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Health Policy
February 16, 2021

Declining Life Expectancy in the United States: The Need for Social Policy as Health Policy

Author Affiliations
  • 1Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 2Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
  • 3Department of Sociology, Yale University, New Haven, Connecticut
  • 4Institution for Social and Policy Studies, Yale University, New Haven, Connecticut
  • 5Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston
  • 6Harvard Medical School, Boston, Massachusetts
JAMA. 2021;325(7):621-622. doi:10.1001/jama.2020.26339

Even before the coronavirus disease 2019 (COVID-19) pandemic occurred, the US was mired in a 40-year population health crisis. Since 1980, life expectancy in the US has increasingly fallen behind that of peer countries, culminating in an unprecedented decline in longevity since 2014.1 Life expectancy at birth in the US in 1980 was 73.6 years, in 2014 was 78.9 years, and in 2018 was 78.7 years. These long-standing trends have been driven by increasing mortality among working-age adults, specifically those of lower socioeconomic status. While working-age adults with a 4-year college degree have experienced gains in life expectancy, those with only a high school diploma have experienced a decline.2 Similarly, the gap in longevity between the top and bottom 5% of the household earnings distribution has increased by 2.6 years from 2001 to 2014, with life expectancies at 40 years of age in these 2 groups of 79.7 and 89.4 years, respectively, in 2014.3 At the same time, differences in longevity continue to be pronounced across racial and ethnic groups, led by elevated rates of mortality among Black and American Indian adults.1 The persistent widening of socioeconomic gradients in life expectancy, even as per capita expenditures on health care have increased substantially, suggest that social and economic forces are likely to be the central drivers of the decline in US life expectancy.

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