Why is American life expectancy declining for the second time in a row?

Despite having the hightest healthcare spending among peer wealthy nations, the US has a shorter life expectancy compared to those countries which spend far less on healthcare.

According to the latest report from the National Center for Health Statistics, the last two years marked the biggest drop in a century, with an estimated life expectancy falling to 76 years for Americans born in 2021.

The US has the highest per person healthcare spending, reaching an estimated $12,318 per capita in 2021 based on the Organization for Economic Cooperation and Development (OECD). Still, life expectancy has declined since 2014.Until 2014 life expectancy at birth in the US — a crucial indicator of population health —was steadily rising. Yet it plateaued and then dropped.

According to the data from the Centers for Disease Control and Prevention, an American was expected to live nearly 79 years in 2020, however, life expectancy fell to 77 and dropped further, to just over 76, in 2021.

Here are the top drivers of declining life expectancy in the US for the second time in a row.

While Covid-19 mortality and accidental injuries driven by drug overdoses accounted for about two-thirds of the decline in life expectancy, lifespan is also affected by the additional factors such as gun-related homicide and suicide, road accidents, maternal mortality, heart and liver disease and socioeconomical inequalities among nations.

1. COVID-19: The US drop-off is largely driven by the pandemic. Since the beginning of the pandemic, Covid-19 has claimed the lives of over a million Americans, by far the highest reported death toll of any country. In 2021, coronavirus remained the third biggest cause of death among nations.

Other causes of death in the United States, such as heart disease, accidents, stroke, Alzheimer's disease, and diabetes, have also been indirectly impacted by the pandemic, probably because of people being hesitant to seek medical care for fear of contracting Covid-19.

In the next few years, the pandemic's effects on several other causes of death might also become apparent, according to the researchers. For instance, the pandemic kept many people from obtaining their routine cancer screening, which could lead to an increase in cancer mortality in the future.

2. Overdoses: The new numbers also reflect the acute mental health crisis that has developed along with the pandemic. Almost 106,000 people died last year from drug overdoses, which has a significant role in reducing life expectancy in the US.

In the US the mortality rate has increased more than 10-fold since 1990, while overdose deaths have continued to be a very uncommon cause of death in other countries. 

No other nation has experienced a rise in overdose deaths as significant as the US, affecting life expectancy in the country because many victims are relatively young. Today, while the US has by far the highest fatality rate for overdoses, these deaths are still thankfully a relatively rare cause of death overall. 

3. Maternal mortality: Maternal mortality is the other leading cause of death contributing to the decline in life expectancy in the US. Although maternal mortality is declining in almost all countries around the world, mother deaths are becoming more common in the US. According to the report, 1,205 people died of maternal causes in the US in 2021, which represents a 40% increase from the previous year. 

4. Suicide: The average lifespan of Americans has decreased also as a result of an increase in suicide that are a high risk for younger people.  The US stands out in particular in suicides from firearms, which are uncommon in other countries around the world. 

5. Poverty and economic inequality: Deep-rooted inequities and structural racism are also contributing more to ethnic breakdown in life expectancy than other rich countries.

According to Ann Bullock, a former head of diabetes treatment and prevention at the federal Indian Health Service agency, Native American and Alaska Native populations had the lowest life expectancy of any race or ethnicity, 65.2 years.

Indigenous peoples, who already had high rates of chronic disease —  resulting from poverty, prejudice, and limited access to healthcare —  made them vulnerable to serious Covid-19.

What can be done?

The recent decline of 2.7 years since 2019 was the largest since World War I — and erased all of the gains in life expectancy since 1996, according to Joshua Sharfstein, director of the Bloomberg American Health Initiative.

“We have to shake off the feeling that things are going to just keep getting worse,” he says, adding that there are no quick fixes, but there are absolutely things that can be done. 

The report published by Bloomberg American Health Initiative outlines 10 critical yet practical steps for how decision makers at all levels can address the root causes of declining life expectancy in the US. Some important highlights from article suggest below:

Congress should approve the Biden administration's complete request for more funds for public health outreach, COVID-19 vaccination, therapies, and research in order to put the country on the path to health.

Even without so many deaths from Covid, US life expectancy would still be declining due to overdose. Fatal overdoses are most often caused by fentanyl, which is today sold for direct consumption as well as combined with other drugs, such as methamphetamine and cocaine.

Effective treatment with medications for opioid use disorder, and providing access to medications can support an American's journey toward recovery.

READ MORE: US life expectancy falls for second straight year, Covid-19 a key factor