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By Matthew Rees

Food and Health Fact #170:

A national calamity: America's lagging life expectancy

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Fluctuations in a nation’s average life expectancy are a crude but useful way of measuring whether health is improving or deteriorating. In the United States (and most developed nations), those fluctuations have been almost entirely upward for the past 150 years.

Not anymore. The Centers for Disease Control and Prevention published shocking data last week: U.S. life expectancy has declined three years since 2019. This followed modest declines in 2015, 2016, and 2017. The projected lifespan of an American – 76.1 years (and just 73.2 years for males) – is now at its lowest point since 1996.

Why the decline? The CDC attributes half of it to Covid-19, while the other leading factors were unintentional injuries (16 percent), heart disease (4 percent), liver disease (3 percent), and suicide (2 percent). The remaining 25 percent of the decline was chalked up to “residual” factors.

Covid was a global phenomenon, of course, so it’s instructive to look at how other countries have fared over the past two years. The answer? The United States has done worse – much worse.

Let’s start with other developed countries. Their life expectancy only declined modestly from 2019 to 2020 (0.55 years). It then increased modestly from 2020 to 2021 (0.26 years), according to research published in June. (Even pre-Covid, U.S. life expectancy was nearly four years lower than other peer countries, and it’s also below several developing countries.)

Now let’s look at the Covid mortality rate, among countries of all income groups. Here, the United States has the world’s sixteenth-highest Covid mortality rate (per 100,000 people). The list of countries with much lower mortality rates is long, spans the globe, and includes places with much less developed health-care systems, including Bolivia, India, Iraq, Libya, Russia, and Zambia.

Why is the United States an outlier?

The answer is not, as some have asserted, simply the low vaccination rates in the United States. While just 79 percent of Americans are fully or partially vaccinated against Covid, this is on par with other high-income countries. (See the world’s vaccination rates in this nifty chart.)

It seems that something more fundamental must be handicapping Americans, and – curiously – it’s something most media coverage has glossed over: the poor health of the U.S. population.

When a country is saddled with extremely high rates of chronic disease -- more than half of all American adults have such a disease -- it shouldn’t be a surprise that an agent like Covid would ravage the population (particularly when we know that the most vulnerable populations fit into one or more categories: old, poor, and rural). Among Americans, obesity – the underlying cause for so many chronic conditions – is 40 percent or higher in all three of those categories.

The magnitude of chronic disease risk was highlighted in research published last year by the Friedman School of Nutrition Science at Tufts. Their study showed that 64 percent of Covid-related hospitalizations were a product of obesity, diabetes, hypertension, and heart failure.

Amid that gloomy outlook, a key question facing policymakers and the public health community in the United States is what to do about the ongoing deterioration in Americans’ health.

David Choksi, a former health commissioner of New York City, looks to history to identify two different responses to health crises. Writing recently in the New York Times, he suggested that following the Spanish flu outbreak in 1918, there was no wholesale response to ensure it wouldn’t happen again.

He contrasted this with “a great sanitary awakening” that followed the 19th century outbreaks of typhus, smallpox, dysentery, and cholera, which he described as having “changed the way society thought about protecting health as a public responsibility.”

He has a sobering assessment of the U.S. response so far, saying it is akin to the Spanish flu experience. “We are at risk of a similar collective amnesia after Covid-19.”

That doesn’t bode well for reversing the life expectancy decline of the past two years. But even when life expectancy begins to rise again, the U.S. population will remain dramatically unhealthier than people in other peer countries (and many developing countries).

The best way – and perhaps only way – to reverse that trend, and prevent most of America’s leading causes of death, will be through an improvement in the American diet. And that pressing need is, for the time being, all but absent from the national agenda.