One measure of longevity that may better reflect the quality of a medical care in a country is life expectancy at age 50. According to a recent article in the Penn SAS Magazine (p. 16-p.17) life expectancy in the U.S. for non-smokers is 84.9 for females and 81.2 for males. These figures rank 7th and 9th among all developed nations.
Longevity for smokers is significantly shorter. In the U.S., the longevity is 82.3 for females and 78.5 for men. These figures rank 17th and 14th among developed nations.
The observation that the life expectancy for smokers is shorter is not surprising. However, why does the U.S. rank so much worse for life expectancy for smokers than non-smokers? Is the U.S. medical treatment for smokers so much worse than that of other developed countries? I would guess not.
The likely cause of the ranking change is due to the selection of people into the smoking group. It many be the case that smokers in the U.S., are poorer, less educated and more likely to be obese than non-smokers. Thus, because the group of smokers is at a socioeconomic disadvantage, this can explain why the U.S. longevity ranking is lower for smokers than non-smokers.
Many people stereotype that in France, smoking may be more respectable in high class society and smoking may not be as concentrated in poorer individuals. In fact, we observe that France ranks 4th in female life expectancy for non-smokers but 3rd in female life expectancy for smokers. A similar phenomenon may exist in Spain; the life expectancy for non-smoking females ranks 11th, but the life expectancy for smokers is 5th in the world. However, these trends are not as strong for differences in male life expectancy between smokers and non-smokers.