The good news is that the large pandemic-related decline in life expectancy will almost certainly prove transitory. While the tragic loss of life due to Covid-19 is all too real, unless it continues to kill at the same rate each year, its negative impact on life expectancy will fade. The bad news is that the adverse health trends which were already weighing on life expectancy before the pandemic struck may continue to weigh on it long after the pandemic has passed.
We are talking about the increase in morbidity associated with lifestyle-related health conditions and behaviors, especially obesity and substance abuse, and the consequent increase in premature mortality from heart disease, diabetes, alcoholic liver disease, opioid overdoses, and so on down the list.
This brings us to the crux of the matter, which is that the overall US life expectancy numbers conceal widely different outcomes by socioeconomic status. Faced with adversity, many Americans like to say that “we’re all in it together.” But when it comes to life expectancy, this isn’t true. Life expectancy is still rising for those Americans who are more affluent and better educated, while it is falling for those who are not. The United States is a nation already beset by deep divisions. Now we are adding one more to the mix.
America is usually quick to take action in response to immediate threats, as it did with Pearl Harbor, the 9/11 terrorist attacks and, however imperfectly, Covid-19. It finds it harder to act when faced with slow-motion crises whose costs only become apparent over the course of many years or decades. Yet such crises may be every bit as threatening to the nation’s future.
Confronting the gathering health crisis afflicting much of America will require far-reaching reforms. There will need to be a major educational campaign, involving all levels of government and civil society, that raises awareness of the risks of destructive lifestyle behaviors. It worked with smoking beginning in the 1960s, and it could work with obesity and substance abuse today. But education alone is unlikely to be enough.
Success will require reforms that improve today’s unequal access to the health care system, and especially primary care and preventive services. It may also require broader economic reforms that address the root causes of the ongoing divergence in US health expectancy and life expectancy, which are to be found, at least in part, in high poverty rates, rising income inequality, and the hollowing out of the middle class.
If we fail to meet the challenge, the costs to individuals and their families, to government budgets and to the overall economy will continue to mount. But the greatest cost of all may be the loss of social cohesion if Americans become two separate peoples, one long-lived and one short-lived.
Correction: An earlier version incorrectly omitted several words regarding the US opioid death rate, which as of 2016 was at least double that of every other country in the OECD except Canada and Estonia.