A Better Approach to Life Expectancy

They call the years between ages 25 and 65 the prime of life because it is supposed to be the period during which an adult enjoys his or her best health and maximum productivity. Yet to a disturbing degree, that description no longer fits Americans' experience. Between 2010 and 2017, the mortality rate for 25-to-64-year-olds increased from 328.5 deaths per 100,000 to 348.2 per 100,000 – or about 6 percent – according to a new study in the Journal of the American Medical Association. This contributed to a reversal of what had been decades of progress (albeit slower since the 1980s) in life expectancy, which stood at 78.6 years in 2017, down from the all-time high of 78.9 years in 2014. This simply should not be occurring in a rich country whose peer nations have maintained or improved life expectancy figures in recent years.

Embarrassment, we hope, gives way to urgency. The study confirms that the mass opioid addiction epidemic that began in the late 1990s ranks as one of the great public-health disasters in American history. Between 1999 and 2017, deaths from drug overdoses more than quadrupled among prime-age adults. Yet deaths due to 34 other causes – among them suicide, obesity and organ-system disease – also rose significantly. Accordingly, though better access to drug treatment will probably ameliorate the situation, change and reform will also be needed in mental health, as well as in nutrition and recreation. So, too, will improvements be needed in traffic safety and, yes, gun safety.

In principle, progress should be achievable. Though the death rates are stunning when expressed in numbers per 100,000, they translate to 33,000 “excess” fatalities beyond what the country would have experienced between 2010 and 2017, or roughly 4,000 per year. Each such death is an unquantifiable tragedy, of course; we mention the figure simply to underscore that hope is as rational as alarm. Indeed, preliminary figures from the Centers for Disease Control and Prevention suggest a slight decline in opioid-involved overdose deaths from 2017 to 2018, in contrast to sharp increases from 2014 to 2017 due to fentanyl. The goal should be a quick reversal of backsliding, followed by a resumption of improvement.

This is a moral issue, not a partisan one. Still, it's noticeable that death rates for prime-age adults rose most steeply in parts of the country where manufacturing jobs disappeared in decades past – and where voters supported President Donald Trump in 2016. A third of the 33,000 “excess” deaths from 2010 to 2017 occurred in just four states: Ohio, Pennsylvania, Kentucky and Indiana. Plainly, there is some connection between the social and economic distress that these higher death rates connote and the public's susceptibility to demagogic populism.

Equally plainly, Trump's policies have had, at best, a mixed impact on the states that voted for him. He has presided over a continuation of the economic expansion that began under his predecessor, and goosed it with tax cuts – while simultaneously undermining the most important health-care legislation in a generation: Obamacare. Democrats have an opportunity to show their approaches to the economy and health care will materially improve people's lives. The new data on life expectancy certainly shows that a better approach is needed.

– The Washington Post