JOHN YANG: Life expectancy for the average American has dropped for the second year in a row, it's now 76 years, while life expectancy fell around the world in 2020, because of COVID other countries have rebounded in 2021.

But the United States continued its decline hitting the lowest point in nearly two decades.

Dr. Steven Woolf is Director Emeritus of the Virginia Commonwealth University Center on Society and Health.

I know we're focusing on the just the last two years, but this is a longer trend, is it not?

DR. STEVEN WOOLF, Virginia Commonwealth University Center School of Medicine: Absolutely.

Our problems really began back in the 1990s.

Life expectancy has been increasing in all industrialized countries.

But starting then the pace of increase in the United States began to fall off.

And then after 2010, it just stopped increasing altogether and plateaued.

JOHN YANG: What are the factors in that?

Why is that happening?

DR. STEVEN WOOLF: Well, it's being driven by an increase in death rates in young and middle-aged adults 25 to 64.

And most of those relate to the problems of drug overdoses, suicides, alcohol related causes.

These are sometimes called deaths of despair, but also cardiometabolic diseases like diabetes and other conditions caused by obesity.

JOHN YANG: And I know that you've taken a closer look at that younger age range.

What were you finding?

DR. STEVEN WOOLF: Well, we found that death rates increased in that young adult and middle age group.

But there was something disturbing in the new data for 2021.

Yes, it showed this massive decrease in life expectancy, but it also showed an increase in death rates in children and teenagers.

And an increase of that size has not been seen in my entire career.

JOHN YANG: And what are the factors that play into that?

Well, keep in mind that death rates have been falling dramatically in young people due to progress in pediatric medicine and curing cancer and deaths from birth defects.

We've also markedly reduced the risk of deaths from car accidents.

But this upward trend is the result of four causes, suicides, homicides, drug overdoses and car accidents, mainly in young people 10 to 19 years old.

JOHN YANG: These are not organic problems.

They seem preventable?

DR. STEVEN WOOLF: Yeah, this is not a cancer cell.

This is not a microorganism.

These are manmade pathogens.

And that's what's tragic about this.

These deaths are preventable.

JOHN YANG: And you talked about drug overdoses and gun violence, obviously, is that -- how big a factor are they?

DR. STEVEN WOOLF: Well, the firearm issue is a prominent reason for this increase in mortality and young people.

It accounts for about half of the suicides committed by young people and the majority of homicides.

So firearms play a large role in contributing to this, but not the only one.

Clearly, there's a mental health crisis that's fueling it.

And lately, drug overdose, death rates have begun increasing.

JOHN YANG: So it sounds like this is not a question about health care in the traditional sense that thinking about going to the doctor or going to a hospital.

DR. STEVEN WOOLF: Well, health is about more than health care.

And as a doctor, I often have to emphasize that, but portions of this problem are related to health care, in terms of people's ability to access services that they need, particularly in the area of mental health.

This mental health crisis began years ago, suicide rates started increasing in young people in 2007.

But access to mental health services and substance abuse counseling is just not -- what it needs to be in this country.

JOHN YANG: Why is this particularly to the United States?

Why to other industrialized nations are not seeing the same thing, is it societal?

DR. STEVEN WOOLF: Well, we can look at some obvious explanations like the fact that we don't have universal health care systems, but frankly, it has a lot to do with how we approach public policy in this country, around social and economic issues.

Those are the major drivers of health.

And other countries have been much more successful in pursuing policies that invest in children education and provide economic support for families that are going through tough times.

We don't have that kind of safety net of the United States, and we've paid the price for it.

Other countries have outperformed the United States as much as 50 years, 50-year period in which other countries have achieved higher life expectancy than the U.S. JOHN YANG: You mentioned universal health care, are there other things that other industrialized nations are doing that the United States is not doing?

DR. STEVEN WOOLF: Yes, for many years, other countries have outperformed the United States in terms of their investments in education, so their children are getting better education.

They've also established programs for many years that provide economic support for families that are dealing with unemployment or other problems.

Investments in parental leave, minimum wage, policies of the sort that often run into political hurdles in the United States are widely adopted in other countries and their populations are living longer.

JOHN YANG: What other public policy and public health implications are there from this?

DR. STEVEN WOOLF: Well, I think we're really destined to see life expectancy continuing to fall or at least not increase unless we take this seriously and make some changes in public policy.

The concerning problem I mentioned with children and teenagers means that the death rate is increasing for children one to 19.

And put simply that means our young people are less likely to reach age 20 in adulthood.

So we need to do something to try to save our children if they're going to have a future.

That's as healthy as ours.

JOHN YANG: Dr. Steven Woolf from Virginia Commonwealth University., thank you very much.

DR. STEVEN WOOLF: Thank you.