In pandemics, people die. They die in incredibly frightful numbers. That may be why so few media commentators greeted this week’s biggest news story — the release of the latest stats on U.S. life expectancy — with anything much more than a shrug.
The new stats from the Centers for Disease Control and Prevention show that life expectancy in the United States fell by a year and half over the course of 2020, a dramatically deep drop for such a brief period of time, the deepest drop since the middle of World War II.
That news quickly made front pages across the nation, but then faded away rather quickly. Commentators saw little cause for comment. Life expectancy is dropping? What else, the attitude seemed to be, could we Americans have expected in the middle of a pandemic?
Actually, we could have expected a great deal more. We could have expected that the world’s richest country, the society that spends twice as much on health per capita as the rest of the developed world, would have performed far better against COVID-19 than any other nation. We didn’t even come close, a reality the latest life expectancy stats make unquestionably clear.
But our national life-expectancy stats have an even more significant story to tell. That story doesn’t involve how rapidly our life expectancies have fallen over the last year. The more significant story: how slowly our lives in the United States have been lengthening over the past four decades.
Back in the middle of the 20th century, Americans enjoyed world-class lifespans. Only four other nations had women living longer lives than women in the United States, only eight other for men. But then we began a long slow descent down the global mortality rankings. By 2010, people in the world’s longest-lived society, Japan, could expect to live 83.2 years. The 2010 U.S. life expectancy: 79.6 years.
Since then, the life expectancy gap between the United States and its peer developed nations has only widened. The latest United Nations research, released this past December and covering 2019, has life expectancy in Japan up to 84.6 years and the U.S. down at 78.9. Overall, the UN figures have the United States ranked 35th worldwide in life expectancy, tied with Lebanon and the Maldives.
How wide — in medical terms — has the life expectancy gap between global pacesetters like Japan and laggards like the United States become? This wide: If here in the United States we somehow totally eliminated deaths from cancer, people in a Japan where cancer remained a killer would still on average live almost three years longer than people in the United States.
What explains why the United States is doing so poorly? In a single word: inequality. Growing numbers of epidemiologists — the scientists who study the health of populations — have come to see America’s widening gap between our most affluent and everyone else as the prime culprit for our disappointing health outcomes. Over recent decades, our global life-expectancy standing has plummeted as our society has become ever more unequal.
The most compelling case for inequality’s astonishingly negative health impact comes in two books from the British epidemiologists Richard Wilkinson and Kate Pickett. In The Spirit Level: Why Greater Equality Makes Societies Stronger and The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Well-Being, the two researchers follow the statistical trail and explore just how an economic phenomenon — the maldistribution of income and wealth — can undermine our physical and mental well-being.
The Equality Trust, a London-based nonprofit Wilkinson and Pickett helped establish a dozen years ago, currently offers online a broad overview of the latest research on just what makes inequality so potent a health hazard. The “most plausible explanation” for inequality’s powerfully negative impact, the Equality Trust sums up, revolves around “status anxiety.” Inequality shoves people into steep social hierarchies that increase status competition and generate an ever-present stress that undermines our health.
“The greater the material differences between us, the more important status and money become,” add Wilkinson and Pickett. “The more unequal the society, the more people feel anxiety about status and how they are seen and judged. These effects are seen across all income groups — from the poorest to the richest tenth of the population.”
Dr. Stephen Bezruchka of the University of Washington School of Public Health has been working for over 20 years to get the same message across to Americans.
“Healthier societies have a smaller gap between the rich and the poor than we do,” he observes. “That gap causes an enormous amount of stress in our society — road rage, air rage, stress at work, child abuse. I say stress is the 21st century tobacco. We have learned that inequality kills.”
Bezruchka has advanced the notion of a global “Health Olympics” to help get that “inequality kills” message across. If the world’s developed nations competed on health outcomes in the same way they compete in sports like sprinting and swimming, with the “race” how long you live, the United States would finish dead last.
Bezruchka also likes to quote the late great epidemiologist Geoffrey Rose, author of the widely acclaimed 1992 book, The Strategy of Preventive Medicine.
“There is no known biological reason,” Rose notes right upfront in that influential volume, “why every population should not be as healthy as the best.”
But political and economic reasons for differences in population health do abound. And inequality tops the list, a reality that actually leaves Bezruchka with a sense of hope. After all, we don’t have to discover some fantastic new miracle cure to lengthen the lives Americans lead. We just have to forge a more equal America.
“Our gross levels of current inequality are not inevitable,” as Bezruchka wrote with his health care colleague Mary Anne Mercer just before the last summer Olympics in 2016. “Reasonable and fair economic policies can change them.”