For Whom The Bell Tolls

In late November 2018, the news media reported that, according to the CDC, life expectancy (at birth) in the US had decline to 78.6 years.  This was the second time in three years that life expectancy had declined from the previous year.  The fact that it has happened in the midst of a long period of economic growth it is indeed stunning.  For perspective, consider that this places the US 29^th out of 34 OECD countries, and almost 3 years behind crisis-stricken Greece where life expectancy is 81.5 years.   Moreover, 65-year olds in 23 other OECD countries are expected to live longer than their age peers in the US.  Despite spending more on health care in general and in serving those over 65 in particular, the US is still achieving mediocre results.  For a country that invented many of the modern tools of public and private sector management this is a striking evidence of poor performance to put it charitably

The interesting question then to ask is: Whom do we fail to protect from premature death and why?  Let’s first take a look at who is at risk?  (That’s why the title of this essay.)  The data point to several directions.

First, infant mortality.  In a 2014 survey, the US had the highest infant mortality rate (5.8 per 1000 birth) in a group of 12 countries of comparable economic standards.  In a 2016 survey, the US ranked 33^rd (higher ranking means more) in infant mortality compared to 44 industrialized countries.  Further, in the US and for not well-known yet reasons, black newborns and their mothers seem to be more at risk at birth than other demographic groups.

Second, death by suicide.  The US ranked 35^th (higher ranking means more) in suicide rates out of the same 44 countries in 2016.  US suicide rates are higher in rural than in urban areas according to 2011-2015 data.

Third, gun victims.  In 2015, 64% of all homicides were gun-related, double the percentage in Canada (30.5%) and, of course, way much higher than in other countries.  Most of these deaths by gun are suicides.  The higher gun ownership in rural areas than urban areas (51% vs. 25%), means that living in the countryside and owning a gun is hazardous to your health.  Being a black American is also deadly, as the chance to be killed by gun is 21.6% vs. 11.9% for whites.

Fourth, drug overdose and opioids.  A record 72,000 Americans died of drug overdose and opioids in 2017.  The fastest growth is occurring in rural areas and in Midwestern states in particular.

Fifth, mid-life and less educated whites.  Princeton University professors Deaton and Case recently reported an accelerating rate of mortality among mid-life, less-educated whites since 1999 relative to the mortality rates of other US demographic groups.  Leading causes were family dysfunction, social isolation, addiction, and obesity.   In contrast, peer groups in other developed countries are found to have extended their life expectancy.

What has attracted a lot of interest is the plight of rural Americans.  In the past, interest focused mostly on black young men in inner cities who faced grim prospects for a normal life span because of crime and gun violence.  This problem has not entirely gone away, but the fact that Americans living in the quiet of rural settings are now an endangered species is surprisingly new.  To my surprise I found that the median household income is higher in rural than urban areas ($54,296 vs $52,386 as of 2016).  Poverty is also lower in rural than in urban areas (13.3% vs. 16%).  Although aggregate statistics can obscure differences in income and poverty within populations of rural and urban areas, income does not appear to explain differences in these dire statistics between rural and urban areas.

Instead, what surveys and the experts point to is a cluster of factors that make life very difficult for rural Americans.  Such factors include social isolation due to low population density, job losses and shrinking career opportunities, broken marriages, and poorer health care.  Health care providers and facilities are scarcer in rural areas.  Studies point out the insufficient numbers of medical specialists, especially in the treatment of mental and psychological ailments.  This leads many rural people to persistent depression and dependence on drugs, mostly opioids.  Even participation in the digital social community is limited for rural people.  Whereas only 3% of urban people had no access to broadband in 2017, that percentage stood at 35% for rural Americans.  This also means that rural people have much less opportunity to participate in the knowledge or new digital economy of our time.

All the above statistics point to our inability or unwillingness as a society to either allocate our tax dollars appropriately or to curb whatever is killing us.  I am talking about policies concerning availability of health care, treatment of mental ailments and drug (including opioids) abuse, and guns.  A country that mustered the will, determination, and resources to send a man to the moon seems less capable of summoning the political will and enough sense of social solidarity to protect its citizens from conditions that lead to substandard living and death.

I understand that keeping ourselves healthy and alive starts with our own sense of personal responsibility.  Conservatives and libertarians, in particular, are fond of reminding us this and up to a point they are right.  But the social and economic environment where people live also impacts the opportunities they have and the choices they make.  And if because of limited opportunities and support or bad personal choices they fall in trouble, shouldn’t our society have an obligation to remedy the situation?

Americans like to point out that our system of free markets and capitalism proved to be superior compared to the command system of communist countries.  The new reality though is that we now compete with countries that apply various versions of free markets, even if sometimes mixed with state intervention.  The question I see then is this: How will we make our case for the superiority of our socio-economic version of capitalism if in the most critical gauge of national health, i.e., life expectancy, we fail, and especially when we consider the causes of this failure?

The sources for the above statistics were: US Census, OECD, CDC, and the Kaiser Family Foundation.

Author: George Papaioannou

Distinguished Professor Emeritus (Finance), Hofstra University, USA. Author of Underwriting and the New Issues Market. Former Vice Dean, Zarb School of Business, Hofstra University. Board Director, Jovia Financial Federal Credit Union. View all posts by George Papaioannou