The Quiet Crisis: America’s Life Expectancy Decline

American life expectancy during COVID fell quickly, as would be expected. The average lifespan for an American was 78.8 in 2019, dropping significantly to 76.1 in 2021.

This was a minor blip in the news and was generally reported as a COVID-caused setback. However, this was hiding an alarming trend – life expectancy, pardon the pun, had flat-lined starting early in the last decade. If you look at a graph, it is kind of difficult to ignore:

This graph points to a sort of tug-of-war that was going on starting in the 1990s between advances in medical science and an increase in interest in living a healthy lifestyle and a disturbing trend that was hidden in the data by the science advances: deaths of despair, referring to the loss of life due to suicide and addiction to drugs and alcohol. At some point around 2010, for reasons that are not clear, advancements against cardiovascular disease froze, and deaths of despair began to overwhelm the progress.

There are a few books that called this trend to my attention. One is Dreamland: The True Tale of America’s Opiate Epidemic, by Sam Quinones. If you want a good understanding of what exactly went on with the opiate epidemic, ignore JD Vance’s “blame the poors for their laziness” tome Hillbilly Elegy and read Dreamland. While it covered all angles of the opiate story, from the callous corporate leaders to the corrupt doctors who created pill mills of OxyContin in America’s Rust Belt and Appalachia to the rise of black tar heroin from Mexico replacing the opiates, it also tells a story loss of community and refusal of self-examination. The title itself is about a place in Portsmouth, Ohio, known as Dreamland. This place was a giant swimming pool built by a primary employer that was more than just a pool, but the heart of the community. It disappeared, small businesses disappeared, and jobs disappeared, so despair grew and grew. Addiction took hold.

What about the refusal of self-examination? Well, given this is a small town, deaths from addiction were hidden, and stories were made up such as “they got sick.” The reason for this was it just couldn’t happen in our town, that stuff only happens in cities. This was repeated over and over again, until the problem was too deep to ignore, and had dug into the very soul of these communities.

The other book that paid attention to the rise in premature deaths was Jonathan Metzl’s Dying of Whiteness. Metzl’s book really delved into things like the racism that is so deeply ingrained in many low-income rural areas, where he talked to people who were on death’s door with chronic illness and still proud that their governor refused Medicare expansion that would improve their care. For the simple reason that they do not want “welfare queens” and “Mexicans” getting handouts, ignoring the fact that they themselves are low-income. He also delved into the gun culture, and how viewing guns as a solution for a variety of problems also means an increase in gun-related suicide, a method of killing yourself that is horrifyingly effective.

All of this has contributed to this decline in life expectancy, but it is also a much more complicated issue than just guns, racism, and addiction. Last week, Chris Hayes interviewed economists Anne Case and Angus Deaton on his podcast Why Is This Happening? Case and Deaton have put out a study that digs deep into this American tragedy and finds a plethora of reasons.

For starters, life expectancy continues to have winners and losers in America. There are the usual racial and income disparities that fall exactly where anyone with an honest view of American society would expect: minorities and low-income people have lower life expectancies. They also found that people without a bachelor’s degree, which makes up the majority of Americans, have a lower life expectancy.

But they also found other possible reasons. One is the decline of social institutions such as churches and other community groups which has led to an epidemic of loneliness in America. Increasing economic inequality means that access to quality healthcare is also down, given how tied health insurance is to our work.

Related to this, Case and Deaton point to the decline of unions, which not only guaranteed a good wage and health benefits, but also a societal connection and a focus on workplace safety. Hayes, Case, and Deaton also point to the rise of neoliberalism, which ravaged unions, good paying jobs, social safety nets, and a sense of societal purpose, as a likely contributing factor.

It is hard not to see that. It is also hard not to see how such a loss of income, quality healthcare community, and hope combined with easy access to drugs and guns would lead to such an outcome. Add to this the effects of climate change, with its increase in extreme weather events (and lately, unhealthy air) and a sudden and disturbing increase in anti-science sentiment (see my piece on that this Friday), and it is obvious the level of challenge America is facing.

All is not doom and gloom. Case and Deaton see good things happening with the Biden Administration, including moving away from the type of neoliberalism worldview that led in part to this crisis. By implementing comprehensive solutions that prioritize mental health, invest in education, and promote economic justice, society can begin to reverse this deeply troubling trend and create a healthier, more equitable future for all Americans.

Because despite all our wealth, we are rapidly falling behind our peer nations in this most important of all statistics – life, and death. Perhaps we need to even take the step of Biden issuing a moonshot-style challenge, similar to when John F. Kennedy challenged our nation to land on the moon by the end of the 1960s. It seems that life and death would be that important.

The last word goes to Vampire Weekend.