The steep decline in US life expectancy raises questions most politicians want to avoid

The worst decline in a century reveals our for-profit healthcare system for what it really is

Published September 3, 2022 2:00PM (EDT)

Gravestones in a cemetery (Getty Images/Marc Bruxelle)
Gravestones in a cemetery (Getty Images/Marc Bruxelle)

The powers that be really want to turn the page on the COVID pandemic, even though the United States is still suffering hundreds of deaths a day and thousands of new hospitalizations. Evidently, that's a number of deaths and admissions Congress can live with. Two thirds of the country is vaccinated, and just about a third are boosted. And with the need to aid the defense of Ukraine, COVID is, evidently, so yesterday. 

President Biden, in post–Labor Day campaign mode, has said that he wants to "save the soul" of America. But his administration and the Democratic-led Congress are risking a lot putting the health of the body politic on the back burner by letting COVID pandemic aid lapse.

ABC News matter of factly reported that with "COVID-19 funding drying up and no fresh cash infusion from Congress," the Biden administration announced it was suspending its offer of providing free at-home rapid tests. 

"The administration has been clear about our urgent COVID-19 response funding needs," a senior administration official told ABC News. "We have warned that congressional inaction would force unacceptable trade-offs and harm our overall COVID-19 preparedness and response — and that the consequences would likely worsen over time." 

Looking away

Meanwhile, there's been no post-mortem scrutiny of America's expensive, for-profit healthcare system, which limits both access to care as well as public health surveillance, and which likely contributed to our catastrophic COVID death toll. Our nation, which accounts for just 4.25 percent of the world's population, now has more than one million COVID deaths — which equates to over 14 percent of the world's COVID deaths.

"Prior to the COVID pandemic, we'd already seen a drop in life expectancy due to 'diseases of despair' — drug and alcohol overdose, complications of drug and alcohol use, and suicide," Gounder wrote.

And the deaths are only part of the pandemic misery index. A recent Brookings Institute analysis found that "around 16 million working-age (those aged 18 to 65) have long COVID today, of those, two to four million are out of work due to long COVID." More than two years into this pandemic, we still have no accurate assessment of the impact of COVID on the essential workforce, though such an analysis is pending at the Centers for Disease Control and Prevention (CDC).

Sadly, it's not just Congress that's down-shifting on this once-in-a-century public health crisis that is  ongoing due to long COVID. Back on August 19, the Wall Street Journal reported that the Biden administration, through its Department of Health and Human Services (DHHS), was already planning to end the free distribution of COVID tests and vaccines. "End of government underwriting of such medicines could lead to windfall for drugmakers," proclaimed the headline. Specifically, DHHS would be "shifting more control of pricing and coverage to the healthcare industry in ways that could generate sales for companies — and costs for consumers — for years to come." 

Why, because that's worked so well? 

Mind you this soft unwinding of the COVID response comes as we are getting the initial damage reports on just what COVID has wrought — with federal public health officials now saying that from 2019 to 2020, the U.S. saw the biggest drop in life expectancy in a century. The New York Times reported that in 2021, the average American could expect to live until the age of 76," which "represents a loss of almost three years since 2019, when Americans could expect to live, on average, nearly 79 years."

In the weeds

The National Vital Statistics Report , issued by the U.S. Department of Health and Human Services, found that in all 50 states and Washington D.C, the average life expectancy declined. The decline ranged from 0.2 years in Hawaii to three years in New York State, where the average life span fell from 80.7 to 77.7 years of age. The latest state-by-state statistics showed that the gender longevity gap, which favors women, now ranged from 3.9 years in Utah to 7 years in Washington, D.C.

According to the 50 state analysis, the "states with the lowest life expectancy at birth were mostly Southern states (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, South Carolina, Tennessee, and West Virginia) but also included D.C., Indiana, Missouri, New Mexico, Ohio, and Oklahoma."

"The states with the lowest life expectancies are also the states least likely to have expanded Medicaid coverage."

"The states with the greatest decreases in life expectancy at birth from 2019 to 2020 included those in the Southwest and U.S.–Mexico border area (Arizona, New Mexico, and Texas), Louisiana, Mississippi, Illinois, New York, New Jersey, and D.C.," the researchers found. "Overall, life expectancy in the United States declined by 1.8 years from 2019 to 2020, mostly due to the COVID-19 pandemic and increases in unintentional injuries (mainly drug overdose deaths)."

While the latest drop in life expectancy is the largest in decades, the U.S. has been slipping for years and in 2019, marked the third year in a row that we posted a decline. This is a significant shift from the years between 1959 and 2014, when life expectancy was consistently on the upswing. The last time the U.S. had a three year decline, was just before World War I, amid the Spanish Flu pandemic that killed 650,000 Americans.

Shailly Gupta Barnes is the policy director at the Kairos Center and helped research and write a county-by-county analysis that looked at COVID death rates, race, and income for the Rev. Dr. William Barber's Poor People's Campaign. Barnes saw the drop in life expectancy as a failure of American social policy. 

"First, the decline in life expectancy is, as you noted, is not new," Barnes wrote to Salon. "The downward pattern was noted in 2015 and has continued since then, although the COVID-19 pandemic accelerated this dramatically. A drop of three years in some parts of the country is shocking. It also directly confronts the idea that individual behavior could have changed pandemic outcomes. This change from 2019 to 2020 reflects a systemic failure in our health care system, including that, our peer countries experienced only one-third as much of a decline and then an increase, as they adapted a more effective COVID response."

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Barnes continued: "Second, based on our pandemic study, 'A Poor People's Pandemic,' it is likely that this burden was inequitably distributed among poor and low-income communities. According to our research, poor and low-income counties experienced death rates that were twice as high as richer counties. At different phases of the pandemic, their death rates were up to 5 times higher. These counties are home to a disproportionate percentage of people of color, including 27 percent of all indigenous people, 15 percent of all Black people, 13 percent of all Hispanic people."

Barnes observes that from the CDC state-by-state tables we see that the two states "with the lowest life expectancy are West Virginia and Mississippi, with life expectancies four and five years less than the national average. These are two of the poorest states in the country, one whose population is more than 96 percent white, another whose population is more than one-third Black. Alongside the systemic health failures, we have to consider the systemic poverty and racism that is embedded in these disparities. This is also clear from the geography of the decline, with states in the south, south west and midwest among the worst off."

Want a second opinion?

Dr. Celine Gounder is one of the nation's leading public health physicians and infectious disease experts as well as the editor-at-Large for public health for Kaiser Health News. She continues to treat patients at Bellevue Hospital, one of New York City's municipal hospitals and served on President-Elect Biden's COVID transition team.  She said there's a link between states that refused to expand Medicaid and their rates of declining life expectancy.

"The states with the lowest life expectancies are also the states least likely to have expanded Medicaid coverage," Gounder wrote in an email. "Medicaid is also the largest payor for mental health services, and Medicaid expansion would also expand access to mental health care. Settlements with companies like Purdue and Janssen are providing a much-needed influx of funds to address the opioid overdose crisis, giving state and local governments the opportunity to invest in effective evidence-based approaches that save lives." 

But, Gounder argues declining life expectancy is not entirely the function of our healthcare system.

"Prior to the COVID pandemic, we'd already seen a drop in life expectancy due to 'diseases of despair' — drug and alcohol overdose, complications of drug and alcohol use, and suicide," Gounder wrote. "I think that much of this is tied to the decline of civil society, the loss of good jobs that didn't require a college degree, rising inequality, and disillusionment with the American Dream, or the idea that hard work pays off. These aren't challenges that can be solved by the health care sector or even public health, but much can be done to mitigate these trends." 

Dr. Edward Zuroweste, is  the founding director of the Migrant Clinicians Network, an international non-profit that serves migrant and immigrant workers. Zuroweste observed that states like Louisiana, Alabama, Mississippi, and West Virginia, according to the CDC, were also some of the worst states to have a baby in. He says there is global scientific consensus that universal access to healthcare improves outcomes society wide.

Birth and death

"You can see that [that CDC data] is very close also to the list of the 50 states you referred to me," Zuroweste wrote in an email. "It has long been known in the primary healthcare and public health care world that mortality, morbidity worldwide can be linked to either strong or weak primary and public health care infrastructures. Where you have universal and accessible and affordable healthcare for all you have better morbidity and mortality statistics across the board and, I would argue that it makes total overall economic sense also, and the opposite is true."

"The understaffing of public health increased dramatically during the Great Recession and never recovered. Trump's administration pushed an already-crippled public health infrastructure (caused by neglect during the Obama administration) over the edge."

Zeroweste continued: "But, for some unknown reason the US has decided to ignore the obvious and continue to make this a state-by-state decision, and you can see the dramatic variations depending on where you live in our country.

"Overall, the US is lagging way behind other developed countries with regards to almost all health parameters," Zeroweste added.

Dr. Joseph Q. Jarvis is a long-time family and public health physician, and the author of "For the Hurt of My People: Original Conservatism & Better, Simpler Healthcare" in which he makes a case for a single-payer system. He observes that the U.S. spends $4 trillion on healthcare annually, by far the most of any country in the world, yet 68,000 people die every year due to a lack of healthcare. 

As a consequence, he reasons, our profit-driven healthcare system results in millions of Americans missing out basic proven medical interventions, while both political parties are co-opted by the current system thanks to a steady stream of campaign contributions from the lobbyists for the very profitable — yet unhealthy — status quo. "Universal health care, with each American having a primary care home, would greatly enhance pandemic preparedness," Jarvis responded to a Salon query. "Communicable disease control depends upon case identification and reporting, which is only possible if the case gets competent health care, has the diagnosis established, and a report is sent to the public health department. Of course, if it is to be effective, that health department must be adequately staffed."

Bi-partisan betrayal

"Public health funding (and staffing) has been inadequate for communicable disease control throughout my entire public health career (which began in the 1980s)," Jarvis noted. "But the understaffing of public health increased dramatically during the Great Recession and never recovered. Trump's administration pushed an already-crippled public health infrastructure (caused by neglect during the Obama administration) over the edge, especially in terms of international health surveillance — exactly the kind of surveillance needed for worldwide pandemics."

If we were a "developing nation," non-governmental organizations, the World Bank and the International Monetary Fund would characterize our steep decline in average life expectancy as an abysmal performance. (We might even get an improvement plan.) Sadly, you can count on a corporate media to continue to flatter the elites who profit off all of this scarcity to turn a blind eye to this fundamental failure of the state to buttress the longevity of its people. What good is the state, any state, if it can't deliver on that? 

We'd be a much healthier nation if we paid more attention to our life expectancy and less to the Gross National Product. A big part of our lousy performance as a country is we measure the wrong things to plot our success. Sadly, whether it be education, healthcare or housing, our system is all about preserving and amassing great wealth — and if you happen to deliver on those three, well, that's just a happy coincidence. 

As the climate crisis deepens and infectious diseases proliferate, as they are already, universal health care must be seen as a civil defense imperative. Whether we like it or not, the health of all of us, regardless of zip code or social standing, is intimately linked to our own individual well being. Premature death can be contagious.

By Bob Hennelly

Bob Hennelly has written and reported for the Village Voice, Pacifica Radio, WNYC, CBS MoneyWatch and other outlets. His book, "Stuck Nation: Can the United States Change Course on Our History of Choosing Profits Over People?" was published in 2021 by Democracy@Work. He is now a reporter for the Chief-Leader, covering public unions and the civil service in New York City. Follow him on Twitter: @stucknation

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