April 14 , 2023
Shrinking Lifespans in the US
In the last two years, life expectancy in the US has fallen from 78 years to 76 years. This sharp downturn comes after a century of gradually lengthening lifespans.
The obvious cause of this was the COVID pandemic, and it is reasonable to expect the numbers to revert to their long run average this year. But even if they do, there is a troubling gap between the lifespans of Americans and those in other developed countries.
Back in 1980, life expectancy in the US and Western Europe and Japan were all about the same. But over the last 40 years, while the figures rose for the rest of the developed world, the US lagged behind. On the eve of the pandemic, most advanced societies like the UK, Germany, and France had life expectancy of about 82 years. The US on the other hand was only at 79 years, ranking about 45 th in the world, behind even Cuba and Costa Rica. What went wrong in the US?
The first place to look is health care, but the US actually spends far more on healthcare per person than any other nation. While some of that is wasted, in general American seniors do in fact benefit, and have longer survival times than senior citizens in other nations. The average American that reaches the age of 65 can expect to live another 20 years.
What is shortening the number for the population as a whole is deaths of children and young adults. Life expectancy is the age by which 50% of all those born will have died. In nations that have high infant mortality, this is the primary reason for lower life expectancy. They reach that 50% figure faster because they begin with the handicap of infant deaths.
In the US, infant mortality is very low, though it could be even lower to match the best European and East Asian states. But there are a number of factors that raise the mortality of younger Americans. Gun violence is a big one. Not just murders, but also suicides. To commit suicide without a gun is rather difficult, but a gun can make it much easier to carry out in a moment of despair. Another factor is accidental deaths, particularly car accidents. The US has a much higher rate of vehicle deaths than other nations. Third is the drug epidemic, particularly fentanyl, which is killing almost 100,000 Americans per year. Combined, 1 in 25 newborns will die before they reach the age of 40 in the US, compared to 1 in 100 in the UK or Germany.
The US also has a less healthy population than other nations. In particular is the rate of obesity, which has become epidemic over the last thirty years. Overweight Americans have higher rates of high blood pressure, diabetes, strokes, cardiovascular disease, and respiratory problems.
While the US overall falls short, there is significant disparity between genders and races. Asian-Americans, for example, have a life expectancy almost 11 years longer than African-Americans, and women live significantly longer than men. African-American men had a shockingly low life expectancy of only 70 years in 2022.
There is another divide in the US, a political divide between Red and Blue states. In liberal states like California, Washington, and New York, life expectancy is closer to the European norms, while in conservative states like Texas and Georgia it is much lower. These reflect a whole set of public policy choices, including the fact that conservative states continue to avoid implementing the expansion of Medicaid under Obamacare to cover most of the working poor with health insurance. Gun laws are much laxer and public investments in public health measures are stingier.
The COVID pandemic exacerbated many of these trends in the US. Obese patients were more likely to have severe COVID and die. Conservative Americans were much more skeptical of public health guidance and vaccine importance. Much of the disparity in COVID death rates between Red and Blue states is explained by different rates of COVID vaccination by the population. This was a totally self-inflicted wound and several hundred thousand Americans died needlessly long after a protective vaccine was available.
The US is an immensely wealthy country. Other than a few small nations like Norway and the UAE, Americans have the highest per capita incomes in the world. But all this wealth does not translate into the single most important item we all value, a long and healthy life. Americans die sooner in larger numbers than their peers due to guns, drugs, bad diet and lack of exercise, and a political culture that does not see healthcare as a human right. With the end of COVID the American life expectancy should rebound in 2023, but it will remain well short of where it should be given how rich this country is.
