This post is just a brief reminder of what American “exceptionalism” has come to: The U.S. is exceptional in short lives.
This graph[1] shows the historical trajectory in expected lifespans for the U.S. and several large, affluent, western, democratic, “peer” countries. (You can choose other peer countries from Our World in Data; it won’t change the story.) Generally, lifespans have been growing. However: In the 1970s American lifespans were lengthening roughly in pace with those of peer countries. Then in the 1980s the U.S. and Denmark started falling behind. From 2000 on, Denmark rejoined the peer countries while the U.S. fell further and further behind. Even before the American disaster that was Covid, the U.S. was exceptional among western nations in how young its people died.
Why?
This baleful American exceptionalism was long visible, if not as extreme as in 2021. In 2011, a panel of the National Research Council convened to describe and explain it. (Things worsened after 2011 and then crashed during Covid.) How did the NRC panel understand the situation revealed in this graph?
It’s not just that Americans are dying young, they are dying at exceptionally high rates for a wide variety of medical causes: infant and childbearing mortality, accidents, gun deaths, drug overdoses and poisonings, neurological issues, and cardiovascular diseases. In 2011, the American disadvantage was especially noticeable for those under 50, but the immunity of the elderly has eroded since.
Why has this happened? The easy answers are wrong. It’s not the lack of money—the U.S. spends more per capita on health than any of our peers—but perhaps on how we spend our money. It’s not because there are poor people, racial minorities, and immigrants in America. Even affluent, non-Hispanic White Americans have shorter lives than the average members of our peer countries. (And immigrants here are generally healthier than the native-born.)
The American death crisis is so broad, the NRC concluded, that its sources must be systemic and fundamental:[2]
- the distinctively patchwork health system we have;
- our distinctive habits—Americans are more obese, increasingly so, more likely to be drug-addicted, less likely to visit doctors than other westerners;
- and our distinctive culture, with its prioritizing individual autonomy over expertise, authority, and the collective good (as exemplified in low rates of child immunizations and the unnecessary Covid deaths after the vaccine arrived). Can this culture change?
P.S. Just received this announcement: the National Institute of Aging just published a Notice of Special Interest (NOSI) – U.S. Health in the International Perspective (NOT-AG-24-004). It is designed to stimulate applications for conducting research that examines mechanisms and causes behind the increasing U.S. health disadvantage, which refers to worsening life expectancies and health outcomes in the U.S. compared to other countries.
—— NOTES —
[1] “Data Page: Life expectancy at birth”, part of the following publication: Saloni Dattani, Lucas Rodés-Guirao, Hannah Ritchie, Esteban Ortiz-Ospina and Max Roser (2023) – “Life Expectancy”. Data adapted from Human Mortality Database, United Nations, Zijdeman et al., James C. Riley. Retrieved from https://ourworldindata.org/grapher/life-expectancy.
[2] Specifically, NRC summarizes these findings (p. 207):
- The U.S. health system suffers from a large uninsured population, financial barriers to care, a shortage of primary care providers, and potentially important gaps in the quality of care (Chapter 4). • Americans have a higher prevalence of certain unhealthy behaviors involving caloric intake, sedentary behavior, drug use, unprotected sex, driving without seatbelts, and the use of firearms (Chapter 5). • The United States lags in educational achievement, and it has high income inequality and poverty rates and lower social mobility than most other high-income countries (Chapter 6). • Americans live in an obesogenic built environment that discourages physical activity, and they live in more racially segregated communities (see Chapter 7).