The Fall in Life Expectancy is a Fall in Expectations

American life expectancy has fallen for the third year in a row.  The Centers for Disease Control and Prevention has reported that life expectancy fell in 2015, 2016, and 2017.  That is two years of President Obama’s time in office and one year of President Trump’s time in office.  This is a bipartisan crisis.       

This is an indictment of our political, media, and health care systems.  People are dying who shouldn’t be dying.   

This simple fact should be repeated, in the news day in and day out.  Local reporting and national media outletsshould be targeting and following up on the hot spots of this crisis.      

Absent a civil war or the AIDS pandemic in Africa, this has not been seen in international health.  The last time life expectancy fell in theUnited States it was 1993 during the height of the HIV epidemic.  That decline lasted a single year.  Three years in a row of declining Americanlife expectancy has not occurred since World War I.

Only honest, independent criticism will fix this problem after a cold hard look at the facts.  We cannot treat unless we diagnose.   

  Since 2000, suicide has risen 18%in the United States while it has fallen 29% across the rest of the worldaccording to The Economist.  The suicide rate (13.4 per 100,000 people)was below the world average and nowit is above the world average.  It is now inching towards the high butdeclining rate of Japan, a nation once famous for seppuku suicide rituals among samurai. 

Much of this is due to much laxer gun laws in the United States than other nations since firearms are a common method of reducing suicide.  Australia famously saw a large drop in murders when it passed gun control laws in the1990s, but the effect on suicides was even larger.  Suicide rates vary between states but are high in states with high gun ownership rates (Alaska)and lower in states with fewer guns (New Jersey).   

But the gun issue would be misleading in the American context as the percentage of households owning guns has been declining or at least stagnant since the 1990s.  The rise in gun sales is going to existing gun owners (more guns in fewer households) not to families who never owned guns in general.     

  What instead is occurring are “deaths of despair” as Nobel Prizing-winning Princeton economist Angus Deaton put it.  The rising gap between rich, poor, and middle class is also killing people on a grand scale according to the Dr. Michael Marmot at University College London.  Inequality is bad for your health.    

 The striking increase in death rates in the United States is driven by whites without college degrees.  One would first think that this is related to the opiate crisis of the last few years, and one would be partially right.  However, drug, alcohol, and suicide deaths have been rising since approximately 1990.  It is thought to be linked to the lack of steady, well-paying jobs which began to disappear for the high school-educated in the 1990s.  The increase in the Hispanic population (which paradoxically has lower mortality rates than whites) may have masked these life expectancy declines because they live three years longerthan non-Hispanic whites.  

The closest international analogy to the United States is the former Communist bloc nations of Eastern Europe and Russia in the 1990s.  The economic collapse of Russia after the fall of the Soviet Union led to millions losing their guaranteed jobs for life.  The government privatized state-owned companies and cut back massively on the public health system.  Joblessnessskyrocketed and suicides and alcohol abuse did too.  Male life expectancy fell almost a decade to57 years.  People stopped having children too.

Obviously, the health and economic situation are not nearly as dire in the United States today but there are parallels such as the dramatic drop in young people having children since the recession.  Companies who provided jobs for life such as General Motors and IBM with generous pensions benefits did not go out of business like in Russia but began to end those guarantees for new employees while downsizing the overall headcount. Public spending cuts supervised by the International Monetary Fund increased tuberculosis deaths in Eastern Europe.  American budget austerity has likewise contributed to the dramatic increase in STDs including gonorrhea and syphilis after reaching record lows.

At the end of the day, the blame for the three-year fall in American life expectancy despite the increase in the percentage of people with health insurance points to the importance of the social determinants of health.  A healthcare system focused completely on health insurance payment models than actual people’s health is a product of a political system focused completely on campaign profits than actual voter’s social, job, and health needs.  America’s politics is actually making us sick.