Columns for The Lufkin News

Life Expectancy in the United States

Posted May 13, 2023 by Sidney C. Roberts, MD, FACR

US life expectancy is lower than other developed countries. What is killing us? And why are some areas of the country (including deep East Texas) worse off than others? The answers may surprise you.

No, it’s not COVID-19 – though the pandemic did hit us harder than any other wealthy country.[1] Three years into the pandemic, more than 100 million cases have been reported and more than 1.1 million people have died.[2] The real death toll from COVID-19, based on excess deaths in the first 2 years of the pandemic, is probably 15% higher.[3]

Despite dwindling pandemic deaths, life expectancy in the United States continues to decline while life expectancy in other countries is improving. As John Burn-Murdoch writes in the Financial Times, “As recently as 10 years ago, you might have struggled to pick the US out of the pack on a chart of life expectancy, but today that task could scarcely be easier.”[4] The average US baby born today is expected to live four years less than a child born in similarly wealthy countries. I don’t know about you, but the older I get, those four years seem increasingly precious. But the gap within the United States is the real story. According to American Inequality, Americans born in certain areas of Mississippi and Florida may die 20 years younger than their peers born in parts of Colorado and California.[5]

What gives? Where does this discrepancy lie, if not from COVID-19? More specifically, why is life expectancy going up in other countries, but not the United States, where we stopped adding years way back in 2010?[6] There are many factors that influence life expectancy,[7] including high maternal mortality[8] and rising mortality rates among U.S. children and adolescents.[9] More broadly, so-called social determinants of health, which vary widely in this country, have been identified, including economic stability, education, access to quality health care, neighborhoods, and social context.[10]

For example, there is a “painfully high” correlation between household income and life expectancy.[11] Jeremy Ney, writing in American Inequality, notes, “Poverty in America is not about income alone. Low-income communities, regardless of the state, are more likely to struggle with access to affordable healthcare; they are more likely to live near toxic sites and develop lung cancer; they are more likely to live in food deserts and wrestle with illnesses like heart disease and obesity; and they are more likely to die younger from drug overdoses.”[12]

Burn-Murdoch looked at other factors that contribute to mortality. Obesity, for example, does account for a little over a year of excess mortality in the United States. Gun deaths – both homicide and suicide – as well as road accidents also account for some excess mortality. This makes sense; Americans are more overweight and drive a lot more than our European counterparts, and guns are ubiquitous.

Point of personal privilege here. I am a gun owner. I hunt dove in West Texas every Labor Day weekend. I would not be afraid to shoot an intruder – if they can get past my two German Shepherds. I do wish that the gun lobby would acknowledge that a sizable majority of Americans want stricter gun laws.[13]

A favorite slogan[14] of the National Rifle Association and others is guns don’t kill people; people kill people. And yet, the relationship between gun access and gun violence in the United States compared with other developed countries is undeniable. The interplay between gun violence, mental health disorders, and substance abuse is significant,[15] a fact that makes folly of simplistic answers. Yet, some answers – red flag laws, for example – are simple. Unfortunately, gun idolatry is now a core right-wing value.[16]

There is still one major topic we have not discussed. Those life expectancy impacts from obesity, guns, and accidents – though significant and avoidable – are not the main drivers in the United States according to Ben-Murdoch. The overlooked culprit? Opioids.[17] Ben-Murdoch states emphatically that overall US life expectancy would not have fallen in the absence of the opioid crisis.

National drug overdose deaths topped 100,000 in 2021,[18] driven largely by synthetic fentanyl. Have no doubt: fentanyl is in East Texas.[19] I am grateful for local prevention and treatment organizations like The Coalition,[20] ADAC,[21] and Burke[22] for the tireless work they do in Angelina County.

It may seem that the factors discussed above are entwined together in a Gordian knot,[23] never to be unloosed. Short of a modern-day Alexander the Great coming along and slicing the proverbial knot in half, we must support initiatives that attack each issue not only individually but cooperatively across the spectrum of health, education, and financial security.

Some concrete actions that may address state and regional disparities are ripe for government intervention[24] but can be politically sensitive. These include adopting Earned Income Tax Credits (EITC) and Child Tax Credits (CTC), Medicaid expansion, stricter gun control, and drug overdose prevention. All of these are areas where Texas can do better.

I have written several times about the need to expand Medicaid in Texas. KFF, a health policy and research organization, maps states that haven’t expanded Medicaid under the Affordable Care Act.[25] The correlation with poorer life expectancy is unmistakable.[26]

We don’t live as long in Angelina County as many other parts of the country. We land at 76.1 years,[27] nearly two years less than the US average of 78 years and a full decade less than the nearly 87 years of some counties. Jeremy Ney dreams, “While life may be unequal, death should not be.”[28] But death is unequal precisely because life isn’t equal. We must work together to love our neighbor in concrete, measurable ways. It might just add years to our lives.

[1] https://time.com/6270808/americas-life-expectancy-divide/

[2] https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html

[3] https://www.whitehouse.gov/cea/written-materials/2022/07/12/excess-mortality-during-the-pandemic-the-role-of-health-insurance/

[4] https://www.ft.com/content/b3972fb1-55d9-41a8-8953-aad827f40c28

[5] https://time.com/6270808/americas-life-expectancy-divide/

[6] https://jamanetwork.com/journals/jama/article-abstract/2802602

[7] https://www.npr.org/sections/health-shots/2023/03/25/1164819944/live-free-and-die-the-sad-state-of-u-s-life-expectancy

[8] https://www.npr.org/sections/health-shots/2023/03/16/1163786037/maternal-deaths-in-the-u-s-spiked-in-2021-cdc-reports

[9] https://jamanetwork.com/journals/jama/article-abstract/2802602

[10] https://health.gov/healthypeople/priority-areas/social-determinants-health

[11] https://americaninequality.substack.com/p/life-expectancy-and-inequality

[12] https://time.com/6270808/americas-life-expectancy-divide/

[13] https://apnews.com/article/gun-violence-covid-health-chicago-c912ecc5619e925c5ea7447d36808715

[14] https://en.wikipedia.org/wiki/Guns_don%27t_kill_people,_people_kill_people

[15] https://pubmed.ncbi.nlm.nih.gov/35039797/

[16] https://www.nytimes.com/2023/04/23/opinion/guns-shootings-stand-your-ground.html

[17] https://www.ft.com/content/b3972fb1-55d9-41a8-8953-aad827f40c28

[18] https://www.cdc.gov/nchs/products/databriefs/db457.htm

[19] https://www.cbs19.tv/article/news/local/fentanyl-related-deaths-in-east-texas-for-2022/501-fc4b73e3-88b1-4234-9386-fcdc0adadf38#longform_chapter_4

[20] https://www.angelinacoalition.org/

[21] http://www.adacdet.org/

[22] https://myburke.org/

[23] https://www.history.com/news/what-was-the-gordian-knot

[24] https://time.com/6270808/americas-life-expectancy-divide/

[25] https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

[26] https://twitter.com/nickmmark/status/1642565772567535616?s=51&t=4L_Itr3YfQ7jMXrwTfSWBw

[27] https://americaninequality.substack.com/p/life-expectancy-and-inequality

[28] https://americaninequality.substack.com/p/life-expectancy-and-inequality

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