What's behind the fall in life expectancy in the U.S.?
Updated 21:43, 29-Nov-2019
Chris Hawke
A senior citizen sits with a physician. /VCG Photo

A senior citizen sits with a physician. /VCG Photo

Editor's note: Chris Hawke is a graduate of the Columbia Graduate School of Journalism and a journalist who has reported for over two decades from Beijing, New York, the United Nations, Tokyo, Bangkok, Islamabad, and Kabul for AP, UPI, and CBS. The article reflects the author's views and not necessarily those of CGTN.

Life expectancy in the United States is falling, even as it rises in Europe and around the world. A new study finds the drop is most pronounced in the industrial Midwest and Appalachia, mostly Republican states that have been going through economically challenging times.

In contrast, residents of New York, California and Texas, the country's most populous states, as well as Oregon, are living longer, according to the study, published this week in the prestigious Journal of the American Medical Association.

This study in many ways echoes other research focusing on so-called "deaths of despair" plaguing middle-aged white people. However, this finds the early deaths are happening to people of all races, and all ages, to differing degrees.

A major cause of increasing midlife mortality is a large increase in fatal drug overdoses, beginning in the 1990s. Suicides and organ system diseases including hypertensive diseases, alcoholic liver disease, infectious diseases and liver cancer were also significant factors.

The study cited three lines of evidence that may explain the declines.

First, it noted the U.S. health disadvantage compared to other nations and increase in midlife deaths started in the 1980s and 90s, "a period marked by a major transformation in the nation's economy, substantial job losses in manufacturing and other sectors, contraction of the middle class, wage stagnation, and reduced intergenerational mobility. Income inequality widened, surpassing levels in other countries, concurrent with the deepening U.S. health disadvantage.”

Second, adults with little education and women, those most vulnerable to the changing economy, experienced the largest increase in death rates.

Third, the increase in death rates was "concentrated in areas with a history of economic challenges, such as rural U.S. areas and the industrial Midwest," and was lowest on the west coast and  in populous states with more robust economies.

The study notes that a possible reason for larger life expectancy gains in metropolitan areas is an increase in the population with college degrees. It added that any theory explaining the decreasing US life expectancy must explain why this trend is less pronounced in other industrialized countries.

Average life expectancy in the United States fell behind other wealthy countries in 1998, and the gap has grown steadily since. According to the World Health Organization, global life expectancy grew by 5.5 years between 2000 and 2016.

Life expectancy in China, for example, has jumped from 44 in 1960 to 71.4 in 2000 to 76.34 in 2015, according to the National Bureau of Statistics of China. Every wealthy country except the United States has universal health coverage.

U.S. Veterans Affairs Secretary Dr. David Shulkin (R) explains equipment to White House Physician Dr. Ronny L. Jackson (L) and U.S. President Donald Trump, August 3, 2017. /VCG Photo

U.S. Veterans Affairs Secretary Dr. David Shulkin (R) explains equipment to White House Physician Dr. Ronny L. Jackson (L) and U.S. President Donald Trump, August 3, 2017. /VCG Photo

Right now in the United States, healthcare is a major and divisive political issue. Americans are paying by far more for their medical care than anyone, and dying earlier than everyone else. However, wealthy Americans have access to the best medical care in the world.

A quick look at a map of the increase in mortality rates confirms that it largely matches the parts of the country where President Donald Trump is popular or competitive.

Maps of the United States showing racial diversity, passport ownership, marriage rates, religiosity, education levels, wealth, and employment in "old economy" sectors like agriculture, trade and manufacturing versus "new economy" sectors like health care services and technology would look quite similar to the mortality map.

It is a much-discussed irony of U.S. politics that Republican policies, such as repealing Obamacare, hit these regions the hardest. Liberal states like New York, for instance, have their own health care systems offering a safety net for the poor.

Elizabeth Warren, who is a front runner in some polls to be the Democratic candidate for president in 2020, is advocating a Canadian-style medical care system. However, pundits and many of her Democratic opponents are calling her proposals to do what all other wealthy nations do "unworkable" and "unrealistic," and say a pledge to give medical care to all citizens will prevent her from ever being elected.

The sad fact is, large portions of the U.S. public are being left behind by the information revolution. The world is changing, and the days when a high school diploma was a ticket to a steady job and middle class life are long gone. This is not only breaking the spirit of many people, but as this study shows, actually killing them.

The mortality study notes the problem goes beyond drug and alcohol addiction and stress, saying, "The causes of economic despair may be more nuanced; perceptions and frustrated expectations may matter as much as absolute income or net worth."

It offers a hint about a possible solution, noting, "Social protection policies deserve special attention: countries with higher life expectancy spend more of their budgets on social services and outperform the United States in terms of education, child poverty, and other measures of well-being."

For the moment, the areas of the U.S. that are dying for these kinds of services are the areas that want them the least.

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