Column: Life Expectancy

The average life expectancy of Americans has been declining in recent years. This applies to Americans of every skin shade, ethnic extraction, and national origin. Men have been hardest hit, but women are also exhibiting a progressive decline in longevity. This may surprise citizens who have long embraced the myth that America has the best healthcare in the world, but for those of us working as healthcare providers, the decline in average life expectancy is neither unexpected nor inexplicable. Our country has some of the best medical institutions and healthcare providers in the world, but access to these facilities and people is extremely variable. In recent years, each innovation intended to spread health assets more evenly across the country has been attacked and nullified by local and national legislative bodies with considerable energy and enthusiasm.  Financing and programs offered to all states to improve healthcare have been rejected by many states for reasons apparent only to the most unapologetic politicians.

There are numerous methods for determining average life expectancy. Consequently, there is considerable variability in the number arrived at using different methods. What is consistent with all methods adopted is that Americans are dying sooner than they did 5 years ago. Of course, there has been a dramatic improvement in average life expectancy in our country over the past century, but most of these gains are attributable to advances in sanitation, water treatment, sewage management, antibiotic and vaccine developments, techniques to identify treatable diseases earlier in their courses, and more federal enforcement of standards for the development of drugs and medical devices.

In 2019, the average citizen could expect to live 78.8 years. In 2020, this figure dropped by 1.8 years, and in 2021 it fell by another 0.8 years. The drop in life expectancy during those 2 years, 2020 and 2021, was the largest decline experienced in the U.S. during the prior century. Men had a much steeper loss in life expectancy than did women, but women also participated in this shortening of life expectancy. The difference in average life expectancy of American men as compared to that of American women is now the greatest it has been since 1996.  Women generally survive about 6 years longer than men.

There are obvious and not so obvious reasons for our declining life expectancy. The Covid-19 pandemic played a role, but resistance to vaccinations that were free and widely accessible played an even larger role. After the development of the first Covid vaccines, nine out of ten Covid deaths occurred in people who were unvaccinated. Refusing vaccination was promoted as a sign of religious fervor or political commitment. Claims that vaccines are more dangerous than the diseases they prevent were predictably resurrected along with long discredited studies meant to undermine the acceptance of vaccination programs. The motivation behind many of these false claims remains obscure.  For some media hoaxsters, it helped expand listener or viewer audiences by spreading lies that fit with the prejudices of their audiences.

The reliance on “thoughts and prayers,” rather than vaccines, accounted for nearly one million American pandemic deaths in 2020 and 2021. The flood of Covid related illnesses overwhelmed many hospitals and caused collateral deaths and disease by the diversion of hospital resources away from the problems healthcare providers customarily manage. People with heart attacks, strokes, cancer and accident-related problems found themselves competing for resources with unvaccinated Covid sufferers.

Even without the deaths attributable to the Covid pandemic, American life expectancies were decreased by several less obvious but more familiar problems. Accidents and “unintentional” injuries, including those from illicit drug overdoses, had a major impact on life expectancies in recent years. From the beginning of April, 2021, to the end of March, 2022, more than 109,000 Americans died from overdoses. Death from illicit fentanyl consumption has increased as deaths from Covid have decreased. 

The traditional causes of American mortality, which include heart disease, stroke, cancer, motor vehicle accidents, firearm murders, suicides, chronic liver disease (think alcohol), and various non-gun homicides, continue unabated. Despite advances in the diagnosis and treatment of all of these problems, other than homicides, over the past two decades, the United States has hit a limit on life extension. The underlying problem is partly limited access to healthcare resources.  An increasing number of Americans cannot get or cannot afford good, consistent healthcare. Some of the reduction in life expectancy is self-inflicted. Americans continue to shorten their lives with illicit drug use, chronic alcoholism, and gun violence.

Those who believe that the American healthcare system will provide them with the longest life expectancy in the world are simply wrong. By most current measures, the United States ranks 46th in terms of average life expectancy in comparison to other countries. Some assessments rank it below 54 other countries. Currently, the average lifespan of an American ranks below that of an Estonian and just above that of a Turkish citizen. This poor ranking is not a function of the ethnic or national background of our diverse population. We are, for the most part, a nation of immigrants, and the average life expectancies in many of the countries from which our citizens or their ancestors originated are longer than those of the average American. The average life expectancy of a citizen of Japan is over 85 years; that of a citizen of Italy, 84 years; of Greece, 82 years; of Slovenia, 81 years; of Chile, 80 years.

In 1965, President Lyndon Johnson signed bills that created Medicare and Medicaid. These initiatives were opposed by the medical establishment and numerous state legislatures. Despite efforts to kill these programs, they became entrenched in the American psyche as irrevocable “entitlements” for the elderly and the poor.  Subsequent efforts to expand these programs have had some success (e.g., unlimited access to renal dialysis) and some resounding failures (e.g., the “public option”). Unless American lawmakers allow the development of a more equitable and rational healthcare system (dare I say Medicare for all) we may soon see the life expectancies for our citizens to rival that of Belarus (74 years) or North Korea (72 years). Part of the American dream is for our children to have longer lives than we, their parents.  If we can break our illicit drug habits, curb our alcohol consumption, wean ourselves off guns, learn to drive less recklessly, and trust science more than superstitions we may yet realize that part of the American dream.

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.

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