How long a person can expect to live is one of the most fundamentally revealing facts about a country, and here, in the richest country in the world, the answer is not just bleak but increasingly so. Americans are now dying younger on average than they used to, breaking from all global and historical patterns of predictable improvement. They are dying younger than in any peer countries, even accounting for the larger impact of the pandemic here. They are dying younger than in China, Cuba, the Czech Republic or Lebanon.
You may think this problem is a matter of 70-year-olds who won’t live to see 80 or perhaps about the so-called deaths of despair among white middle-aged men. These were the predominant explanations five years ago, after the country’s longevity statistics first flatlined and then took a turn for the worse — alone among wealthy nations in the modern history of the world.
But increasingly the American mortality anomaly, which is still growing, is explained not by the middle-aged or elderly but by the deaths of children and teenagers. One in 25 American 5-year-olds now won’t live to see 40, a death rate about four times as high as in other wealthy nations. And although the spike in death rates among the young has been dramatic since the beginning of the pandemic, little of the impact is from Covid-19. Over three pandemic years, Covid-19 was responsible for just 2 percent of American pediatric and juvenile deaths.
Firearms account for almost half of the increase. Homicide accounted for 6.9 percent of deaths among that group, defined as those 19 years old or younger, and suicide accounted for 6.8 percent, according to a January analysis published in JAMA Network Open. Car crashes and accidental drug overdoses — which the National Center for Health Statistics collates along with other accidental deaths as “unintentional injuries” — accounted for 18.4 percent. In 2021, according to a JAMA essay published in March, more than twice as many kids died from poisoning, including drug overdoses, as from Covid-19. More than three times as many died of suicide, more than four times as many died from homicide, and more than five times as many died in car crashes and other transportation accidents (which began increasing during the pandemic after a long, steady decline).
Last week, the former Treasury secretary Larry Summers called the deepening life expectancy crisis, documented in recent surveys and studies, “the most disturbing set of data on America that I have encountered in a long time” and “especially scary remembering that demographics were the best early warning on the collapse of the U.S.S.R.” In many ways this feels like hyperbole. And yet, by the most fundamental measures of human flourishing, the United States is moving not forward but backward, at unprecedented speed, and now the country’s catastrophic mortality anomaly has spread to its children.
The new life expectancy studies pick up the thread of work by Anne Case and the Nobel laureate Angus Deaton, economists who, beginning in 2015, suggested that a broad social malady was visible in the growing mortality rates of non-college-educated white men in middle age. Their research into what they called “deaths of despair” offered a sort of data-based corollary to a narrative about the country’s left behind, stitched together in the aftermath of Donald Trump’s rise, in part to make sense of it. In the years since, the same data has invited a whole competitive roster of divergent analyses: that such deaths reflected social dysfunctions driven by ballooning income inequality; that they illustrated health disparities that frequently tracked those inequalities, from obesity and cigarette smoking; that they showcased the country’s threadbare social safety net, which briefly expanded during the pandemic and then abruptly shrank; that they arose from striking declines in what conservatives often call prosocial values like patriotism and religiosity.
The new data tells a somewhat different story. In the big picture, opioids still play a large role, and suicide contributes, too. But that pattern of elevated middle-aged mortality is giving way to a growing crisis of juvenile death. The demographics are shifting away from those narrow markers of class and race identified by Case and Deaton, as well.
Mortality is still increasing more quickly for those without a college degree, but as John Burn-Murdoch demonstrated vividly in The Financial Times, except for a few superrich Americans, individuals at every percentile of income are now dying sooner than their counterparts in Britain, for instance. For the poorer half of the country, simply being an American is equivalent to about four full years of life lost compared with the average Brit. For the richer half, being an American is not quite as bad but is still the equivalent of losing, on average, about two years of life. And this is even though an American earning an income in the 75th percentile is much richer than a Brit at the same income percentile, since American incomes are much higher.
This is not to say that longevity declines are uniform, exactly. Black Americans, on average, can expect to live five fewer years than white Americans; Black American men have lower life expectancies than men in Rwanda, Laos and North Korea. White Americans, in turn, can expect to live seven fewer years than Asian Americans. Life expectancy in the Black Belt of the Deep South is as much as 20 years lower than it is north of the Mason-Dixon line and west of the Mississippi, according to the American Inequality Project. And there is even a notable difference between counties that supported Joe Biden in 2020 and counties that supported Trump.
While the past few years of data are skewed by Covid mortality, you still see the American anomaly even if you subtract the pandemic: In all other nations of that counterfactual world, The Financial Times calculated, life expectancy would have either stabilized or increased, while in the United States the huge surge in violent deaths alone would have cut the country’s life expectancy by a full year.
For earlier generations, life expectancy at birth was often a misleading statistic, because before modern medicine, if a person survived childhood and adolescence, he or she could be expected to live at least to contemporary middle age, and so the remarkably low median life expectancy estimate was suppressed by how many newborns did not make it to 10 or 20. (Thomas Jefferson wasn’t an old man when he wrote the Declaration of Independence at 33, when life expectancy was probably about 45, but only two of his six children with his wife, Martha, survived to adulthood.)
In modern America, a similar if less dramatic threshold appears to have emerged. If you make it to retirement age, you can expect to live about as long as your counterparts in other wealthy countries. This is its own kind of failure, given how much more money Americans spend on health care. But it is merely a waste, not a horror. The horror is that, as Burn-Murdoch memorably put it, in the average American kindergarten at least one child can expect to be buried by his or her parents. The country’s exceptionalism of violence is more striking among the young but extends into early adulthood; from age 25 to 34, Americans’ chances of dying are, by some estimates, more than twice as high, on average, as their counterparts’ in Britain and Japan.
And the death rates are growing at a startling speed. According to that March JAMA essay, the death rate among America’s youths increased by 10.7 percent from 2019 to 2020 and 8.3 percent from 2020 to 2021. The phenomenon was more pronounced among older children and adolescents, but the death rate among those age 1 to 9 increased by 8.4 percent from 2020 to 2021, and almost none of that effect was the result of the pandemic itself.
The pandemic years look even grimmer when we examine pediatric mortality by cause. Guns were responsible for almost half of the increase from 2019 to 2020, as homicides among children age 10 to 19 grew more than 39 percent. Deaths from drug overdoses for that age cohort more than doubled. In 2021, as schools reopened, pediatric deaths from Covid nearly doubled but still accounted for only one-fifth of the increase in overall pediatric deaths — a large increase on top of the previous year’s even larger one.
The disparities are remarkable and striking, as well. Most of the increase in pediatric mortality was among males, with female deaths making only a small jump. Almost two-thirds of the victims of homicide were non-Hispanic Black youths 10 to 19, who had a homicide rate six times as high as that of Hispanic children and teenagers, and more than 20 times as high as that of white children and teenagers. In recent years, the authors of the JAMA essay write, deaths from overdose were higher among white children and teenagers, but increases in the death rates among Black and Hispanic children and teenagers erased that gap, statistically speaking, in 2020.
In this way, the new data manages to invert and upend the deaths of despair story while only confirming the country’s longstanding patterns of tragic inequality. That narrative, focused on the self-destruction of older and less-educated white men, took hold in part because it pointed to an intuitive sense of national psychic malaise and postindustrial decline. But the familiar narratives about the country’s problems are proving more enduring: The country is a violent place and is getting more violent, and the footfall of that violence and social brutality is not felt equally, however much attention is paid to the travails of the “forgotten” working class. Probably we should be much more focused on protecting our young.
David Wallace-Wells (@dwallacewells), a writer for Opinion and a columnist for The New York Times Magazine, is the author of “The Uninhabitable Earth.”
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