LLife expectancy in America dropped sharply in 2020. It dropped again in 2021. The COVID-19 pandemic certainly played a part, but that’s not all. Eight of the top ten leading causes of death also increased during the same period. Maternal, infant and adolescent mortality has also increased. In August 2022, federal health officials released new data showing that across all demographic groups, Americans are dying younger.
Ten years ago, a landmark report titled “Shorter Lives, Poorer Health” documented for the first time a widespread “US health deficit,” a shortfall in the health and survival of Americans relative to other high-income countries. [Aron was the report’s study director]. On some measures, such as violent deaths among 15- to 24-year-old males, the divergence with other rich countries began to widen as early as the 1950s. The report showed that the United States had the lowest life expectancy among similar countries and the highest rates of injuries, illnesses and deaths from dozens of causes. Evidence of this disadvantage has been found for young and old, rich and poor, men and women, and Americans of all races and ethnicities.
Another landmark report released in 2021, titled “High and Rising Death Rates Among Working-Age Adults,” showed that US death rates increased in middle age (ages 25-64), the best years for family formation, children’s education, assistance, and employment. More surprisingly, the increase in mortality among US children and youth between 2019 and 2021 represents a profound crisis. While they are not predictive of future mortality conditions, which are likely to change, current survival rates indicate that one in 25 five-year-old American children will not reach their 40th birthday.
The reasons behind these disturbing trends are many and, one could argue, uniquely American. Here are five:
A bad start in life for many young Americans
Beyond the latest data on rising pediatric mortality rates, it’s clear that the United States is failing its younger citizens on multiple fronts. For at least a decade, cross-national comparisons of child and adolescent well-being in rich countries have shown that the United States is at or near the bottom on most measures. These measures include material well-being, health and safety, behaviors and risks, education, housing, family-friendly policies and social protection. Furthermore, careful analyzes of overall levels of social spending by country show that, compared to other high-income nations, the United States stands out for As spend, don’t How much spend. US spending is much less redistributive, with fewer benefits for children, families and the underprivileged. In addition to high infant and maternal mortality rates, the latest data show that US children are in the midst of a deepening mental health crisis, with increased access to firearms and opioids driving up suicide rates, homicide and overdose. In 2020, gun-related injuries surpassed automobile accidents to become the leading cause of death among American youth ages 1-19.
Read More: Americans are dying younger, but where you live matters
A dysfunctional and expensive healthcare system
Among the many factors that drive health and survival is health care. The United States has long been known to have one of the most complex, fragmented and expensive healthcare systems in the world. For millions of Americans, affordable, affordable, quality health care is simply out of reach (and the uninsured are more likely to die young than the insured), or it is effectively unavailable, or disappearing under pressure. policies, as in the case of sexual and reproductive health issues. The US healthcare system, its high costs and poor health outcomes, is starting to “make sense” when viewed through the lens of a business case and its optimization of revenue and profits, rather than health and well being. As Dr. Elisabeth Rosenthal, editor-in-chief of KFF Health News, puts it about the US medical market, “a lifetime of treatment is preferable to a cure” and “prices will rise as far as the market will support it.” It should come as no surprise, then, that the US healthcare system is one of the engines of ill health and survival for Americans, many of whom are medically uninsured, underinsured, undertreated or overtreated, distrusted of the system, and drowned in medical debt. Finally, the staggering $4.3 trillion (or $12,914 per person) spent annually on health care in the United States far outpaces spending elsewhere in the world and crowds out other social investments that matter for development, human protection and prosperity.
Social systems that undermine well-being and accelerate inequality
In addition to health care, many other aspects of life and the policy-driven systems that underpin them are compromising the health and well-being of Americans. Lives have been diminished and lost due to the US approach to food and nutrition, housing and civic infrastructure, education and training, employment and entrepreneurship, crime and security, economic development and community, credit and financial services, social protection and safety nets and environmental conditions. Deep dives into most of these systems often reach two surprisingly consistent conclusions: (1) they’re perpetuating or accelerating inequality, and (2) they’re working as intended, meaning their seemingly perverse effects are a feature, not a bug. These systems reflect both historical factors and ongoing choices by policy makers and private sector interests. The good news here is that other countries are making different choices, which (in theory) means the US can do it too. We can rein in the negative commercial determinants of health (private sector activities that affect health) and instead build genuine systems of care and adopt a health-in-all-policy agenda, defined by the CDC as “a collaborative approach that integrates and articulates health considerations into policymaking across all sectors to improve the health of all communities and people.
An inadequate political response to growing inequality and precariousness
The large and growing US health and survival disadvantage is, in part, a reflection and accelerator of economic inequality and insecurity. Income and wealth inequality in the United States is high, has increased substantially in recent decades, and exceeds levels in other advanced democracies. Some might argue that high levels of inequality are acceptable as long as long-term opportunities and socio-economic mobility remain high. But those opportunities and mobility have seen a dramatic reduction over the past half century, with only half of children earning more than their parents today, compared with 90 percent of children born in 1940. Equally important, Americans vastly underestimate actual levels. of wealth inequality and still prefer wealth to be distributed more fairly. The conditions that produce such high levels of inequality – and the ways to mitigate or reverse them – are obviously matters of public policy. In addition to more progressive tax and transfer policies, which also impact many middle-class rights, any policy that expands access to the social determinants of health – nutrition, education, employment, housing, transport, security, justice, care – will be in turn improving the health and well-being of the population. Policy makers influence their availability, accessibility and affordability. One of the reasons other high-income nations outperform the United States in terms of health and survival is because the many resources that matter to health and well-being are distributed (or redistributed) more equally and have better care systems and stronger social protection.
Structural racism, racial capitalism and related injustices
While US healthcare disadvantage affects all Americans, even the privileged ones, the most marginalized communities have always paid a much higher cost. The latest data on US life expectancy by race/ethnicity confirms this and is a powerful reminder of the continuing influence of systemic racism on the American landscape. As Dr. Camara Jones, former president of the American Public Health Association explains, racism is “a system of structuring opportunities and assigning value based on the social interpretation of one’s appearance (what we call ‘race’), which disadvantages unfairly benefits some individuals and communities, unfairly benefits other individuals and communities, and undermines the strength of the whole society through the wastage of human resources.”By unfairly structuring opportunities and allocating access to resources that matter for health and survival, racism structural, racial capitalism (the interconnections between capital accumulation and racial exploitation) and other forms of injustice directly affect the health of the population.It is critical to recognize these root causes of US disadvantage in terms of health and survival, rather than fall prey to overly simplistic narratives that blame individual people and places for their ill health. Seemingly race-neutral policies and practices often perpetuate a lasting legacy of racism, protecting the health of some communities at the expense of others. A fascinating example is when the Florida Department of Agriculture banned sugar farmers from burning sugarcane “when the wind blows from the east” in an effort to protect wealthier, whiter communities from their toxic fumes.
Declining life expectancy in the United States, and particularly rising child and adolescent mortality rates, should be a loud wake-up call to the nation. The most promising but still urgent news is that we can change this reality: the conditions of life and death are the direct reflection of our values and priorities and the policies that choose to govern our communities and the nation as a whole. If we are to enjoy a similar level of health, well-being, and survival as other advanced democratic nations, Americans will have to make a fundamentally different set of policy choices.
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