Covid-19 has caused the largest decline in U.S. life expectancy since World War II, the federal government reported yesterday. But Covid is not the only reason that life expectancy in this country fell last year to its lowest level in almost two decades.
Even before the pandemic, the U.S. was mired in an alarming period of rising mortality. It had no modern precedent: During the second half of the 2010s, life expectancy fell on a sustained basis for the first time since the fighting of World War II killed several hundred thousand Americans.
Deaths of despair
It’s hard to imagine a more alarming sign of a society’s well-being than an inability to keep its citizens alive. While some of the reasons are mysterious, others are fairly clear. American society has become far more unequal than it used to be, and the recent increases in mortality are concentrated among working-class Americans, especially those without a four-year college degree.
For many, daily life lacks the structure, status and meaning that it once had, as the Princeton University economists Anne Case and Angus Deaton have explained. Many people feel less of a connection to an employer, a labor union, a church or community groups. They are less likely to be married. They are more likely to endure chronic pain and to report being unhappy.
These trends have led to a surge of “deaths of despair” (a phrase that Case and Deaton coined), from drugs, alcohol and suicide. Other health problems, including diabetes and strokes, have also surged among the working class. Notably, the class gaps in life expectancy seem to be starker in the U.S. than in most other rich countries.
Covid, of course, has aggravated the country’s health inequalities. Working-class Americans were more likely to contract severe versions of Covid last year, for a mix of reasons. Many could not work from home. Others received lower-quality medical care after getting sick.
Since vaccines became widely available this year, working-class people have been less likely to get a shot. At first, vaccine access was playing a major role. Today, vaccine skepticism is the dominant explanation. (All of which suggests that Covid will continue to exacerbate health disparities beyond 2020; yesterday’s report on life expectancy did not include data for 2021.)
Race and sex
Covid has also caused sharp increases in racial inequality. As a Times article on the new report explains:
From 2019 to 2020, Hispanic people experienced the greatest drop in life expectancy — three years — and Black Americans saw a decrease of 2.9 years. White Americans experienced the smallest decline, of 1.2 years.
I exchanged emails with Case and Deaton yesterday, and they pointed out that racial patterns contain some nuances. Hispanic Americans live longer on average than non-Hispanic Americans, both Black and white — yet the impact of Covid was worst among Hispanics. “This is not simply a story of existing inequalities just getting worse,” Case and Deaton wrote.
The fact that many Hispanic people work in frontline jobs that exposed them to the virus surely plays a role. But Black workers also tend to hold these jobs. It’s unclear exactly why Covid has hit Hispanic communities somewhat harder than Black communities (and would be a worthy subject for academic research).
Covid has also killed more men than women, Case and Deaton pointed out, increasing the mortality gap between the sexes, after years in which it had mostly been shrinking. Life expectancy was 5.7 years longer for women last year, up from 5.1 years in 2019. The gap had fallen to a low of 4.8 years in the early 2010s.
The bottom line: Covid has both worsened and exposed a crisis in health inequality. But that crisis existed before Covid and will continue to exist when the pandemic is over.
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