Editor’s Note: Richard Jackson is president of the Global Aging Institute (GAI), a non-profit research and educational organization located in Alexandria, Virginia. This article is based on “From Longevity Leader to Longevity Laggard,” a report jointly published by GAI and The Terry Group. The opinions expressed in this commentary are his own. View more opinion articles on CNN.
Life expectancy in modern, affluent societies is supposed to move in only one direction: upward. But that is not what is happening in the United States. The 2010s were the first decade in American history in which life expectancy failed to rise since the federal government began keeping comprehensive mortality statistics in 1900. Then along came Covid-19.
According to the Centers for Disease Control and Prevention, US life expectancy fell by 1.5 years in 2020, by far the largest one-year drop since World War II, with Blacks and Hispanics suffering even larger declines.
The good news is that the large pandemic-related decline in life expectancy will almost certainly prove transitory. While the tragic loss of life due to Covid-19 is all too real, unless it continues to kill at the same rate each year, its negative impact on life expectancy will fade. The bad news is that the adverse health trends which were already weighing on life expectancy before the pandemic struck may continue to weigh on it long after the pandemic has passed.
We are talking about the increase in morbidity associated with lifestyle-related health conditions and behaviors, especially obesity and substance abuse, and the consequent increase in premature mortality from heart disease, diabetes, alcoholic liver disease, opioid overdoses, and so on down the list.
Unlike Covid-19, which has disproportionately afflicted the elderly, these health conditions and behaviors mostly afflict young and midlife adults, who have more remaining years of life to lose. And unlike Covid-19, no one has developed a vaccine to combat them. Turning the corner on America’s health crisis will require a major educational campaign, together with reforms that improve access to the health system. It may also require broader economic reforms that reduce poverty and inequality.
This brings us to the crux of the matter, which is that the overall US life expectancy numbers conceal widely different outcomes by socioeconomic status. Faced with adversity, many Americans like to say that “we’re all in it together.” But when it comes to life expectancy, this isn’t true. Life expectancy is still rising for those Americans who are more affluent and better educated, while it is falling for those who are not. The United States is a nation already beset by deep divisions. Now we are adding one more to the mix.
The divergence in life expectancy is stunning. A 2015 study by the National Academy of Sciences found that life expectancy at age 50 for men born in 1960 was almost thirteen years higher for those in the highest quintile of the income distribution than for those in the lowest quintile, while for women born in 1960, it was almost fourteen years higher.
A 2021 study by Anne Case and Angus Deaton, the authors of “Deaths of Despair and the Future of Capitalism,” found that the life expectancy of college-educated Americans has continued to rise over the past two decades, while that of non-college-educated Americans has been falling since 2010. This was true for the population as a whole, for both men and women, and for both Blacks and Whites.
Not so long ago, the United States was among the rich world’s longevity leaders. Today, it is its longevity laggard, with a lower life expectancy at birth than any other high-income member of the Organization for Economic Cooperation and Development except Hungary, Poland, and the three Baltic States.
The most important reason for the slide in US life expectancy rankings has been the deteriorating health of the US population. The United States as of 2017 had the third-highest obesity rate in the OECD (only Mexico and Chile were higher) and the third-highest incidence of diabetes (only Mexico and Turkey were higher). As for substance abuse, the US opioid-related death rate was not only the highest in the OECD as of 2016, but was also at least double that of every other member country except Canada and Estonia.
America is usually quick to take action in response to immediate threats, as it did with Pearl Harbor, the 9/11 terrorist attacks and, however imperfectly, Covid-19. It finds it harder to act when faced with slow-motion crises whose costs only become apparent over the course of many years or decades. Yet such crises may be every bit as threatening to the nation’s future.
Confronting the gathering health crisis afflicting much of America will require far-reaching reforms. There will need to be a major educational campaign, involving all levels of government and civil society, that raises awareness of the risks of destructive lifestyle behaviors. It worked with smoking beginning in the 1960s, and it could work with obesity and substance abuse today. But education alone is unlikely to be enough.
Success will require reforms that improve today’s unequal access to the health care system, and especially primary care and preventive services. It may also require broader economic reforms that address the root causes of the ongoing divergence in US health expectancy and life expectancy, which are to be found, at least in part, in high poverty rates, rising income inequality, and the hollowing out of the middle class.
If we fail to meet the challenge, the costs to individuals and their families, to government budgets and to the overall economy will continue to mount. But the greatest cost of all may be the loss of social cohesion if Americans become two separate peoples, one long-lived and one short-lived.
Correction: An earlier version incorrectly omitted several words regarding the US opioid death rate, which as of 2016 was at least double that of every other country in the OECD except Canada and Estonia.