In 2013, we conducted a cross-country study for the National Research Council and the Institute of Medicine. Our report, “US Health in International Perspective: Shorter Lives, Poorer Health,” documented how Americans, even the most fortunate, are poorer and die sooner than people in other wealthy countries.
Evidence of a significant and growing health disadvantage in the United States dates back to the 1980s and persists to this day. In the United States, life expectancy fell below the OECD average in 1998 and has since fallen even further behind. In 2010, the life expectancy of Americans stopped improving altogether, peaking until 2014, then declining for three consecutive years, as it continued to climb in peer countries. In 2018, the United States ranked 46th in the world for life expectancy, according to the World Bank.
With the arrival of COVID-19 at the end of 2019, its global spread in 2020 and its devastating effects on human mortality, life expectancy was expected to drop in many countries. But the magnitude of the decline in the United States has been shocking. Our recently published study (co-authored with Ryan Masters) shows that in 2020, life expectancy in the United States has plunged by 1.9 years, a drop not seen since WWII. This drop was 8.5 times the average recorded by 16 other high-income countries, further widening our cross-border life expectancy gap.
In American communities of color, the decline was even more alarming. Compared to a decrease of 1.4 years among white Americans, life expectancy among black and Hispanic Americans fell by 3.3 years and 3.9 years, respectively. Years of progress in narrowing the death gap between blacks and whites has been erased, and the Hispanic population – who historically enjoyed a longer life expectancy than whites – have seen this benefit almost entirely. erased. Unfortunately, data limitations have prevented us from estimating changes for other important groups, including Native Americans, whose health and survival rates are among the worst in the country.
So how can our country prevent these excessive deaths? Certainly not by spending more on health care, given that we are already spending more than all other countries (by far) and will always die prematurely. Health care, while essential, accounts for no more than 20 percent of health outcomes. The solutions go beyond medicine. Epidemiologists, public health experts and social scientists have long understood that our living conditions – the so-called social determinants of health – determine whether we live long, healthy and productive lives. Our risk of illness and injury is strongly influenced by our education, income, housing, neighborhoods and workplaces.
Living conditions that maintain health and promote well-being are simply lacking for too many Americans. In a context of growing income and wealth inequality, many families are deprived of essential resources and basic protections, including education and training, good jobs, a stable income, safe and affordable housing and community services to help families raise children and support young people, the elderly, and people with disabilities.
A new report from the National Academies has found that death rates are rising among Americans in their prime – between the ages of 25 and 64, when many are working, raising children and caring for dependents. This means that in addition to the many other challenges they face, American children and youth are now more likely to lose a parent and need bereavement care.
The implications of these trends for the country’s families, communities, employers, economy and national security are enormous, but the solutions are not a mystery. Halting the decline in the health of Americans requires adequate and equitable investments in child care, education, jobs that pay a living wage, and affordable housing. We need to invest not only in people, but also in communities. Health depends on the conditions outside our door, such as clean air, green spaces, strong social networks, and services for individuals and families with social, economic and health needs. What sets other countries with better health outcomes apart are reasonable and equitable investments in people and places.
Historically, such investments have met resistance from powerful interest groups and privileged classes seeking to protect private capital, profits and power. Our nation lives with results. We spend more on mass incarceration than on child care. Unlike other countries, we allow the marketing of unhealthy foods, cigarettes, guns and opioids with limited regulatory constraints. Americans made a deadly deal to accept shorter lives, for themselves and their children, to protect these arrangements.
And racial inequalities have haunted this nation for generations. Let’s be clear: it’s racism – not race – that is behind racial disparities in health, such as higher death rates from COVID-19 and dozens of other diseases. The sharp declines in survival for black and brown Americans that our study reports are not explained by skin color, but rather reflect the systemic racism that permeates nearly every aspect of life in this country, including health. . Those baffled by the notion of systemic racism often blame its victims for lacking “personal responsibility,” but racial disparities are less about the choices people make than the choices society gives them.
The end of the pandemic will bring relief to many Americans, but it will not end America’s health and survival crisis. The good news is that addressing the US health disadvantage does not require a new list of policy proposals, but a greater focus on those currently being debated. Policies to create jobs, expand infrastructure, invest in human capital, and tackle systemic racism will do more to address America’s health disadvantage than anything doctors or hospitals could. make. The reverse is also true: failing to act – failing to build an economy for the 21st century centered on people and justice – will condemn our children to shorter lives and poorer health and diminish the future of all of us. country.
Steven H. Woolf, author of over 200 publications, is Professor at the Virginia Commonwealth University School of Medicine, Director Emeritus of its Center on Society and Health, and Fellow of the National Academy of Medicine. Follow Woolf on Twitter: @shwool.
Laudan Y. Aron is a senior researcher at the Urban Institute’s Center for Health Policy where she co-leads the Urban Intercentric Initiative on Social Determinants of Health and the National Coordinating Center for the Policy Research Program. action (P4A) of the Robert Wood Johnson Foundation. . Follow Aron on Twitter: @laudyaron.
Woolf and Aron are the editors of “US Health in International Perspective: Shorter Lives, Poorer Health”.