Recently, there has been political talk suggesting that the United States should make Canada the 51st state and buy Greenland from Denmark. Acquiring Canada would improve the health of the U.S. But acquiring Greenland would worsen the health of the average citizen. The reason? Greenland has the highest prevalence of cigarette smoking in the world.
Greenlanders smoke… a lot
This morning, I was giving our first year medical students their lung cancer lecture as part of their pulmonary course. Each year, I review the demographics of lung cancer and the demographics of cigarette smoking, the greatest risk factor for lung cancer. In the U.S., the states with the highest prevalence of smoking are those in the Mississippi River Valley and the Ohio River Valley. Worldwide, the country with the highest prevalence of smoking is the tiny Micronesian island nation of Nauru where 48.3% of adults smoke. But Nauru holds its distinction only because Greenland is technically not an independent country, but instead is an autonomous region of the Kingdom of Denmark. With a smoking prevalence of 60% of adults in 2018, Greenland would have the highest smoking rate in the world if it were an independent nation. In contrast, the overall prevalence of cigarette smoking in the U.S. is 12% of adults. The smoking rate in Greenland is nearly 3 times higher than West Virginia, the state with the highest prevalence of smoking in the U.S. at 21%.
About 15% of smokers will develop lung cancer. A much higher percentage will die from other smoking-related diseases, such as COPD, cardiovascular disease, stroke, and cancers in other parts of the body. Based on the numbers, about 1 out of every 10 Greenlanders is going to develop lung cancer, a much higher number than anywhere in the U.S.
Greenland’s life expectancy
The life expectancy from birth in Greenland is 71.3 years but there is a significant gender disparity: the life expectancy for men is 69.6 years and the life expectancy for women is 73.2 years. In the U.S. the life expectancy from birth is 76.4 years (73.5 years for men and 79.3 years for women). But there is tremendous variation between the 50 states with a life expectancy of 79.9 years in Hawaii to low of 70.9 years in Mississippi and 71.0 years in West Virginia (the only two states with a shorter life expectancy than Greenland).
The U.S. already has the lowest life expectancy of all developed countries. Acquiring Greenland would not improve America’s average life expectancy.
Greenland’s personal income levels
The median personal income in Greenland is $34,000/year. In contrast, the median personal income in the U.S. is $48,000. However, the cost of living in Greenland is approximately 25% higher than in the United States, meaning that the personal income in Greenland of $34,00/year can purchase the same amount of goods and services as $27,000/year in the U.S. Furthermore, Greenland is heavily dependent on support from Denmark with about one-third of Greenland’s revenue coming from Danish government transfers (about $700 million per year). Without this financial support from Denmark, the average personal income would drop by about one-third, to $22,000/year or the U.S. equivalent buying power of about $18,000/year.
To put that in context, the U.S. poverty level is currently $15,000 for a single person or $31,000 for a family of four. An American can qualify for Medicaid if their income is less than $20,783 (in other words, 138% of the poverty level). As a result, if the U.S. acquired Greenland, the average Greenlander would have an income low enough to qualify for Medicaid, when income is adjusted for the high cost of living in Greenland.
The good news is that the population of Greenland is only 57,000, making it smaller in population than all 50 U.S. states as well as Washington DC, Puerto Rico, Guam, and the U.S. Virgin Islands. Many Americans view Greenland is similar to Alaska but with Alaska’s population of 740,000, it is 13-times more populous than Greenland. However, Greenland is larger in geographic size at 836,000 square miles than Alaska at 665,000 square miles.
Acquiring Greenland would not be a good public health deal for the U.S.
There are several reasons why the U.S. would like to acquire Greenland – most notably for Greenland’s untapped mineral wealth and its strategic military location in the Arctic. But from a health standpoint, the U.S. would be acquiring a lot of future lung cancer if it were to buy Greenland. It would also be acquiring a population that would largely be dependent on Medicaid.
To buy Greenland means that you are buying the people who live there. And those people come with a lower life expectancy, higher smoking rate, and lower income than the rest of the U.S. With acquisition comes responsibility and that responsibility extends to healthcare.
January 28, 2025
