People in the United States, The Post explains, are dying earlier and earlier than people in the rest of the world. Among wealthy nations, ours was once about average; now, it is behind its peers and falling fast. This drop began before the coronavirus pandemic, after life expectancy peaked at 78.9 years in 2014, but covid-19 accentuated the crisis, killing dramatically more people per capita here than in similarly well-off countries. People in the highest-income areas of the United States do not live longer than people in the poorest parts of France. Meanwhile, people in the poorest parts of the United States live much shorter lives than those in the richer ones.
Some of the culprits are the usual suspects in mainstream discourse: opioids, for example, or guns. But public enemy No. 1 is chronic disease, from cancer to heart and liver ailments. The Post reports that these illnesses “erase more than twice as many years of life among people younger than 65 as all the overdoses, homicides, suicides and car accidents combined.”
What is going wrong? The health-care system is the obvious place to start. Some blame the country’s lack of universal coverage. Yet the Affordable Care Act enrolled more people in health plans, and life expectancy has still declined over the past 10 years. The challenge is that building a healthier population doesn’t pay as well as treating a sick one does. Pharmaceutical companies profit when they create drugs that treat disease, rather than the drivers of it. The more patients a private medical facility sees, the more money it makes. The country has a desperate dearth of primary-care doctors — but pays them a pittance compared with specialists.
Realigning these incentives isn’t an easy job, or a cheap one; the evidence suggests it is a myth that better preventive care saves money. Fewer people dying young is still worth some spending. But also worthwhile is looking for ways to promote good health and save money, too.
The Post homed in on some of the poor, rural areas in which early deaths are endemic, examining three counties whose primary difference is the state in which they’re located and, therefore, the laws to which they’ve been subject: Ashtabula in Ohio, Erie in Pennsylvania and Chautauqua in New York. All are nestled up against Lake Erie, and all have felt the effects of industrial jobs’ steady disappearance.
Ashtabula residents were much more likely in 2020 than Erie or Chautauqua residents to meet early ends, in many cases thanks to complications related to smoking or diabetes, as well as motor vehicle collisions. And it turns out that roughly 1 in 5 Ohioans will die before 65 — putting the state in the company of Ecuador and Slovakia. For years now, the state’s Republican-led legislature has blocked tobacco tax increases. Ohio’s highway safety laws are also less stringent than its neighbors’.
Around the country, meanwhile, processed food and drinks full of high-fructose corn syrup and other sugars abound. (Even a newly popular type of infant formula, The Post found, uses corn syrup solids as a sweetener.) Add warning labels, make these options more expensive to purchase or limit people’s ability to buy junk food with government nutrition assistance — and people might be less likely to fall into harmful dietary habits.
The final piece to the United States’ ongoing tragedy might be the most dispiriting: People begin to feel bad, it turns out, because they feel bad. Mental and emotional ailments take a physical toll on the body. Depression, anxiety and post-traumatic stress disorder can raise blood pressure or exacerbate diabetes. To make matters worse, those in difficult economic straits could end up working jobs that wear on their health — with long hours that render it hard to secure a doctor’s appointment. That also means the groups already most marginalized are often hit the hardest.
Fixing the country’s life-and-death problem, in this light, will require confronting some of its broadest and deepest rooted issues. But focusing on incentives to promote better health, so that the tide moves with the project instead of against it, will provide a manageable place to begin.
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