After two years of dramatic declines in life expectancy in the United States, there is some good news. According to data released this week by the Centers for Disease Control and Prevention, the United States turned a corner and added 1.1 years of life expectancy between 2021 and 2022. But the public health crisis in the United States continues unabated as fewer resources are allocated to the disease. prevention and preventive causes of premature deaths. Public health is not a priority for federal and state governments, as well as the private health sectors. As a result, the sharp divergence between life expectancy in the United States and its peers is likely to persist.
The 1.1 year increase in life expectancy reported by the CDC results mainly (84%) from the reduction in mortality due to Covid-19. Relatively minor factors included reductions in deaths from heart disease (3.6%), unintentional injuries (2.6%), cancer (2.2%), and homicide (1.5%).
Life expectancy gains were particularly noticeable for the non-Hispanic American Indian and Alaska Native population, from 2.3 years or 65.6 to 67.9 years; 2.2 years for the Hispanic population, or 77.8 to 80; and 1.6 years for the non-Hispanic black population, or 71.2 to 72.8.*
The troubling news, however, is that life expectancy in the United States in 2022 is still 1.3 years lower than in 2019 and lower than it was twenty years ago, largely due to many types of chronic diseases such as obesity and diabetes, and increases in drug overdoses and suicides. , homicides, vehicular fatalities, and infant and maternal mortality.
Furthermore, what is striking is the the gap is widening between men and women. According to research published in November in JAMA Internal Medicine, the life expectancy of a man is now 73 years; that of a woman is 79 years. This is the largest difference in life expectancy between the sexes since 1996. The growing disparity is worrying. Preventable causes such as the opioid epidemic and suicides tend to affect men more than women.
The United States is far behind its wealthy and comparable peers: Other wealthy countries like Japan, Korea, Portugal, the United Kingdom and Italy all enjoy life expectancies of 80 years or more. The figure below shows how much life expectancy in the United States has deviated from the average for a comparable country between the early 1980s and 2021.
Life expectancy in the United States differs from that of its peers.
KFF
Even less wealthy countries like Turkey (78.6) and China (78.2) are doing significantly better than the United States.
Compared to other large, wealthy countries, the United States has seen a larger decline in life expectancy due to the Covid-19 pandemic and a considerably slower rebound so far.
At the beginning of the year I wrote that the biggest health story from 2022, it was not Covid-19. It wasn’t RSV or the flu either. It wasn’t cancer, diabetes or cardiovascular disease. This has been the worrying trend in life expectancy in the United States for decades.
Robert Califf, commissioner of the Food and Drug Administration, agrees. In a tweet yesterday he wrote:
“We face extraordinary public health headwinds, with a significant decline in life expectancy. The major decline in the United States is not just a trend. I would say it’s catastrophic. »
Attributing this solely to Covid-19 is a mistake. Life expectancy in the United States stagnated between 2012 and 2019. And before 2012, starting in the early 1980s, the upward slope representing the increase in life expectancy was much flatter in the United States than in any other comparable country, as shown in the graph above.
Addressing this multi-faceted, multi-causal problem will require dedicated resources, targeting each public health issue. It’s not as if the United States doesn’t spend a lot on health care, both in absolute and relative terms. Rather, it is where the expenses are allocated that matters. Relatively little is devoted to public health.
The public health expenditure category includes all government expenditures on public health functions such as epidemiological surveillance, immunization services, disease prevention, and preventive care programs.
The part of public health of total health expenditure increased from 1.36% in 1960 to 3.18% in 2002, then fell to 2.65% in 2014. It is expected to decrease further to reach 2.40% in 2023.
The U.S. health care system appears well designed to treat acute illnesses. But it is poorly equipped when it comes to preventive and chronic care.
Take for example infant and maternal mortality. Premature births and infant mortality are reaching worrying levels in the United States, according to a recently released report. by March of Dimes. In 2022, 10.4% of all babies were born prematurely – before 37 weeks gestation – which is slightly below the 2021 peak of 10.5%, a decade high, and represents by far the highest risk of premature birth among wealthy peers. In the United Kingdom, for example, the the rate is 7.6%; in Italy it’s 6.8%; in Japan it is about 5%. Even in global comparison, the United States performs poorly. The figure of 10.4% is higher than the global average by 9.9%.
Premature births are responsible for nearly 16% of infant deaths. Furthermore, preliminary data from the CDC shows that the United States faces a corresponding crisis when it comes to infant mortality, which increased by 3% in 2022 compared to 2021, from 5.44 infant deaths per 1,000 live births to 5.6. Like the premature birth rate, the infant mortality rate in the United States is much higher than in comparable countries. The distribution is also uneven across races and ethnicities: for black babies, the mortality rate is 10.9 per 1,000, almost 2.5 times that of white babies.
Then there is maternal mortality. The United States is an extreme country outlier with the highest rate of pregnancy-related deaths among its peers: specifically, 23.8 deaths per 100,000 live births in 2020, compared to a figure of 3.6 deaths per 100 live births in equally wealthy countries.
If the United States wants to structurally change the overall trend in life expectancy, it must reorganize its health priorities and spend significantly more on targeted public health initiatives. Not only will federal and state governments need to invest, but private health sectors will also need to do their part.
A passage from a book published ten years ago by the Institute of Medicine authors sums up the problem perfectly: “To society’s detriment, its fixation on clinical care and its delivery eclipses attention to population-based activities that offer efficient and effective approaches to improving the health of the nation. »
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* The increase or decrease in life expectancy constitutes the sum of the positive and negative contributions of mortality rates by cause. Decreases in these rates contribute to increasing life expectancy, while increases contribute to decreasing life expectancy.
