Freedom and Mortality
Ten years ago, a panel at the National Institutes of Health issued a report under the title,
Shorter Lives, Poorer Health. These years later, the U.S. has experienced an unprecedented second consecutive annual reduction in average life expectancy, and last week we learned that the latest statistical analyses show maternal mortality reached an historical high mark in 2021. Steven Woolf, lead author of the maternal mortality paper told National Public Radio this was the first increase he has encountered in his career: "It's always been declining in the United States for as long as I can remember."
The broader outlook:
Across the lifespan, and across every demographic group, Americans die at younger ages than their counterparts in other wealthy nations.
How could this happen? In a country that prides itself on scientific excellence and innovation, and spends an incredible amount of money on health care, the population keeps dying at younger and younger ages.
One group of people are not surprised at all: Woolf and the other researchers involved in a landmark, 400-page study ten years ago with a name that says it all: "Shorter Lives, Poorer Health." The research by a panel convened by the National Academy of Sciences and funded by the National Institutes of Health compared U.S. health and death with other developed countries. The results showed – convincingly – that the U.S. was stalling on health advances in the population while other countries raced ahead.
The authors tried to sound an alarm, but found few in the public or government or private sectors were willing to listen. In the years since, the trends have worsened. American life expectancy is lower than that of Cuba, Lebanon, and Czechia.
(Simmons-Duffin↱)
Ten years ago, American children were less likely to live to age 5 than their cohort peers in other affluent nations. Study authors describe a "U.S. health disadvantage", with lower lifespan expectancy and lesser health than in other high-income countries.
Woolf explains that ten years ago, "We went into this with an open mind", trying to figure out the how and why of that disadvantage. Across age and ethnicity, economy and geography, "What we found was that the problem existed in almost every category we looked at."
That's why, says Eileen Crimmins, professor of gerontology at the University of Southern California who was also on the panel that produced the report, they made a deliberate choice to focus on the health of the U.S. population as a whole.
"That was a decision – not to emphasize the differences in our population, because there is data that actually shows that even the top proportion of the U.S. population does worse than the top proportion of other populations," she explains. "We were trying to just say – look, this is an American problem."
If we consider several ways of looking at the numbers, such as public health and medical care, individual behaviors, social factors, living environment, and public policies, Woolf says, "In every one of those five buckets, we found problems that distinguish the United States from other countries."
Yes, Americans eat more calories and lack universal access to health care. But there's also higher child poverty, racial segregation, social isolation, and more. Even the way cities are designed makes access to good food more difficult.
"Everybody has a pet thing they worry about and say, 'it's oral health' or 'it's suicides' – everyone has something that they're legitimately interested in and want to see more attention to," says John Haaga, who was the director of the Division of Behavioral and Social Research at the National Institute on Aging at NIH, before he retired. "The great value of an exercise like this one was to step back and say, 'OK, all of these things are going on, but which of them best account for these long-term population level trends that we're seeing?' "
The answer is varied. A big part of the difference between life and death in the U.S. and its peer countries is people dying or being killed before age 50. The "Shorter Lives" report specifically points to factors like teen pregnancy, drug overdoses, HIV, fatal car crashes, injuries, and violence.
"Two years difference in life expectancy probably comes from the fact that firearms are so available in the United States," Crimmins says. "There's the opioid epidemic, which is clearly ours – that was our drug companies and other countries didn't have that because those drugs were more controlled. Some of the difference comes from the fact that we are more likely to drive more miles. We have more cars," and ultimately, more fatal crashes.
"When we were doing it, we were joking we should call it 'Live free and die' …", Crimmins says..
And while it was not all bad news, ten years ago, even the good news was laced through with shadow": With higher survival rate
after 75, higher screening and survival rates for cancer, better attendance of blood pressure and cholesterol, lower stroke mortality, fewer smokers per capita, and higher average income, Americans are still showing some sort of "disadvantage": "Behind the statistics," the study said, "are the faces of young people – infants, children, and adolescents – who are unwell and dying early because conditions in this country are not as favorable as those in other countries."
But if sometimes the recommendations seem pretty straightforward—
The NIH should undertake a "thorough examination of the policies and approaches that countries with better health outcomes have found useful and that may have application, with adaptations, in the United States," the authors wrote.
In other words: let's figure out what they are doing that works in other places, and do it over here.
Dr. Ravi Sawhney, who helped conceive of and launch the "Shorter Lives" study at NIH before he left the agency, had high hopes that the report would make a mark. "I really thought that when the results came out, they would be so obvious that people would say: Let's finally do this," he says.
Ten years on, how much of the detailed action plan has been done?
"To be brief, very little of that happened," Woolf says.
Woolf suggests NIH officials were not interested in promoting awareness of the report, nor following up on research recommendations. Crimmins suggests, "There was a little bit more research, but there wasn't any policy reaction. I thought there might be, because it's embarrassing, but it just tends to be ignored." She also noted that some interest comes from people seeking "marvelous things they think are going to delay aging". Haaga agrees that, "Not nearly enough has been done, given the stakes and whate we could learn."
In response to NPR's request for comment for this story, NIH pointed to a subsequent panel on midlife mortality, several initiatives the agency has undertaken on disparities between subgroups within the U.S., and a recent paper funded by NIH that looked again at international life expectancy.
Outgoing NIH Director Francis Collins told NPR in 2021 that it bothered him that there hadn't been more gains to American life expectancy during his tenure. In his view, the success of NIH in achieving scientific breakthroughs hadn't translated to more gains because of problems in society that the research agency had little power to change.
Woolf calls it a misconception to assume that America's great scientific minds and medical discoveries translate to progress for the health of the population. "We are actually very innovative in making these kinds of breakthroughs, but we do very poorly in providing them to our population," he says.
DSHS Secretary Xavier Becerra considered life exepectancy during a recent press conference, pointing to Covid, vaccine hesitancy, mental health, and firearm violence. Of the latter, he said, "We can't touch everything. We can't touch state laws that allow an individual to buy an assault weapon and then kill so many people. We can only come in afterwards."
CDC, like NIH, responded to NPR by pointing out some of their research work on related subjects, and HHS ducked a question suggesting a national commission to address life expectancy and health concerns.
Sawhney blames the federal government, complaining that Americans already know they are overweight, sicker, and shorter-lived than others, but, "It's just the NIH and the CDC that don't want to take the responsibility for that failure."
Crimmins observed that lawmakers and other officials just don't like the issue. She convened a meeeting with CDC, and brought international experts, only to be told, "we can't have anything but an American solution to these issues". Haaga agrees that "international studies are not the flavor of the month", and "never will be".
Woolf believes the larger tragedy of excess deaths in the U.S. "dwarfs what happened during COVID-19 … We've lost many more Americans cumulatively because of this longer systemic issue."
And the answers these experts describe are familiar: Learn and understand what works, and then apply those solutions, such as universal health care, health and safety protections, education access, and early childhood wellness.
But that's the thing: Americans aren't ready to agree to that sort of outcome, ostensibly for the sake of "freedom".
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Notes:
Simmons-Duffin, Selena. "'Live free and die'? The sad state of U.S. life expectancy". National Public Radio. 25 March 2023. 26 March 2023. http://bit.ly/3TNi1Cn