Years of widening economic inequality, compounded by the pandemic and political storm and stress, have given Americans the impression that the country is on the wrong track. Now there’s empirical data to show just how far the country has run off the rails: Life expectancies have been falling.
The Centers for Disease Control and Prevention reported last year that life expectancy at birth fell in 2021 to its lowest level since 1996, a decline of nearly a year from 2020. That was after a decline by 1.8 years from 2019 to 2020, producing the worst two-year decline since 1921-23.
These figures open a window on a set of pathologies unique to America. Most developed countries have begun to recover the longevity losses they experienced during the pandemic; thus far, there’s scant evidence that the U.S. is following the trend.
“COVID-19 has erased two decades of life expectancy growth in the U.S., whereas the average life expectancy for comparable countries has decreased only marginally, to 2018 levels,” the Kaiser Family Foundation Health System Tracker found.
That may not be surprising. Few countries other than the U.S. turned COVID and anti-pandemic options into political issues, converting such proven treatments as vaccines into partisan litmus tests.
But COVID is far from the only explanation for America’s dismal trend line. The pandemic accounted for about half the decline in life expectancy, according to the CDC. “Unintentional injuries,” a category that includes drug overdoses, contributed an additional 16 percent, followed by heart disease (4.1 percent), chronic liver disease (3 percent) and suicide (2.1 percent).
Those factors haven’t occurred in a vacuum. They’re connected to what the CDC called “the social determinants of health” — “economic policies and systems, development agendas, social norms, social policies, racism, climate change and political systems.” Americans with the shortest life expectancies “tend to have the most poverty, face the most food insecurity, and have less or no access to health care,” Robert H. Shmerling of Harvard Medical School wrote in October.
The magnitude and diversity of the problem should prompt Americans to engage in serious soul-searching. There’s little evidence of that happening.
The lowest average life expectancies are seen in the states of the Southeast, according to 2020 figures from the CDC. South Carolina, Oklahoma, Arkansas, Tennessee, Kentucky, Alabama, Louisiana, West Virginia and Mississippi all had life expectancies of less than 75 years.
Washington ranks high
The highest life expectancies were generally in the West and Northeast. Hawaii ranks first at 80.7, followed by Washington. These geographical disparities aren’t artifacts of pure geography or demographics; they’re the consequences of policy decisions at the state level.
Of the 20 states with the worst life expectancies, eight are among the 12 that have not implemented Medicaid expansion under the Affordable Care Act. The consequences of this obstinate Republican-driven resistance to a program whose expense is more than 90 percent covered by the federal government include closures of rural hospitals and high rates of uninsured residents.
The factors contributing to America’s decline in life expectancies could point to a decline in its international stature. In 1995, U.S. life expectancy was about six months less than those of high-income countries; by 2020 it was about three years, according to the World Bank.
When one examines the factors exerting the greatest influence on longevity, the issue comes sharply into focus.
“Inequality in America is about so much more than income,” says Jeremy Ney, an expert in social and economic disparities. “It’s health care and housing and education and taxes and race and gender and location. Life-expectancy inequality in America is tied up in all these very different factors.”
Life expectancy is one of the least understood socioeconomic factors in American demography. We’ve written often about the folly of trying to address Social Security’s fiscal imbalance by raising the retirement age, a “reform” based on the assumption that average life expectancy is a universal constant.
This idea, however, entirely overlooks the diversity of factors in longevity rates, and how closely they’re tied to all other social and economic conditions. Until we come to grips with that basic truth, there will be no hope of reversing the trend line.
Michael Hiltzik is a columnist for the Los Angeles Times.
