Food and Health Fact #203

“We are experiencing the greatest decline in life expectancy in modern American history, and it is not at all clear that we’re going to have . . . a national effort to turn this around.”

-Ashish Jha, Dean of Brown University’s public health school

That quote appears in a recent Washington Post article — one of many the paper has published in recent months on the topic Jha references: America’s declining life expectancy. This topic has been largely overlooked by policymakers, the press, and (to a lesser extent) the public health community. (Scroll to the bottom to find links to all of the Post articles in their “Dying Early: America’s Life Expectancy Crisis” series.)

The basics are startling: Life expectancy in the United States is lower than in any of the world’s advanced economies. What’s more, people in several countries with much lower living standards, such as Costa Rica, also live longer than Americans.

This trend goes back several years, though Covid-19 intensified it. From 2019-21, U.S. life expectancy declined by 2.4 years to 76.4 – its lowest level since 1996. In 2022 (the most recent year available), life expectancy rebounded to 77.5 years, as the number of Covid deaths declined (though there was an increase in deaths from the flu, pneumonia, fetal and infant conditions, and kidney disease).

But even before Covid, U.S. life expectancy had declined slightly for several years – for the first time in a century. If you’re looking for a reason to be pessimistic about the state of the nation, the life expectancy figures are a good place to start.

There are several reasons why the U.S. is saddled with low life expectancy, but the Post analysis shows one factor exceeds all the others.

Chronic diseases are those that typically require care for at least a year. The most common ones are heart disease, cancer, lung disease, diabetes, Alzheimer’s, stroke, and kidney disease – and 60 percent of Americans have at least one (and 40 percent have two or more). These diseases are not typically a function of genetics. Instead, they stem from poor nutrition, smoking, excessive drinking, and physical inactivity, says the CDC.

The role of poor nutrition is critical. The Post points out that “the rate of obesity deaths for adults 35 to 64 doubled from 1979 to 2000, then doubled again from 2000 to 2019.” Obesity is about to become the leading cause of preventable cancer – passing tobacco use. Absent an improvement in the American diet, the incidence of chronic disease will continue and U.S. life expectancy will continue to lag.

What’s striking is that billions of dollars are devoted to research on trying to cure diseases such as cancer, but infinitely less is devoted to preventing the onset of these diseases. Prevention is simply not a national priority, as I’ve written about several times in the past (see here and here and here).

Shortcomings in America’s health-care system are one part of the problem. The Post points out that the share of total health spending devoted to primary care was just 4.6 percent in 2020, whereas the comparable figure among the OECD’s high-income nations has been up to 14 percent. That matters, given that primary care doctors are typically the front-line physicians that can identify health conditions before they worsen – and focus on prevention.

But that is not happening as often as it should, which means many people only get treatment when they’re already sick. And the medical school curriculum at American medical schools typically contains little if any focus on the basics of nutrition, so it’s questionable how much would be gained from having a greater share of primary care doctors.

The constellation of inefficiencies and misguided incentives in U.S. health care contributes to arguably the most shocking statistic of all – the United States spends about twice as much, per capita, on health care as other wealthy nations – and has far and away the lowest life expectancy. Japan has the lowest level of health spending among wealthy nations – and the highest life expectancy. (See all the depressing details here.)

These facts are a reminder that “health” has only a limited association with “health care.” Many other factors determine individuals’ health profile, including socio-economic status, genetics, and – often most important of all – personal behavior.

(A technical aside on life expectancy numbers. This article draws on what’s known as “period life expectancy” data, which is cited in virtually all reports that get published on the topic. But there’s also “cohort life expectancy” data that paints a less alarming portrait. If you want to know more about the two models, a useful explainer is here. While I will leave it to economists and demographers to adjudicate between the models, it’s clear the United States has a very high rate of chronic disease – much higher than the rate found in other high-income countries – and that prevalence contributes to high rates of mortality. The “period” data reflects this in a way the “cohort” data does not.)

The Post series examined why policymakers have largely ignored the life-expectancy crisis. (It’s never been mentioned by President Biden and it’s been a non-issue in the Republican presidential campaign.) Two passages stood out:

That focus on short-term achievements, coupled with the health-care system’s orientation toward treatment over prevention, are reasons to believe this sad state of affairs isn’t going to change in the foreseeable future. (My doomsday outlook seems to be aligned with America’s broader political moment, according to the Post.)

The best way – and perhaps the only way – to achieve a meaningful reversal in the life expectancy trends, and prevent most of America’s leading causes of death, will be through an improvement in the American diet (as I’ve written before). But that pressing need is all but absent from the national agenda.

Washington Post articles on U.S. life expectancy and chronic disease

• The Post’s big picture findings on life expectancy

• The life expectancy crisis is not a political priority

• An epidemic of chronic illness

• The slow rebound in U.S. life expectancy after Covid

• Comparing health and health care in the U.S. and Portugal

• Life expectancy comparison by country

• Primary care saves lives

• How Lunchables ended up in school lunches

• How public policy in Ohio diminishes life expectancy