Welcome to the first full week of 2019. We hope you enjoyed some end-of-year rest and good cheer. Here in America, the new year is off to a mixed start.
Last Friday’s Employment Situation report for December was uniformly upbeat: higher-than-expected growth in payroll jobs, an uptick in the length of the average workweek, and the 3.2 percent year-over-year rate of increase in hourly wages was the fastest since 2009. And yet, America rang in its New Year with more than 800,000 federal employees throughout the country not reporting to work due to the funding standoff between the White House and Congress. This federal-government shutdown, now in its 17th day, is emblematic of the prevailing dysfunction in Washington.
Your correspondents firmly believe that each new year brings new opportunity for renewal and progress. It is in that optimistic spirit that we focus our first missive of 2019 on the paradoxically grim topic of falling life expectancy in America.
For close to a century, America enjoyed steady gains in the number of years its citizens could be expected to live. At the start of the 20th century, it was about 48 for whites and 34 for blacks. Today, those numbers are about 79 and 75, respectively, according to the federal government’s Centers for Disease Control and Prevention. That rise is a by-product of a number of changes through the decades, which include medical breakthroughs, better health-care technologies, improved sanitation, healthier eating, increased spending on health, and higher incomes. These dramatic gains in life expectancy, which have been experienced in most of the world’s other countries, ranks as one of the most remarkable developments—and indicators of progress—in human history.
Dramatic gains in life expectancy, which have been experienced in most of the world’s other countries, ranks as one of the most remarkable developments—and indicators of progress—in human history.
Thus it was startling, as the December holidays were getting underway, to read the announcement by the CDC that U.S. life expectancy declined in 2017, to 78.6 years. Even more startling, it was the third consecutive year life expectancy had fallen. The last time that happened in the United States? The years 1916–18, which coincided with World War I and the Spanish flu epidemic—an outbreak that killed 675,000 people in the United States and 50 million worldwide. “These sobering statistics are a wake-up call that we are losing too many Americans, too early and too often, to conditions that are preventable,” grimly pronounced the director of the CDC.
While many different economic indicators, such as growth in household incomes, can measure a nation’s progress, life expectancy has the virtue of being brutally simple. Falling life expectancy calls out deep underlying challenges that aren’t being met. A litany of statistics attest to those unmet challenges, which exemplify what economists Anne Case and Angus Deaton have recently called “deaths of despair.”
As one journalist pointed out, “In the nation’s 10 leading causes of death, only the cancer death rate fell in 2017. Meanwhile, there were increases in seven others—suicide, stroke, diabetes, Alzheimer’s, flu/pneumonia, chronic lower respiratory diseases and unintentional injuries.”
Parsing the data reveals that the premature deaths have been heavily concentrated among select segments of the population. While those with low incomes have not fared well, the most important determinant of early deaths seems to have been education—or a lack thereof. A new paper coauthored by Dartmouth economist Paul Novosad points out that the mortality increases among middle-age whites from 1992–2015 were almost entirely accounted for by individuals in the lowest 10 percent of the education distribution. Indeed, it’s noteworthy that among those who died from opioid overdoses in 2015, 68 percent had only a high school diploma or less. More broadly, notes Novosad and his coauthor, “death rates for the least educated have dramatically diverged from death rates of other groups, in virtually all middle-age race and gender groups.”
While those with low incomes have not fared well, the most important determinant of early deaths seems to have been education—or a lack thereof.
We open this new year with such bracing data because it presents a massive opportunity for so many Americans to help make things better—starting with the sizable number of people contemplating running for president in 2020. Indeed, falling life expectancy may get outsized attention thanks to the long-standing political quirk that New Hampshire holds the first presidential primary election. New Hampshire’s 2017 death rate from opioids—34 per 100,000 people—was the third highest in the country, more than double the national rate of 14.9 and behind only West Virginia and Ohio. Your correspondents can attest firsthand to the opioid ravages in communities not far from the Dartmouth campus.
As 2018 was closing, Washington managed to rise above its general dysfunction to take a first step in the right direction. In October, President Trump signed opioid legislation that passed the House and Senate with overwhelming majorities of 393–8 and 98–1, respectively. Provisions of this new law include expanding substance-abuse treatment for Medicaid patients and promoting research on nonaddictive pain treatments.
Yet so much remains to be done here. Let us welcome 2019 in the hope that this year leaders will envision and deliver fresh solutions to the problems that unite—rather than divide—all of us, such as falling life expectancy. Happy New Year. Let’s get busy.