots fired and also began talking to the teen.

"(Heber and Fields) talked him into putting that shotgun down. He in fact told the teacher, "I don't want to shoot you,' and named the person that he wanted to shoot," Youngblood said.

"The heroics of these two people goes without saying. ... They could have just as easily ... (have) tried to get out of the classroom and left students, and they didn't," the sheriff said. "They knew not to let him leave the classroom with that shotgun."

The shooter didn't show up for first period, then interrupted the class.

Youngblood did not release the student's disciplinary record, saying he didn't have it.

The Sheriff's Department did not release the boy's name because he was a juvenile and had yet to be charged.

But many students and community members said they knew the boy and said he was often teased, including Alex Patterson, 18, who went to Taft with the suspect before graduating last year.

"He comes off as the kind of kid who would do something like this," Patterson said. "He talked about it a lot, but nobody thought he would."

Trish Montes, who lived next door to the suspect, said he was "a short guy" and "small" who was teased about his stature by many, including the victim.

"Maybe people will learn not to bully people," Montes said. "I hate to be crappy about it, but that kid was bullying him."

Montes said her son had worked at the school and tutored the boy last year, sometimes walking with him between classes because he felt sorry for him.

"All I ever heard about him was good things from my son," Montes said. "He wasn't Mr. Popularity, but he was a smart kid. It's a shame. My kid said he was like a genius. It's a shame because he could have made something of himself."

Officials said a female student was hospitalized with possible hearing damage because the shotgun was fired close to her ear, and another girl suffered minor injuries during the scramble to flee when she fell over a table.

Officials said there's usually an armed officer on campus, but the person wasn't there because he was snowed in. Taft police officers arrived within 60 seconds of first reports.

The alleged shooter apparently lives close to the school, and neighbors saw him carrying the gun into school and called 911, KBAK says.

Wilhelmina Reum, whose daughter Alexis Singleton is a fourth-grader at a nearby elementary school, got word of the attack while she was about 35 miles away in Bakersfield and immediately sped back to Taft.

"I just kept thinking this can't be happening in my little town," she told The Associated Press.

"I was afraid I was going to get hurt," Alexis said. "I just wanted my mom to get here so I could go home."

Taft is a community of fewer than 10,000 people amid oil and natural gas production fields about 120 miles northwest of Los Angeles.

About 900 students are enrolled at the high school, which includes ninth through 12th grades.

The attack there came less than a month after a gunman massacred 20 children and six women at Sandy Hook Elementary School in Newtown, Conn., then killed himself.

That shooting prompted President Obama to promise new efforts to curb gun violence. Vice President Biden, who was placed in charge of the initiative, said he would deliver new policy proposals to the president by next week.

Sen. Dianne Feinstein, D-Calif., said in a statement that her father had attended Taft Union and she has visited the school over the years.

"At this moment my thoughts and prayers are with the victims, and I wish them a speedy recovery," Feinstein said. "But how many more shootings must there be in America before we come to the realization that guns and grievances do not belong together?"

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Judge: Holmes Can Face Trial for Aurora Shooting

Jan 10, 2013 8:45pm

(Arapahoe County Sheriff/AP Photo)

In a ruling that comes as little surprise, the judge overseeing the Aurora, Colo., theater massacre has ordered that there is enough evidence against James Holmes to proceed to a trial.

In an order posted late Thursday, Judge William Sylvester wrote that “the People have carried their burden of proof and have established that there is probable cause to believe that Defendant committed the crimes charged.”

The ruling came after a three-day preliminary hearing this week that revealed new details about how Holmes allegedly planned for and carried out the movie theater shooting, including how investigators say he amassed an arsenal of guns and ammunition, how he booby-trapped his apartment to explode, and his bizarre behavior after his arrest.

PHOTOS: Colorado ‘Dark Knight Rises’ Theater Shooting

Holmes is charged with 166 counts, including murder, attempted murder and other charges related to the July 20 shooting that left 12 people dead and 58 wounded by gunfire. An additional 12 people suffered non-gunshot injuries.

One of the next legal steps is an arraignment, at which Holmes will enter a plea. The arraignment was originally expected to take place Friday morning.

Judge Sylvester indicated through a court spokesman that he would allow television and still cameras into the courtroom, providing the outside world the first images of Holmes since a July 23 hearing. Plans for cameras in court, however, were put on hold Thursday afternoon.

“The defense has notified the district attorney that it is not prepared to proceed to arraignment in this case by Friday,” wrote public defenders Daniel King, Tamara Brady and Kristen Nelson Thursday afternoon in a document objecting to cameras in court.

A hearing in the case will still take place Friday morning. In his order, Judge Sylvester said it should technically be considered an arraignment, but noted the defense has requested a continuance.  Legal experts expect the judge will grant the continuance, delaying the arraignment and keeping cameras out of court for now.

Sylvester also ordered that Holmes be held without bail.

Holmes’ attorneys have said in court that the former University of Colorado neuroscience student is mentally ill. The district attorney overseeing the case has not yet announced whether Holmes, now 25, can face the death penalty.

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Global banking rules won't stop next meltdown

IT IS like storm-proofing a building with a paper towel. From 2015, the world's banks will be forced to keep a proportion of their assets in reserve, to prevent a repeat of the 2008 banking crisis. But economists say the rules will make little difference.

Serafín Martínez Jaramillo of the Mexican Central Bank endorses the move but says it doesn't allow for the fact that bad debts can spread through the economy and take down many banks at once. This was at the heart of the 2008 crisis. "You have to incorporate contagion."

Simone Giansante of the University of Bath, UK, has modelled the effects of such rules and found they barely reduce this risk (Social Science Research Network, doi.org/j59).

Many economists say what's needed is a system that can also identify threats ahead of time.

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Foxconn cooperating with authorities in bribe probe

TAIPEI: Taiwan's Hon Hai Precision Industry has come under further scrutiny.

The company - which also goes by the trade name Foxconn - said it is co-operating with a probe by China's law enforcement officials into alleged bribery of its supply-chain partners by employees.

Hon Hai also said it is conducting a full review into its policies and practices to strengthen internal controls.

China Times newspaper reported the department involved in soliciting bribes from suppliers is called Surface Mount Technology.

It is in charge of all major procurements of Hon Hai Precision.

As the world's largest electronics contract maker, it is believed the company's purchase of equipment amounts to tens of billions of US dollars a year.

Local media reported Hon Hai's top management first got an anonymous letter last year that tipped them off on the alleged bribery.

Chairman Terry Gou was believed to be furious and immediately reported the case to the Chinese police, which later led to the arrest of one executive.

Hon Hai is reportedly investigating a dozen other employees suspected of having taken bribes. It has suspended its purchases from an equipment maker accused of offering bribes to the employees.

But Hon Hai said the case is not affecting the company's operation.

Mr Gou had ordered an internal investigation, as well as a review of its procurement procedures.

The incident has again put Hon Hai under scrutiny after a string of worker suicides at its factories in 2009.

Since then, it has tried to improve working conditions and wages for its workers.

But analysts say the latest case is not likely to have any major impact on Hon Hai's operation or its share price.

- CNA/xq

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