Opinion | Healthcare

One thing Americans can't deny: The nation's low life expectancy

The views expressed by contributors are their own and not the view of The Hill

Some Americans may deny climate change, a presidential election outcome, a vaccine's efficacy, war crimes, a domestic insurrection, a mass shooting of children, the nation's racial history, etc. However, one thing that Americans can't deny is the low U.S. life expectancy at birth compared to other advanced countries.  

Among Organization for Economic Cooperation and Development (OECD) countries, U.S. life expectancy does not even appear on the list of the top 20 countries. Countries such as Iceland, Israel, Japan, Norway, Sweden and Switzerland had life expectancies in 2020 that were no less than five years greater than America's figure - i.e., 83 to 85 years of age versus 77 years. Other countries with significantly higher life expectancies than America include Canada, France, Germany, Greece, Italy, Spain and the United Kingdom.

Making U.S. mortality worse, COVID-19 caused about 375,000 deaths during 2020, contributing to a 16 percent increase in the death rate. Of the roughly 3.4 million deaths in 2020, COVID-19 was the third leading cause of death at 11 percent. It was preceded by heart disease and cancer, 21 and 18 percent, respectively, and followed by unintentional injuries, 6 percent, which were the result of drug overdoses, car accidents and falls. 

COVID-19 decreased America's life expectancy at birth by a couple of years, resulting in the biggest drop in life expectancy since World War II. The reduction is expected to continue for at least a second successive year.

The fall in life expectancy due to COVID-19 varied significantly among America's major social groups. Between 2019 and 2020, the decreases in life expectancy at birth were about 3 years among Hispanics and Blacks and 1 year among non-Hispanic whites, with the declines generally greater for men than women. 

Since World War II, life expectancies in America and other developed countries have increased considerably largely due to new medicines, improved medical care, increased access to healthcare and improvements in public health and living conditions. 

During the recent past and prior to the pandemic, America's life expectancy diverged from the broad improving levels, increasing by about three fewer years than experienced by comparable advanced countries. After 2010 and before the COVID-19 pandemic, America was the only developed country whose average life expectancy stopped increasing

American males have lower life expectancies than females, with a difference in life expectancy of about five years at birth and two and a half years at age 65. During middle age, men are more likely to die from most causes, including heart disease, which they experience about seven to 10 years earlier than women.  

Considerable regional variation in life expectancy exists across the country. The Southern states, such as Mississippi, West Virginia, Alabama and Kentucky, have the lowest life expectancies at birth of about 75 years. The states with the highest life expectancies at birth of about 81 years are Hawaii, California, Minnesota and New York.   

Ahead of race and ethnicity, the level of education has been found to be the best predictor of who will live the longest in America. While progress in lowering mortality rates continued into the 21st century for more educated Americans, levels reversed themselves for about two-thirds of Americans lacking a college education. 

Prior to COVID-19, American adults with college degrees were found to be living approximately three years longer than those without one. Improving equity in access and quality of education can be an effective means to improving life expectancy among many middle-aged Americans.

Life expectancy also varies by income, with the poor having shorter lives than the wealthy. The differences in life expectancy at birth between the poorest and richest Americans are 15 and 10 years for men and women, respectively. 

A variety of interrelated social, economic and political factors are behind America's comparatively low life expectancy at birth. Among them are the lack of universal health care, a public health crisis, insufficient federal drug oversight and unhealthy lifestyles that contribute to chronic illnesses. 

In contrast to other advanced developed countries, the United States remains an outlier in its lack of universal healthcare coverage. The high and rising costs of medical care and health insurance with the absence of insurance coverage for about 50 million Americans have resulted in many not receiving needed medical care.

One challenging unhealthy lifestyle in America is cigarette smoking. With about one in seven American adults being a smoker, smoking is the leading cause of preventable deaths. It is responsible for nearly 500,000 deaths per year and smokers dying 10 years earlier than nonsmokers.  

In addition to smoking, other notable unhealthy lifestyles contributing to chronic illnesses and premature deaths are obesity, alcohol misuse and drug overdoses. Among OECD countries, America has the highest percentage of obesity among adults, approximately 42 percent in 2018.   

Over the past several decades, drug overdose mortality has more than tripled in America with approximately 100,000 overdose deaths in the 12 month period ending in April 2021. Drug overdose has become the leading cause of U.S. injury death, more numerous than motor vehicle deaths and homicides. 

America has a higher rate of chronic illnesses than other advanced developed countries. A greater focus on preventative care would contribute to improved health among Americans and increased life expectancies. 

Raising America's comparatively low life expectancy seems unlikely any time soon. Given the current political climate in Congress, America does not appear ready to join other developed countries in providing universal health care to its citizens.  

When America decides to provide universal healthcare, it will contribute considerably to improving the nation's death rates. In particular, it would address troubling chronic health conditions, such as high blood pressure, cancer, diabetes, mental illness, drug addiction and unhealthy lifestyles.  

Joseph Chamie is a consulting demographer, a former director of the United Nations Population Division and author of numerous publications on population issues, including his recent book, "Births, Deaths, Migrations and Other Important Population Matters."

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