A blockbuster analysis of federal mortality data published last week in the Journal of the American Medical Association has been reverberating across the health community.
Since 2014, U.S. life expectancy has been decreasing year after year. The decline is mostly among “working-age” Americans—those ages 25 to 64. But the highest relative jump in death rates—29 percent—from 2010 to 2017 was among people age 25 to 34.
The increased death rates extended to people of all racial and ethnic groups and to suburbs and cities. Suicides, drug overdoses and alcoholism were the main causes, but heart disease, strokes and chronic obstructive pulmonary disease were also factors.
Since 1998, the average life expectancy in the U.S. has fallen behind that of other wealthy countries. This gap is known as the “health disadvantage.” The analysis adds to evidence that the gap is growing even though the United States has the highest per capita health spending globally.
“It’s supposed to be going down, as it is in other countries,” said the lead author of the report, Steven H. Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University. “The fact that the number is climbing, there’s something terribly wrong.”
The analysis shows the increased death rate has not been uniform across the United States. The greatest relative increases in death rates were seen in parts of New England (Maine, New Hampshire and Vermont) and the Ohio Valley (Indiana, Kentucky, Ohio and Pennsylvania). These regions have been hit hard by the opioid epidemic and the collapse of the manufacturing sector.
A third of the estimated 33,000 “excess deaths” that have occurred since 2010 were in the Ohio Valley states. The state with the biggest percentage rise in death rates amongst working-age people was New Hampshire. It is important to note these regions and states are also politically contested in the 2020 presidential election; New Hampshire is the first primary state.
On the east and west coast, in contrast, the life expectancy has improved at roughly the same rate as in Canada.
Some experts see the geographic divide as a reason to be hopeful. John G. Hagga, a director of the division of behavioral and social research at the National Institute on Aging, said: “It’s important because it means this is not somehow deep in our national soul or genetics or something. We know we can do better right here in America. It proves that it’s possible.”
As for the cause of the decline, the authors of the study note that the growth of America’s life expectancy began to slow down compared to other wealthy nations in the 1980s. This period marked the start of the opioid epidemic, the shrinking of the middle class and the widening of income inequality.
While other wealthy countries also experienced an economic change during this period, Woolf says these countries might not have experienced a decline in life expectancy because they provide more support for struggling families. “In other countries, families that fall on hard times have programs and services available to cushion the blow. In America, people often have to fend for themselves,” said Woolf.
A Harvard professor agrees with this hypothesis. Howard Koh of the Harvard T. H. Chan School of Public Health, who was not involved in the study, said, “Other countries spend relatively more in terms of social services. Health is much more than what happens in a doctor’s office. It starts where people live, learn, labor and pray.”
A solution, then, to the declining life expectancy may be to buckle down on investing in social determinants of health (SDOH). Koh says we should pay special attention to how social connections and strong community networks impact well-being.
47% of adults in America—double the number affected a few decades ago—report being lonely. Loneliness has risk rates for early mortality similar to those for obesity and smoking. It is also correlated with adverse health, such as higher systolic blood pressure and cholesterol levels.
It is, therefore, in insurance companies’ best interest to tackle its consumers’ loneliness, and some already have. One program conducted telephonic and in-person outreach by social workers and volunteer phone pals and has already demonstrated positive health outcomes and reduced emergency room utilization.
Insurers should create similar programs for other SDOHs, such as access to recreational opportunities. With the right efforts, we can work together to reverse this three-year norm.
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