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U.S. life expectancy sees ‘massive’ decline, especially in Black and brown communities

A new study found that between 2018 and 2020, U.S. life expectancy decreased by the biggest margin since World War II. The pandemic took an outsized toll in America compared to other countries, with life expectancy as a whole dropping by nearly two years. But for Black and brown Americans, the toll was even worse. William Brangham discusses the study's findings with lead author Dr. Steven Woolf.

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  • Judy Woodruff:

    A troubling new study has found that, between 2018 and 2020, U.S. life expectancy decreased by the biggest margin since World War II.

    And, as William Brangham reports, the COVID-19 pandemic took an outsized toll in the United States compared to other similar high-income nations.

  • William Brangham:

    Judy, as a whole, life expectancy in the U.S. dropped by nearly two years, but for Black and brown Americans, the toll was even worse.

    Among white Americans, life expectancy dropped by 1.4 years. But for Black Americans, it fell by 3.2 years, and, for Latino Americans, lifespans dropped by almost 3.9 years.

    And what's more, when you compare these declines to other similar nations, like France, Israel, or the Netherlands, the drop in the U.S. was more than eight times higher.

    Dr. Steven Woolf is the lead author of the study just published in a British medical journal. He's director emeritus of the Center on Society and Health at Virginia Commonwealth University in Richmond.

    Dr. Woolf, very good to see you.

    Really a striking study that you have put out. For people who don't follow longevity trends the way you have, a nearly two-year decline in life span, how significant is that?

  • Dr. Steven Woolf, Virginia Commonwealth University:

    It's massive.

    That level of decline, for people like us who study these data, is so large, that we haven't seen this kind of decline since World War II in 1943. To give people some perspective, a few years ago, there was a fair amount of press coverage about declining life expectancy in the United States.

    We had a period of three consecutive years where life expectancy was declining, at the same time that it was climbing in other countries. When that decline was happening, it was declining by 0.1 years each year. And it was very worrying.

  • William Brangham:

    Point-one, and now we're talking about one point.

  • Dr. Steven Woolf:

    One-point-nine. Yes, exactly.

    So, this is considerably more. And, as you said, that's about eight-and-a-half times the average decrease that we have seen in peer countries.

  • William Brangham:

    I want to get to that comparison about peer countries in a second.

    But, first off, as I mentioned, the racial disparities, again, are — just seem so glaring in this report. What do you attribute that to?

  • Dr. Steven Woolf:

    Well, we have been tracking racial disparities in health for generations now.

    These — we anticipated a difference in the decrease in life expectancy for people of color, but we were really horrified by the magnitude, 3.3 years in African Americans, 3.9 in Hispanic Americans.

    And what jumps off the page when we see data like this is systemic racism. This is at the heart of why it is that, generation after generation, people of color have experienced different health outcomes. Skin color is not a biological reason for people to have higher death rates. And race is really a social construct.

    So, really, what we're seeing is the effect of decisions and policies society has produced that limit opportunities for good health among people of color.

  • William Brangham:

    And, certainly, we saw that during the pandemic play out. And — but, as you're describing, that happened even prior to the pandemic.

    About those comparisons to those other countries, these are countries that have similar health systems. They're wealthy countries. They are affluent, in — comparable to us in so many ways. And yet we are doing so much worse than they are. How do you explain that?

  • Dr. Steven Woolf:

    Well, it's a trend that's been under way for many years. It actually began in the 1990s.

    And it's not for lack of spending on health care. We spend an enormous amount of health care — on health care in this country, compared to other countries, and have so for a long time.

    But, as a doctor, I will tell you that health care only accounts for about 10 percent to 20 percent of our health outcomes. Our health is really shamed by our social and economic conditions, where we live and our environment. And that's where we're falling short compared to other countries.

    Our health care system could be better, but what's really driving the gap between the United States and other countries is really a lack of investment in our people and in social capital.

  • William Brangham:

    Can you tease that out a little bit more?

    Because I think that that's a connection people often forget, that they're — that we are — the term of art, I know, is social determinants of health. But, for a lay audience, what do you mean by that?

  • Dr. Steven Woolf:

    We mean things like lack of education, income, stable jobs, a livable wage, stable housing, and being in a neighborhood environment that's good for your health.

    That actually matters far more to our health than what doctors and hospitals do. The public doesn't typically think of those as public health issues, but some of the topics in earlier segments about infrastructure and human capital investments, and even the housing instability are, in our view, public health policies.

  • William Brangham:

    And it certainly seems that remedying those is more than just a vaccine that will help us put this particular virus at bay. I mean, I know we talk about getting back to normal all the time, but it sounds like maybe normal is not the best thing to be.

  • Dr. Steven Woolf:

    Yes.

    Yes, we're delighted to see the pandemic receding into the rearview mirror, but normal is not a good place for us. As I have already said, Americans are dying earlier than people in other countries. We're sicker than people in other countries. And that gap is widening.

    So not doing anything about it is only going to make matters progressively worse. And the legacy of systemic racism is with us still, regardless of whether the pandemic is over with.

  • William Brangham:

    We talked — touched about this briefly, but the role that the opioid epidemic played, that certainly receded from the headlines, but we know that that continued as a major driver.

    Is it your sense that, once we stop focusing so much on the virus, we will realize that that too is still an undercurrent in our country?

  • Dr. Steven Woolf:

    Well, it's important to know it did not go away. And, in fact, it looks like overdose deaths have increased during the pandemic.

    Having said that, though, although opioid deaths and drug overdoses are the leading cause of rising mortality rates in much of our population, there are many other health conditions that — where American health status is also deteriorating.

    It's a systemic problem going on in our country that's causing the health of Americans to fail relative to our peers. And solving the opioid epidemic, as important as that is, will not get the system problems resolved.

  • William Brangham:

    I know this is a complicated question, but are there obvious policy remedies that come out of this?

    I mean, it seems like this is another glaring red warning to our society that it's not about just a virus. Do you have any suggestions for policy-makers as to how we help dent this?

  • Dr. Steven Woolf:

    The solutions to this health inequity problem really relate to policies that, as I said, people don't think of as medicine or public health.

    Investments in broadening access to education, providing good 21st century jobs, especially for parts of the country that have struggled the most with job loss and where many of these death rates are increasing the most, and dealing with the inequities that people of color and low-income communities have been struggling with for many years is going to do far more to address this problem than spending more on doctors and hospitals.

  • William Brangham:

    Dr. Steven Woolf, thank you very much for being here. Thanks for coming in.

  • Dr. Steven Woolf:

    It's a pleasure.

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