Whatever Happened to American Longevity?

By Maggie Mahar and Niko Karvounis, Health Beat. Posted May 4, 2008.

Life expectancy is a pretty simple concept: it's an estimation of how long the average person lives. Anyone can understand that. So how is this for a compelling data point: if you look at life expectancy in nations around the globe, you'll find that over the past 20 years, the U.S. has sunk from ranking  No. 11 to  ranking No. 42. In other words, a baby born in 2004 in any one of 41 other countries can expect to live longer than his or her American counterpart.

This may come as a surprise. Sure, we all know the health care system in the U.S. is broken, but life expectancy isn't just tied to medicine -- it's also related to quality of life in a larger sense. (I can live in a nation with the best health care system in the world, but if it's in the throes of civil war, my life expectancy will be short). As we all know, the American standard of living is the envy of the world.  After all, we're the richest country on the globe. So what gives?

While some of us are rich, the average American is not.  And while the rich are living longer, the poor are living shorter.  Factor in the profit motive that drives U.S. healthcare, and you will begin to understand why American medicine has done little to heal the gap between rich and poor.  Over the past twenty-five years, we have poured money into healthcare, but have paid relatively little attention to public health.

This may seem a bold claim, but last month the Congressional Budget Office (CBO) issued a report that provides the numbers:  "In 1980," the CBO found that "life expectancy at birth was 2.8 years more for the highest socioeconomic group than for the lowest. By 2000, that gap had risen to 4.5 years."

The report notes that "the 1.7-year increase in the gap" between socioeconomic groups "amounts to more than half of the increase in overall average life expectancy at birth between 1980 and 2000." In other words, even though the average life expectancy has increased in the U.S., it has grown more slowly because of widening socioeconomic disparities.

Citizens of countries that don't tolerate as much inequality enjoy longer lives. According to numbers from the Census Bureau and the National Center for Health Statistics, a baby born in the United States in 2004 will live an average of 77.9 years. In the U.K., an '04 baby can expect to live 78.7 years; in Germany, 79 years; in Norway, 79.7 years; in Canada, 80.3 years; in Australia, Sweden, and Switzerland, 80.6 years; and in Japan, a newborn can expect to live 81. 4 years.

Somehow or other, when they hear these figures, most Americans just shrug. Indeed, "it is remarkable how complacent the public and the medical profession are in their acceptance of" our low ranking when it comes to life expectancy, "especially in light of trends in national spending on health, " Dr. Steven Schroeder, a professor in the Department of Medicine at the University of California, San Francisco wrote in the New England Journal of Medicine last year.

"One reason for the complacency may be the rationalization that the United States is more ethnically heterogeneous than the nations at the top of the rankings, such as Japan, Switzerland, and Iceland. But," Schroeder pointed out, "even when comparisons are limited to white Americans, our performance is dismal. And even if the health status of white Americans matched that in the leading nations, it would still be incumbent on us to improve the health of the entire nation."

In the OECD countries that outrank us, the gaps between rich and poor are not as great and, not coincidentally, all have universal health insurance. (As Maggie wrote in an earlier post on Health Beat, in countries that are mainly middle-class, there tends to be more social solidarity. People identify with each other, and are more willing to pool their resources to pay for healthcare for everyone.)

But having access to health care is only a small part of health. Schroeder identifies five factors that determine health and longevity: "social circumstances, genetics, environmental exposures, behavioral patterns and health care."  Of these five, when "it comes to reducing early deaths," he points out, "medical care has a relatively minor role."  Indeed, "inadequate health care accounts for only 10% of premature deaths, yet it receives by far the greatest share of resources and attention." 

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Maggie Mahar is a fellow at The Century Foundation and the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006).

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