As life expectancy and fertility rates decline, health politics more key than ever

Lifeexpectancydecline2019-300x205Ohio, Pennsylvania, Kentucky, and Indiana — if you’re obsessed with national politics, these states might register in your mind as key partisan battlegrounds. But if you’re focused on Americans’ health and well-being, these states — along with New Hampshire, Maine, Vermont, and West Virginia — may be causes for different and considerable concern: the nation’s plummeting life expectancy.

These states are flashing warning signs, racking up the greatest relative increases in death rates among young and middle-aged adults (New Hampshire, Maine, Vermont, West Virginia, and Ohio).

Excess deaths among Americans in their prime, that is individuals in the 25 to 64 age group who would live longer if mortality rates improved, also were highly concentrated geographically, with fully a third of them in just four states: Ohio, Pennsylvania, Kentucky and Indiana, experts say.

Public health officials have watched with growing consternation as the U.S. life expectancy has fallen now for three years in a row, declining in a way not experienced in other major, Western industrialized nations, according to a new study published in the Journal of the American Medical Association.

Americans, notably in certain areas, are dying younger than they should be in a trend not seen for decades — not since masculinity revolved around multiple martinis at lunch, devouring thick and rare steaks for as many meals as possible, and, of course, smoking a pack or two of cigarettes each day.

But the nation’s heightened mortality reflects more than just the 1960s unhealthful ways, the JAMA study found. As the Washington Post reported:

 “[T]he broad trend detailed in this study cuts across gender, racial and ethnic lines. By age group, the highest relative jump in death rates from 2010 to 2017 — 29% — has been among people age 25 to 34.”

As the New York Times reported:

“[T]he increased death rates among people in midlife extended … to suburbs and cities. And while suicides, drug overdoses and alcoholism were the main causes, other medical conditions, including heart disease, strokes and chronic obstructive pulmonary disease, also contributed.” The newspaper further added the problem had its “onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England.”

The United States spends significantly more on health care — an estimated $3.5 trillion plus — than comparable Western industrialized nations, while seeing much poorer outcomes, including its declining life expectancy.

This issue cannot be ignored, Dr. Steven Woolf of Virginia Commonwealth University and the study’s lead author, told the New York Times because:

“The whole country is at a health disadvantage compared to other wealthy nations. We are losing people in the most productive period of their lives. Children are losing parents. Employers have a sicker work force.”

The overall lessened life expectancy had its exceptions, failing to hit those who live in metropolitan areas on the coasts, the very young and old — the latter two groups, perhaps, benefiting from big health programs like Medicaid and Medicare.

The hollowing out of the heartland, with its accompanying economic and social despair, has been faulted before as a big cause of life expectancy declines. But answers have eluded politicians, who have targeted battleground states for heavy campaigning and steady promises of steps for regional renewal. Alas, the occupations that once made the areas flush, happy, and optimistic — agriculture, manufacturing, and mining — aren’t in demand in the 21st century as they once were.

The opioid crisis, along with other diseases of despair, have torn apart the declining parts of the nation, fueling the national decline in life expectancy.

Researchers also have announced another falling key metric in the country: The U.S. fertility rate, for the fourth year in a row, extending a steep downward line. As the New York Times reported:

“There were 59.1 births for every 1,000 women of childbearing age in the country last year, a record low, according to the National Center for Health Statistics. The rate was down by 2% from the previous year and has fallen by about 15% since 2007 …Fertility rates are essential measures of a society’s demographic balance. If they are very high, resources like housing and education can be strained by a flood of children, as happened in the postwar Baby Boom years. If they are too low, a country may find itself with too few young people to replace its work force and support its elderly, as in Russia and Japan today.”

The fertility rate plunged with the Great Recession, and experts quoted by the newspaper theorize that young women, in particular, may be slow to start families as they struggle to start careers and establish themselves sufficiently to feel comfortable enough with their economic standing to bear children. This is not helped by young men’s difficulties in keeping up with educational and skill demands to be productive parts of a changing world of work that requires high levels of education and other capacities.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of medical therapies and prescription medications, too many of which turn out to be dangerous drugs.

Staying fit and healthy can be an important way to avoid the considerable problems in the health care system, fraught with medical error, hospital infections and deaths, and misdiagnoses. But if patients can’t make ends meet, are beset with stress and anxiety about their lives, and lack the optimism to care for themselves and their loved ones today so they maintain their well-being for the future, the nation has serious problems.

Health care must a right, not a privilege, and politicians and voters must see that social determinants — including big factors that affect how we live and work — have huge influence on our well-being. Our collective well-being has major sway whether the nation advances or declines. So, we cannot be a country divided, with those who happen to live in one state significantly healthier than those in another. People need good jobs, sound health care, and hope and optimism to prosper. Voters should keep this in mind for the 2020 elections and find leaders who not only make big promises but also have a record of delivering on them.

Graphic credit: Virginia Commonwealth University
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