Why are Americans dying early?
The US is one of the richest countries in the world. In recent years, its economy has grown far faster than Europe.
But, there is another kind of American exceptionalism, Americans are dying earlier.
In 1970, life expectancy was close but since then the gap between the US and similar countries has grown. Covid hit all countries, but it hit the US harder and only magnified an existing trend. It is not that old people are dying a little bit earlier. It is because America has a crisis of young people dying in mid-life. And, it gets worse, the national figure hides the level of inequality in American health. Coastal states like California have a life expectancy of 78, but in West Virginia it is 71. If West Virginia was a country, it would rank 137th in the world between Cambodia and Libya.
The biggest cause is now not race, but educational attainment, with graduates living 6 years longer than those without a degree. Life expectancy is increasingly a factor of income. With only the very richest Americans having a life expectancy similar to European levels.
The US spend more on health care per capita than anywhere else in the world. In recent years, per capita spending has soared. Health spending accounts for 17% of GDP – far higher than anywhere else. Yet, the US remains an exception for spending on health but getting poor life expectancy. For all the expenditure health care, many slip through the net. Nearly 100 million Americans have medical debt, with health care being the biggest cause of bankruptcy. In America, drugs are more expensive than the rest of the advanced world. America is the only advanced country to rely on private insurance and not universal health care. Although the number of uninsured has fallen, gaps still exist. The profit-driven nature of health care in America has particularly hollowed out local hospitals in rural areas leaving those in the poorest health struggling to gain adequate health care. When Covid hit West Virginia many former miners who had existing respiratory diseases from coal, were particularly vulnerable. Since 2005, over 170 rural hospitals have closed. Ironically, in some areas, US health care is outstanding. It is higher survival rates for people over 75 because of very good cancer screening and survival rates. The hit to US life expectancy occurs in mid-life. The young, the poor, who slip through the safety net.
Obesity
Another type of American exceptionalism is in obesity rates. Excluding small microstates like American Samoa, the US has the highest obesity rates in the world, a reflection of poor diet, lack of exercise and a food industry which has pumped high-corn fructose syrup into many goods. American has become addicted to fat and sugar. It has caused rates of diabetes to soar and this is a major cause of early death. American cities are built for the car, and public transport and walking are more limited. This contributes to poor levels of exercise and fitness, but also is a factor in much higher fatality rate on the road.
Americans drive further, they also drive heavier, bigger cars and more likely to be involved in fatal accidents. There is also a different culture, with a greater willingness to take risk.
Opiod Deaths
A feature of American society is that since 1970 it has embraced deregulation more than European countries. In Europe, drug prescriptions are more carefully regulated, but in the US, the aggressive marketing of opiod-based pain killer OxyContin led to an estimated 250,000 deaths from drug overdoses. But, this also spurred a surge in cheap heroin, fentanyl, and other synthetic opioids from people who became addicted to the legal prescription drugs. Annual deaths from synthetic opiods soared in the late 2010s. It wasn’t just the direct deaths, but the rise in helplessness and despair which led to higher suicide rates, economic stagnation and hollowing out of depressed areas.
The US is also an outlier on gun deaths. A reflection of loose gun regulation and strong gun culture. Compared to other countries, US gun deaths is off the chart, but is unable to regulate even semi-automatic weapons used in mass school shootings.
Deaths from guns continue to rise, used in both suicide and murder. The US murder rate is actually lower now than in 1990s, but gun deaths continue to rise.
Another feature of the US deregulation culture is that the US is slower to ban harmful pesticides. Of the 1.2 billion pounds of pesticides used in US agriculture in 2016, approximately 1/4 were pesticides banned in the EU. There is a strong link between harmful pesticides and other chemical pollutants and a rise in heath conditions such as cancer and neurodegenerative diseases such as Parkinsons. The US has seen a 50% rise in annual diagnoses of Parkinsons, and the rate is expected to keep rising. Yet as the American Scientist notes, America has still not banned harmful chemicals linked to the rise of these degenerative diseases.
Inequality in America
However, according to GDP metrics, the US economy is doing very well. It masks a growing inequality and a nation of haves and have nots. Over half a million experience some form of homelessness. Average median wages are no much higher than 40 years ago, with more of the wealth going to the top 1%. The top 25 richest Americans received $400bn of income, paying an average tax rate of just 3.5%. 61% say they are living pay check to paycheck, 70% are financially distressed. Housing costs have eaten into living standards, especially for those renting. Compared to Europe, the US has meagre unemployment benefits and sickness benefit. Americans work longer hours with less protection. The Federal minimum wages is very low. The economy has also struggled to deal with the decline of manufacturing jobs for non-graduate workers.
Any reasons for optimism?
This is all pretty grim, but there are some reasons to be optimistic. Firstly, American has the wealth to tackle this problem if it has the willingness. Regulating chemicals, and pesticides, taxing sugary food. Improving road safety. Providing universal health care to the young, and not just the old. The weight loss drug Ozempic may help reduce obesity rates and improve health outcomes. There are continual improvements in medical treatments, especially around cancer. Artificial intelligence could help improve the implementation of health care. But, on the other hand, there has been strong growth in neurodegenerative diseases which currently have no known cure. Also, global warming means that more Americans could face extremes of temperature and weather. Workers could face working in high temperatures. Access to air-conditioning will be a factor determining health.
Also, a lot of the health outcomes do come down to personal choice and culture. One of the biggest discrepancies between America and Japan is diet. America is much higher in processed foods, saturated fats and sugars. The biggest difference an individual can make is exercise. The biggest cause of death in the US is heart disease. Increasing activity even moderately can significantly improve life expectancy and healthy life expectancy. In recent years, the government has forced a reduction in the price of some drugs, which will help. In fact the cost of Medicare has grown less than expected, although that partly reflects a decline in life expectancy and decline in the cost of treating people in their old age. Other aspects of America’s poor health are linked to an economic inequality that will prove harder to address.
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