June 2023
By Richard Fleming
Photo courtesy of Bruno Aguirre
There is no single, universally-agreed-upon time when each of us leaves mid-life and enters old age. But there is no denying a qualitative change occurs in those of us fortunate enough to live into the golden years. This transition into old age is marked by profound changes: physical, emotional, social, cultural, and economic, among others. In past articles I have reflected on some of these subjects. And in future posts I will continue examining our journey into and through old age.
But today I want to discuss a different, very concerning phenomenon.
For people living in the U.S., our lifespans are falling. In other developed countries, life expectancy is increasing. But not in these United States. I do not mean to be alarmist, but if this problem continues, consider one of the implications – old age may start earlier here than in other developed countries.
Let me explain. For most of the 20th Century, life expectancy in economically developed countries increased over time. The U.S.’s upward trend closely paralleled our peer countries. But starting in 1980, a gap appeared between us and other developed countries. U.S. life expectancy continued increasing, but at a slower rate than elsewhere. Over the subsequent three decades, the gap continued to widen.
Then something unexpected happened. Beginning in 2010, life expectancy in the U.S. stopped increasing. We plateaued. In 2010 our average life expectancy was 78.7 years. Ten years later we lived only one month longer, on average. Among comparable countries, life expectancy continued increasing. In 2010 it was 81.4 years. A decade later it had improved to 82.6 years.
This trend is worrisome. But what happened next is even more startling.
In 2020, because of Covid-19, life expectancy fell around the world. In the U.S., the average lifespan decreased by almost two years. Among our peer countries, lifespans dropped by six months. In late 2020, vaccines became available and Covid treatment protocols advanced. In 2021, thanks to improving approaches to the pandemic, lifespans in our peer countries recovered dramatically, returning almost to their 2019 levels. What happened in the U.S.? In 2021, life expectancy dropped by another year.
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When I was growing up in the 1950s, common wisdom held children would outlive their parents. As healthcare, nutrition, economic security, and safety net programs improved, increasing longevity for each generation was an expectation. A birthright.
But in our country today, this is no longer the case. If current developments hold, many children born in the 2020s may live shorter lives than their parents. Or even their grandparents. There is little doubt children born in the U.S. will, on average, die earlier than children born in Western Europe or a number of Asian countries.
A country with our resources, knowledge base, and technology should do better. But for the past four decades we have been falling further and further behind comparable countries.
The reasons are not complicated. Good health insurance is unavailable to many people in the U.S. Safety net programs are withering. Economic insecurity is worsening year by year for many swaths of the population, which contributes to deaths of despair. Mortality from drug overdoses, gun deaths, and suicide is climbing.
Life expectancy by county
While the lifespan averages I have cited refer to the country as a whole, longevity in the U.S. varies dramatically depending on where you live. From one state to another, life expectancy differs by up to nine years. From one county to the next, life expectancy varies by as much as 20 years. This should not be surprising. State and local government policies vary on issues like access to health care, availability of safety net programs, nutrition assistance programs, gun safety policies, and access to addiction treatment.
Another mortality difference stems from variability in Covid vaccination rates. On both a county and state level, regions with higher vaccination rates have higher life expectancy.
Mortality rates also vary depending on who you are. There is a significant and longstanding racial disparity in longevity in our country. African Americans tend to die 3-4 years earlier than white Americans. Native Americans have the highest mortality rates, living 7 years less than white Americans.
Gender differences in lifespan are also significant. Women tend to live about five years longer than men in the U.S.
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In the middle of the last century, the average lifespan was about 69 years. In those days, old age began around 60. As decades passed, the onset of old age seemed to be pushed later as lifespans lengthened. Today there is certainly room for debate on when old age starts, but 65 years, give or take, is a fair estimate. By that age, mid-life is definitely in the rearview mirror. We enroll in Medicare. Our vision for the future is becoming murkier and the horizon is drawing closer.
But if current trends continue, we may have to recalibrate our expectations for when old age begins. In the future, I wonder if people will once again feel that old age in the U.S. starts at around age 60. In contrast, Japan and Germany may view old age as starting around age 70.
Will the earlier start to old age in the U.S. be a source of national embarrassment? Will it lead to any policy changes? I hope so. Solutions to our mortality problem are not complicated. Many other countries have systems in place which are proven effective. I fervently wish our kids and grandkids can live longer and healthier lives than us.
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I’m a believer that this trend is almost entirely due to our increasingly sedentary life styles and horrible diets, which also do little for our mental health. Fat and physical laziness gets us nothing but debilitating affect on our health. One of my doctors, originally from South America, told me the America diet is the worst on the planet. Sugar and salt laden. Oh, but I love to set on my couch and have my big bowl of chocolate smothered ice cream and cookies.
Excellent post, Richard. How shameful that we’re lagging so far behind so many other countries, and falling ever further behind.
That county-by-county map is illuminating, disturbing and not surprising.
The ACA was a step in the right direction for health care. But I fear that future progress will be blocked by cries of “socialized medicine!” and ongoing right-wing deflection to other topics, such as media attacks on immigrants, trans teens, etc,
Thank you! Very interesting and informative.
Hi-I have been reading and really enjoying your posts since another classmate of ours, Joanne DePhillips, told me about it. I am particularly interested as I have aged significantly following 6 spine surgeries and ongoing nerve pain for the last 7 years. I have now just had surgery to implant a neurostimulator which finally is beginning to provide relief. Having had to retire in 2021 because of the pain, I am working to develop new interests in things like music and gardening. And, I practice being grateful, for my loving husband, grown kids, and dear friends who have helped me through this very dark time. Even at 75, I am looking towards brighter days.
Could fentanyl or misuse of drugs in general have anything to do with it?
Unfortunately, I believe our political climate promoting science deniers made things worse during the pandemic. With their current attitude towards education I do not think this behavior will improve anytime soon and may get worse.
Thank you Richard for your words of wisdom, and pointing out a sad state of affairs in our country. I wonder how we can convince people in those counties that they have a problem. That is the first step to trying to solve the problem.
A purposely provocative post with good data, Thanks, Richard!
Richard, I enjoy reading your comments. Positive thoughts and prayers for the safety, health, and happiness for you and your family. Take Care
Hi Richard,
Excellent information to share with our patients to educate them. It is clear that life span in USA is a bimodal curve and IF we take better care of ourselves with cardiac fitness , diet and exercise, avoid alcohol and tobacco and have access to good medical care to control weight, BP and BS and restrict our sugar and salt intake that we can change these stats and match the Europeans or Asian countries. It would be interesting to look at mortality by each STATE… I think that data is available and some states clearly lag behind because of drugs, tobacco, poor access to medical care and also high perinatal mortality and gun violence etc
Nice topic…also major health care organizations need to do a better job at the education and chronic care programs. Perhaps the NHS from UK can teach us a few things!!?