PLANETARY HEALTH WEEKLY

In March a year ago I wrote about the status of health in the United States and its poor outcomes compared to other rich and not-so-rich nations.  I then went on to point out the political nature of health production in a society.  The evidence on how people in America die far too young has been receiving some attention by the media.

The U.S. health decline has been chronicled in a variety of reports.  A relatively early background paper by the Office of Technology Assessment to the U.S. Congress published in 1993 was titled:  “International health statistics:  what the numbers mean for the United States.”  The key findings there demonstrated major differences in health status between the U.S. and other developed countries.  These included higher deaths in the U.S. among infants on to middle-aged adults.  Differences were not significantly related to measurement errors.  They pointed out that few Americans smoke compared to those in the other countries.  And there were socioeconomic status differences both in the U.S. and in countries with universal access to high-quality medical care.  In discussions I featured their Figure 5-2 which presented the probability of survival for those aged 25 to age 65.  The U.S. fared the worst.  The report had no impact on the federal level and the media did not feature it.

The Institute of Medicine (IOM), the federally funded independent think tank, subsequently issued a series of substantial publications with titles:  International differences in mortality at older ages : dimensions and sources in 2010 followed by Explaining Divergent Levels of Longevity in High-Income Countries in 2011 and in 2013 the culminating document U.S. Health in International Perspective: Shorter Lives, Poorer Health.  There have been subsequent reports with more specific information.  But the 2013 report title says it all.  As is typical of reports, that one received a report in the New York Times followed by the lead editorial the next day that suggested raising public awareness and then it was forgotten

A decade later a National Public Radio program titled:  “Live Free and Die?  The sad state of U.S. Life Expectancy” resurrected the report with updating.  That program featured a graph of life expectancy trends from 1980 to 2021 featuring the U.S. and other rich nations reproduced, as above.  There followed a few media mentions. 

These included a Financial Times of London report that showed COVID-19 had only a small impact on the stark U.S. decline and that higher mortality among younger folk mattered most.  A New York Times piece detailed many of the issues.  Among those expressing concern was Larry Summers, former President of Harvard University and former U.S. Treasury Secretary who tweeted about how disturbing these data were and could they be a harbinger of what happened to Russia after the breakup of the Soviet Union in 1991?  Then there followed an absolute decline in life expectancy that Russia still hasn’t recovered from. 

What needs to be done?  The 2013 IOM report proposed three steps.  The first was to achieve health outcomes set out in the national Healthy People 20xx reports.  Although these do not make comparisons with other nations, the objectives are not achieved at the end of the decade before more lofty ones are proposed.  The next step was to inform the public that Americans are dead first.  The third was to learn from other countries about what we could do to become healthier. 

All are challenging.  Informing the U.S. public in the current era of mis- and disinformation, false facts, and deep fakes in the social media environment is not easy.  The plight of individual issues takes precedence and the media motto is “if it bleeds it leads.”  The U.S. public is not bleeding out but dying from the usual causes of death. 

The changes required will be political, namely decreasing the huge income and wealth inequality and using the proceeds to support early life.  These topics have been covered in previous blogs.

If there ever was a public health emergency in the United States, this is it. 

Stephen Bezruchka, Seattle, WA