If you think life expectancy in the United States is among the longest in the world, you're wrong. In fact, the gap between how long people live in the U.S. compared to those in other high-income countries has been widening for decades. A team of researchers led by Steven Woolf, M.D., director emeritus of Virginia Commonwealth University's Center on Society and Health, wanted to know why.
They published their findings June 23, in The BMJ, a journal published by the British Medical Association. Their research is the first to show the significance of that gap continuing to widen — by a lot. Average life expectancy in the U.S. dropped by almost two years (1.87 to be exact) between 2018 and 2020 — that's the most ever since World War II.
A decline of less than two years might not sound like much, but that now puts life expectancy in the U.S. at 76.87 years. And two years is 8.5 times the average decrease of just 0.22 years 16 other countries experienced in the same time span. The number is even worse when the researchers focused on people of color: The research found life expectancy for Black Americans declined by 3.25 years and 3.88 years for Hispanic Americans. That's 18 and 15 times higher than in peer countries, respectively.
"We expected that life expectancy in the U.S. would decrease, that the drop would be smaller in other countries, and that people of color in the U.S. would be disproportionately affected," Woolf says via email, "but we were stunned by the magnitude of the disparities we found. We did not anticipate that the drop in [life expectancy] in the U.S. would be 8.5 times the average decrease in peer countries. And we were horrified to see the massive decreases in [life expectancy] that the Hispanic and Black population experienced."
Decline Is 'Massive'
Between 1959 and 2016, life expectancy for the average American increased from 69.9 years to 78.9 years, according to a 2019 study in JAMA. But starting in 2014, it declined for three consecutive years, the study showed, likely because more Americans began dying at middle age from drug overdoses, suicide, obesity and other organ system diseases.
These trends were already "very worrying," Woolf said in a press statement. "To give some perspective, when the decline in life expectancy was happening a few years ago, it was a decrease of about 0.1 years each year that was making front-page news. That's the kind of increase or decrease that we're accustomed to each year."
Woolf called the 1.87-year decline "massive."
What's Going On?
So what's to blame for this "massive" drop? There are several factors. First, the leading cause, according to the study, was the COVID-19 pandemic and the country's mishandling of it. More than 600,000 Americans have died of COVID-19 to date, more than any other country. And the botched management early on allowed the virus to spread unmitigated.
But, according to the team's research, national, state and local policy issues that already existed before the pandemic in the United States — and put the country at a health disadvantage — are still in place and also to blame. Think factors like limited access to health care, unemployment, food insecurity and homelessness. The pandemic did draw attention to some of these conditions, as well as the clear inequities in the U.S. health care system.
"The enormous drop between 2018 and 2020 was caused by the COVID-19 pandemic," Woolf says. "Preliminary reports from the CDC suggest that [life expectancy] increased by about 0.1 years between 2018 and 2019, so the stunning decrease reported in our study is almost certainly due to the pandemic. We can blame a virus, opioids, eating habits and other proximate causes, but the long-term decline of U.S. health that began in the 1990s has systemic origins. And it will continue until those root causes are addressed."
BIPOC Disproportionately Affected
As we mentioned previously, life expectancies of people of color, especially Black men and women dropped significantly between 2018 and 2020 — 12.3 times and 20.3 times greater, respectively, than the average decrease for peer countries. For Black men, life expectancy is at its lowest level since 1998, at 67.73 years. Improvements made between 2010 and 2018 to reduce the gap in life expectancy between Black and white populations were completely wiped out between 2018 and 2020.
The decline is even worse for the Hispanic population, with estimated drops in life expectancy 15.9 times and 22.5 times higher among men and women, respectively, compared with those in other countries.
"COVID-19 was a vivid new example of a very old problem. For generations, people of color — particularly Black and Native Americans — have died at higher rates than white people," Woolf says. "This death toll reflects the perennial barriers that people of color have systematically faced in gaining access to the opportunities for good health and well-being, the systemic advantages and privileges the white population has historically enjoyed, and the legacy of systemic racism that is responsible for this divide."
Woolf says the U.S. must address the causes to reverse the trend in declining life expectancy — like tackling the opioid epidemic and obesity — but meaningful change will require the country to invest in human capital.
"The countries that outperform the U.S. have worked harder to offer their children a good education, promote good jobs and livable wages, provide support systems for families facing trying times (including pandemics), and make those resources available across the population to reduce inequities and give everyone a fair shot," he says. "Reversing the trend in declining [life expectancy] requires a commitment to come to the aid of low and moderate-income American families. Policies that leave them behind ... and widen income inequality are likely to result in higher death rates and a widening gap between the health of Americans and other people. And racial disparities will persist until the country gets serious about addressing systemic racism."