According to the Centers for Disease Control and Prevention, life expectancy in the United States fell 1.5 years in 2020, by far the largest decline since World War II, with blacks and Hispanics suffering even larger declines.
The good news is that the large pandemic-induced decline in life expectancy will almost certainly prove temporary. While the tragic loss of life from Covid-19 is all too real, unless it kills at the same rate every year, its negative impact on life expectancy will wear off. The bad news is that the negative health trends that weighed on life expectancy even before the pandemic broke out could weigh on them long after the pandemic ended.
We’re talking about the increase in morbidity related to lifestyle-related health conditions and behaviors, particularly obesity and substance abuse, and the resulting increase in premature mortality from heart disease, diabetes, alcoholic liver disease, opioid overdoses, etc.
In contrast to Covid-19, which affects older people disproportionately, these health conditions and behaviors mainly affect young and medium-sized adults who have even more years of life to lose. And unlike Covid-19, nobody has developed a vaccine to fight it. In order to end the health crisis in the US, a major awareness campaign and reforms that improve access to the health system are required. It may also require broader economic reforms that reduce poverty and inequality.
This brings us to the heart of the matter, which is that US life expectancy totals hide vastly different results by socioeconomic status. In the face of adversity, many Americans like to say that “we’re all in it”. But when it comes to life expectancy, that’s not true. The life expectancy of wealthier and more educated Americans is still increasing while it is decreasing for those who are not. The United States is a nation already deeply ravaged by divisions. Now let’s add one more to the mix.
The divergence in life expectancy is amazing. A 2015 study by the National Academy of Sciences found that life expectancy at age 50 for men born in 1960 was nearly thirteen years higher for those in the top quintile of the income distribution than for those in the bottom quintile, while for women born in 1960 were born, it was almost fourteen years higher. A 2021 study by Anne Case and Angus Deaton, authors of Deaths of Despair and the Future of Capitalism, found that the life expectancy of Americans with college degrees has continued to increase over the past two decades, while that of non- College Members The number of educated Americans has been declining since 2010. This was true for the general population, for men and women, for blacks and whites. Not so long ago, the United States was among the longevity leaders of the rich world. Today, with a lower life expectancy at birth than any other high-income member of the Organization for Economic Co-operation and Development, with the exception of Hungary, Poland and the three Baltic States, it is longevity-lacks. The main driver behind the decline in US life expectancy rankings was the deteriorating health of the US population. The United States had the third highest obesity rate in the OECD in 2017 (only Mexico and Chile were higher) and the third highest incidence of diabetes (only Mexico and Turkey were higher). As for drug abuse, the US opioid death rate in 2016 was not only the highest in the OECD, but was also at least twice that of any other member country and Estonia.
America is usually quick to respond to immediate threats, such as Pearl Harbor, the 9/11 terrorist attacks, and, albeit imperfectly, Covid-19. It is more difficult to act in slow-motion crises, the costs of which only become apparent over the course of many years or decades. But such crises can be just as threatening to the nation’s future.
Tackling the deepening health crisis that is affecting much of America requires far-reaching reforms. A major educational campaign involving all levels of government and civil society is needed to raise awareness of the risks of destructive lifestyles. It worked with smoking starting in the 1960s, and it could work with obesity and substance abuse today. But education alone will probably not be enough.
Reforms that improve today’s unequal access to the health system, particularly primary care and preventive services, are needed to succeed. Broader economic reforms may also be needed to address the root causes of the persistent divergence in US health and life expectancy, reflected at least in part in high poverty rates, rising income inequality, and the erosion of the middle class.
If we do not meet the challenge, the costs for individuals and their families, for national budgets and for the economy as a whole will continue to rise. But the greatest price of all could be the loss of social cohesion as Americans become two separate peoples, one long-lived and one short-lived.
