The photo above is one I took during my recent vacation to Germany. While stopping to tour a beautiful church in a picturesque small Bavarian town, we wandered into the adjacent cemetery and stumbled upon the gravestone of this local legend, who lived (in the 1700s, before modern medical care!) to the ripe old age of 117. I’ve been thinking of Herr Adner lately, because here in 21st century America, things are looking less rosy. After two centuries of unabated progress, in which the health and longevity of Americans slowly but steadily improved, Americans as a whole are getting sicker and dying younger than they were just even a few years ago. In 2019, the average life expectancy in the US was 79; now it’s down to about 76.
Average life expectancy of course is just that – a population average. If we drill down further, there are glaring differences in how well and how long Americans live. A college educated person in New England, for example, is likely to live a much longer life than a high school graduate in the deep south. A rich person on average will liver longer than a poor one. Whites, Asians, and Hispanics tend to live longer than African-Americans or Native Americans. So the average life expectancy is a statistic that obscures some more subtle and nuanced points about the health of American citizens. But still – it’s not like America is dramatically more diverse than it was a decade ago, and these discrepancies have always existed, so the drop in overall life expectancy is a red flag that something is going very, very, wrong in these United states.
Some of the drop in life expectancy is due to specific things that have occurred in the past few years. A lot of Americans died during the COVID pandemic, for example, which certainly accounts for much of the drop in life expectancy during 2020 and 2021, but shouldn’t be having any kind of continued impact. Most other nations saw a drop in life expectancy during those years, but have since rebounded to their pre-pandemic levels or even better.
Then there are the so-called “deaths of despair,” surrounding suicide and opiate use. But even these to me represent an ominous warning sign. Why should a country that (whatever it’s faults, and I don’t deny there are many) largely enjoys peace and prosperity be seeing so many of its citizens self-destruct?
It’s high time that we started paying serious attention to this issue. Our “peer nations” (think of places like the UK, Germany, Japan, Canada, and other countries that are comparable to the US in terms of having a democratic form of government, a largely market driven economy, and a reasonably prosperous standard of living) just aren’t seeing the same levels of decline in health and life expectancy that we are. In fact, many of them are still seeing a slow but steady increase in longevity. No – something is going uniquely wrong in these United States.
Nor is it the case that Americans are living better lives during the time they are here on this earth. Rates of almost every disease imaginable, from cancer, to depression, to diabetes, to dementia, continue to increase. So it’s not just that Americans are, on average, dying younger than they were a few years ago. They are also tending to be sicker, to require more healthcare, and to take more medication along the way.
As a nation we smoke less than many of our peer nations (for example, the French are about twice as likely to smoke as we are), earn much more per capita than almost all of them, and spend a lot more on healthcare. If one were simply to ponder these facts in isolation, they would assume that America would be one of the healthiest countries on earth. And yet, we are as a nation becoming fatter, sicker, more depressed, and shorter-lived than just about any other nation with an advanced economy.
What in the world is going on? To give you the punchline, I’m not 100% certain. Nobody is. But I do have some thoughts on the matter.
The American food supply is more processed than that of most countries. The consumption of ultra-processed foods is an issue in all modern industrialized nations, but Americans eat way more processed foods than people in most other countries (close to 70% of our caloric intake at last count). And many ingredients that are used heavily here in the states are either banned or severely curtailed in other countries. Europeans, for example, put much less high-fructose corn syrup into their food supply than we Americans do. I have previously blogged about the dangers of ultra-processed foods here.
The American environment contains many harmful chemicals that are banned in most other countries. To give just one example, the pesticide paraquat has been implicated in studies going back to the 1960s to increase the risk for Parkinson’s disease and other neurological disorders. The use of this chemical is banned in most other countries, even in China, which is not a country that is exactly famous for having strict environmental regulations. But not so in the US, where it continues to be widely applied to many crops. Thus, Americans are on average exposed to heavier toxic loads than our counterparts in other advanced countries.
America is a more car-oriented country than most of our peer nations. Don’t get me wrong – I love driving as much as the next American, but the fact is that many Europeans, for example, live in more walkable places. So while they do drive a lot, they also are likely to take short walks to go on little errands, or to head to the pub or restaurant around the corner. This means that just in their daily lives, they get a bit more exercise than we do. It also feeds a sense of community that is sorely missing in many parts of America. It’s easier to know your neighbors, for example, when you are likely to bump into each other on the street or at the local bar. I’ve been struck by this any time I travel in Europe, where things like cafes, pubs, and beer gardens are wildly popular and frequently crowded at all hours of the day and night. By contrast, in many parts of the United States, it’s very possible to rarely interact with another human being for long periods of time, which increases the risk for loneliness and social isolation, both of which are strongly associated with increased risk for disease and premature death.
Americans tend to work longer hours than their colleagues in most other countries. Again, don’t get me wrong. Hard work is a good thing, and is one of the reasons why we have a higher standard of living than many other countries. But the work culture here in the US is notoriously high stress, with many workers being expected to put in long hours at the office and then be available even on their off time to respond to emails and text messages. This is not the norm in many other countries, where most workers are expected to work hard at the office, but then take time off to “recharge.” To give just one obvious example, the average American gets 2-3 weeks of vacation per year – and sometimes don’t feel they can even take that – while in most European countries it’s 6-10 weeks. There are real benefits to having an economy that values a strong work ethic, but it’s also just common sense that it’s not good for humans physical or mental health to be constantly under stress.
All modern nations are dealing with the problems of modern life – pesticides in the environment, the proliferation of junk food, the high costs of healthcare, and the changing social and emotional landscape that have been brought by technological advances such as cell phones and social media. Places like Denmark or Finland, which are notable for having happier, healthier, longer-lived populations are no exception. But clearly these other nations are managing these challenges much more effectively than we Americans are.
If we are going to make headway in reversing our slide into decline, we are going to need to start demanding solutions from our politicians. What those solutions are is open to debate, and it is not my place as a doctor to stake out any particular political position – I am a doctor to my patients equally whether they are a Republican, a Democratic, or anything else. My intention here is not to suggest any specific policy proposal, but rather that – whatever your political affiliation and philosophy – it would be worth making your representatives aware that you are concerned about these issues and would like them to consider what might be done about them.
But there is also a strong role here for individual action. You don’t need an act of congress to start making changes in your own life. Get some exercise every day. Prioritize getting good sleep and spending time with your friends and family. Learn to set some boundaries between your work and personal lives. Cut out processed foods from your diet, and when possible, buy foods that are organic or locally produced, and hence less likely to be tainted by a high pesticide load.
By all means, advocate for our leaders to take action, but don’t wait for them to do so. Ultimately, this is your life, and it’s up to you to treat your body as best as you are able.
