Thursday, November 29, 2018

US life expectancy falls again

I had planned to tackle a different topic today until I saw the front-page story announcing “U.S. Life Expectancy Falls Further.” The Centers for Disease Control (CDC) released data on Thursday showing that life expectancy in 2017 fell by a tenth of a year, to 78.6 years. While this may not sound like much, it is in stark contrast with what is happening in most of the developed world, where life expectancy is rising. The U.S. has lost three-tenths of a year since 2014, an astonishing reversal for a wealthy nation, and lags even further behind our peer countries. Life expectancy in Japan is 84.1 years and in Switzerland it is 83.7; these are the two OECD nations with the highest life expectancy. Of the 36 OECD nations, the U.S. ranks 29th. So much for the nonsensical claim that changing our current health care system would result in our losing our “best in the world” health care. Somehow “We’re number 29!” just does not have much ring to it, does it?
As I point out in Prescription for Bankruptcy, not all of a nation’s health is due to health care. One could make the argument that the health care system is actually less important than social factors in determining a country’s overall state of health. When John Snow stopped the Broad Street cholera epidemic in London a century and a half ago, he did it not by inventing a new medication but by removing the handle off the water pump that was the source of most of the local cholera. The dramatic fall in cardiac deaths in the U.S. in the past decades has owed less to medical intervention than to the very effective anti-smoking campaigns that have reduced cigarette smoking.
One of the factors behind our depressing fall in life expectancy has been the increased rate of suicide in the U.S. Around the world, increased urbanization and social stability have led to a dramatic 29% drop in suicides since 2000 (see: The Economist, Nov 24/2018), while in the U.S. the suicide rate is up 18%. Rates are highest among those who have suffered job loss and loss of social support, and are highest among those in the most rural areas. The ready availability of firearms means that when a suicidal impulse occurs – and it is by far most often an impulsive action rather than a carefully-planned decision – it is likely to be “successful.” Also playing a role is the opioid epidemic, and the increased availability of very potent opioids such as fentanyl. These deaths play an outsized role in our lower life expectancy because they occur in young adults.
To move up from the bottom of the heap, we need to reduce the easy access to guns, put more effort into fighting the opioid epidemic, and vastly improve our social support network. A $1 million spent on a new gene therapy may save one life. The same $1 million spent on suicide prevention could save hundreds.

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