The struggle for healthier, longer lives
1. Healthy life expectancy is stalling.?
12 years ago, the National Academy of Scientists and the National Institutes of Health released a 400-page study on how the health of Americans compares to that of other developed countries. The key takeaways? Health advancements in the U.S. are stalling, and considerably. While life expectancy in our peer countries—Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom—continues to grow, the United States continues to decline. And the paper didn’t just sound the alarm for the sake of it—it contains recommendations for the government, and especially NIH, which has a budget of more than $40 billion annually to conduct research to improve Americans' health.
But fast forward to just this past year, a few days before Christmas. Some 12 years after this landmark report, few solutions have been brought to the forefront of any policy agenda, and according to the study’s authors , we have hardly seen funding allocated to necessary research on this issue. Over the past few decades, the situation hasn’t markedly declined, but it has certainly leveled out—and isn’t where it should be, at least compared to our peer nations.?
And that’s just life expectancy. Healthy life expectancy, on the other hand, is the measure of how many years an individual can expect to live in good health, and is frequently referred to as “health span”. In the United States, we don’t rigorously measure and report health span as we do life expectancy, but best estimates indicate that the average American can expect to celebrate only a single birthday in good health after the traditional retirement age of 65. Meanwhile, Singapore, Britain and Japan (along with Canada, Costa Rica and Chile) already report average health spans of at least 70 years.
Why does this matter? Well, Americans live with more sickness and die sooner than their peers in other rich nations, and a decline in the nation’s health has ripple effects—on the economy, workforce productivity, health care costs, and national security. These ripple effects extend over time, and will ultimately shape the health trajectory of the nation.
2. But how did this happen??
As with all complex and widespread issues, the answer is equally so. Yes, Americans eat more calories and lack universal access to health care. But there's also higher child poverty, racial segregation, social isolation—even the way cities are designed makes access to good food more difficult. From a systemic perspective, the United States is set apart: public health, medical care, individual behaviors (diet and tobacco use), social factors (poverty and inequality), the physical environment, and public policies all combine to create a picture of our population's health. In order to understand the compounding effects of a decreasing health and lifespan, it requires a look at the whole of our system—and it is one which is not sufficiently oriented to keep us healthy.?
That’s not to say we’re entirely getting it wrong. The United States has higher survival after age 75 than its peer countries, higher rates of cancer screening and survival, better control of blood pressure and cholesterol levels, lower stroke mortality, lower rates of current smoking, and higher average household income. But ultimately, it’s not enough. Our life expectancy is stagnating, and our healthy life expectancy is going with it.?
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Shameless Self Promotion: If you want to learn more about the “why” behind the changing nature of our health in the United States, you’ll want to check out Season 3 of Century Lives podcast, from the Stanford Center on Longevity. In “Place Matters”, we travel from West Texas to the Bronx, visiting poor and working-class communities that punch above their weight when it comes to healthy aging and life expectancy. In some ways, the communities have little in common–they are urban and rural; Black, White, and Latino–but they share attributes that have produced longer life and better health. Check it out here. ?
3. So what??
The good news about lagging behind peer countries is that it showcases a number of different approaches to address this issue on our own home turf . And, perhaps surprisingly, a lot of these policy and structural changes should begin at birth: the healthiest nations tend to share universal, better coordinated health care, strong health and safety protections, broad access to education, and more investments to help kids get off to a healthy start.?
On a personal level, striving for a healthy lifestyle can be paramount. Of course this is a deeply privileged idea—and one made far more difficult by the lack of healthy food options in less wealthy regions and areas of cities—but a little can go a long way. There’s even this NPR series on “Living Better,” that chronicles different ways that communities are able to reclaim their health.
But really, the changes we need to see should take place on a policy level. The pandemic has been somewhat of a wakeup call, especially while our life expectancy has continued to decline while our peer countries’ has snapped back into place (and even increased), but really, it shouldn’t take a public health emergency for change to occur. Time will tell if our elected officials and research professionals will take the matter further and seek the change we need to see.?
The long and short of it:?