Why Americans Die So Much

September 16, 2021

America has a death problem.

No, I’m not just talking about the past year and a half, during which COVID-19 deaths per capita in the United States outpaced those in similarly rich countries, such as Canada, Japan, and France. And I’m not just talking about the past decade, during which drug overdoses skyrocketed in the U.S., creating a social epidemic of what are often called “deaths of despair.”

I’m talking about the past 30 years. Before the 1990s, average life expectancy in the U.S. was not much different than it was in Germany, the United Kingdom, or France. But since the 1990s, American life spans started falling significantly behind those in similarly wealthy European countries.

According to a new working paper released by the National Bureau of Economic Research, Americans now die earlier than their European counterparts, no matter what age you’re looking at. Compared with Europeans, American babies are more likely to die before they turn 5, American teens are more likely to die before they turn 20, and American adults are more likely to die before they turn 65. At every age, living in the United States carries a higher risk of mortality.

This is America’s unsung death penalty, and it adds up. Average life expectancy surged above 80 years old in just about every Western European country in the 2010s, including Portugal, Spain, France, Italy, Germany, the U.K., Denmark, and Switzerland. In the U.S., by contrast, the average life span has never exceeded 79—and now it’s just taken a historic tumble.

Why is the U.S. so much worse than other developed countries at performing the most basic function of civilization: keeping people alive?

“Europe has better life outcomes than the United States across the board, for white and Black people, in high-poverty areas and low-poverty areas,” Hannes Schwandt, a Northwestern University professor who co-wrote the paper, told me. “It’s important that we collect this data, so that people can ask the right questions, but the data alone does not tell us what the cause of this longevity gap is.”

Finding a straightforward explanation is hard, because there are so many differences between life in the U.S. and Europe. Americans are more likely to kill one another with guns, in large part because Americans have more guns than residents of other countries do.

Americans die more from car accidents, not because our fatality rate per mile driven is unusually high but because we simply drive so much more than people in other countries. Americans also have higher rates of death from infectious disease and pregnancy complications. But what has that got to do with guns, or commuting?

By collecting data on American life spans by ethnicity and by income at the county level—and by comparing them with those of European countries, locality by locality—Schwandt and the other researchers made three important findings.

First, Europe’s mortality rates are shockingly similar between rich and poor communities. Residents of the poorest parts of France live about as long as people in the rich areas around Paris do. “Health improvements among infants, children, and youth have been disseminated within European countries in a way that includes even the poorest areas,” the paper’s authors write.

But in the U.S., which has the highest poverty and inequality of just about any country in the Organization for Economic Cooperation and Development, where you live is much more likely to determine when you’ll die. Infants in the U.S. are considerably more likely to die in the poorest counties than in the richest counties, and this is true for both Black and white babies. Black teenagers in the poorest U.S. areas are roughly twice as likely to die before they turn 20, compared with those in the richest U.S. counties.

In Europe, by contrast, the mortality rate for teenagers in the richest and poorest areas is exactly the same—12 deaths per 100,000. In America, the problem is not just that poverty is higher; it’s that the effect of poverty on longevity is greater too.

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