Life Expectancy in America (Times op-ed)

There was a time when Americans could reasonably expect to live a long life. An American girl born in 1990 could expect to live until age 79. That was one year more than her counterparts in England, Germany, and Denmark. Her brother could expect 72 years, roughly equal to those same European countries. Fast forward to today when U.S. life expectancy has fallen off a cliff compared to other rich nations. The question is: What happened, and why is the richest country in the world doing so poorly? Three reasons are discussed here, Covid 19, opioid addiction/suicides, and access to health care.

Average life expectancy in America declined to 76 years in 2022 according to the CDC’s National Center for Health Statistics. It is 70 years for blacks and 77 for Hispanics. This is the lowest level of all large, developed nations according to a Kaiser Family Foundation (KFF) study dated Dec. 6, 2022. The U.S. now ranks 46th worldwide in life expectancy. Albanians, Cubans, and Lebanese can expect to live longer than Americans, as reported in the Journal of Public Health dated June 2, 2023.

The reason for our poor performance is not the lack of health care spending. On average, the U.S. spends double what other wealthy nations spend. According to a KFF Dec. 6, 2020 study, the U.S. spends approximately $12,300 per capita compared to an average of $6,000 spent by other rich nations. Instead, much of the reason for our dismal performance has to do with the policies we have enacted. The good news is policy solutions are available to help Americans live longer. The bad news is we presently lack the political will to enact them.

One obvious reason for our life expectancy decline is the Covid-19 pandemic. Covid-19 has killed over 1.1 million Americans (World Health Organization, June 2, 2023). This is by far the highest death toll of any country. It accounts for one half of our life expectancy decline according to a Sept. 8, 2022 study by the Council on Foreign Relations. However, this is not the whole story. Our life expectancy had been decreasing prior to the Covid epidemic. Also, other wealthy countries’ life expectancies have bounced back while here in the U.S. they have not. This is because other countries were more willing to adopt preventive measures such as vaccines, while political polarization and misinformation have hampered U.S. efforts. As a result, the U.S. ranks near the bottom in terms of vaccine rates (Oxford Martin School 2022).

A second reason is that the U.S. is experiencing a mental health crisis. In 2015, two Princeton University researchers, Drs. Anne Case and Angus Denton, were examining census data when they made a startling discovery. Life spans were decreasing because middle-aged, white Americans ages 45 to 54 were dying at an abnormally high rate (Proceedings of the National Academy of Sciences 2015). Why would these individuals be dying in the prime of their lives? Case and Denton found that they were dying as a result of mental health disorders and drug and/or alcohol addiction. These problems manifested themselves in chronic liver disease, cirrhosis, and hepatitis. Case and Denton labeled this phenomenon “deaths of despair.”

Suicides and drug overdoses further contributed to these high death rates. According to the CDC’s National Center for Health Statistics, opioid overdose deaths since 1999 total over 932,000. CDC’s preliminary numbers for 2022 show over 105,000 deaths. Suicides from 2000 to 2020 totaled over 800,000, one of the highest rates among wealthy countries (CDC, National Center for Health Statistics 2021).

Neither our government nor our health care system seems capable or willing to respond to this crisis. Too many people with these behavioral health issues do not receive treatment. A 2012 study in the Journal of Drug and Alcohol Abuse found that only 11% of addicted individuals receive treatment. Another 2022 survey of mental health practitioners found that 60% were not taking new patients, and 40% had more than 10 people on waiting lists. The reasons for this treatment gap are lack of bed availability, other resource and staff shortages, and insurance issues. This lack of prevention and treatment leads to unnecessary deaths.

A final issue is access to health care. Wealthy countries that offer universal health care coverage rank well above the U.S. in healthcare access and outcomes. According to a 2021 CDC National Health Statistics article, 8.6% of U.S. citizens are uninsured. Affordability remains the main reason why Americans do not sign up for health coverage. Even when individuals have coverage, high out-of-pocket costs can discourage them from seeking care. A 2023 Commonwealth Fund study demonstrated that nearly half of working-age adults skipped or delayed care due to costs. This same study showed the U.S. lagging behind other high-income countries in health outcome indicators such as obesity, infant/maternal mortality, and suicide rates.

The U.S. can improve its life expectancy, but policy changes are needed. Right now the health care system is based on whether you have health insurance, where you live, and your race/ethnicity. Enacting universal health care coverage would be a good start and would significantly improve health and well-being. Also, the U.S. should develop evidence-based programs to address the opioid crisis and increase access to mental health services. Those initiatives would help, but, most importantly, we need the political will to make these changes. Right now that political will seems in short supply.

Tom Deloe is a member of Gettysburg Democracy for America’s Healthcare and Government Accountability task forces. He lives in Cumberland Township, Adams County.