What’s behind ‘shocking’ U.S. life expectancy decline—and what to do about it

April 13, 2023 – U.S. life expectancy has declined to 76.4 years, the shortest it’s been in nearly two decades, according to December data from the CDC. Two experts from Harvard T.H. Chan School of Public Health—Dean Michelle Williams and Ariadne Labs’ Asaf Bitton—discussed the problem on WP Live, a podcast from the Washington Post.

“The numbers are shocking,” said Williams on the April 10 podcast. She noted that younger people in America are dying at high rates than their counterparts in other high-income countries, and that that the U.S. also has among the highest maternal and infant mortality rates among upper-income countries.

Both Williams and Bitton said that much of the problem stems from the way the U.S. health care system is structured.

“We have a wonderful sick care system that takes care of very sick people,” said Bitton, “but a very inadequate health care system.” He noted that people’s access to health care is contingent on factors such as whether they have health insurance, where they live, or their race or ethnicity. Such inequities mean that not everyone has access to the “upstream factors” that keep people healthy, including things like clean air, clean water, a place to live, a good education, and good food, Bitton said.

Williams agreed. Although the U.S. is a leader in medical and health innovation, she noted, “I think where we are different [than other high-income countries] is that we emphasize rescue care, acute care at the expense of investing in, supporting, and enabling health promotion and disease prevention.”

Other countries where life expectancy is longer than in the U.S. could provide examples for the U.S., Bitton said. “Countries like Costa Rica and Portugal, starting with offering basic health coverage and health insurance to everyone but then integrating their public health and health care infrastructure, have made huge strides that we could learn from,” he said.

Williams pointed out that improving population health in the U.S. is not just the morally right thing to do but could also boost the nation’s economic and social stability. Bitton agreed. “Investing in people’s health shouldn’t be contingent until the moment that they drop in front of us and we take them to the emergency department,” he said. “It should be something that we start to do upstream because it’s smart for them, it’s the right thing to do for the economy and for the country, and it’s the right thing to do for our families and our neighbors.”

Listen to the WP Live podcast: Declining life expectancy in the U.S.