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September 21, 2021

The 'mortality penalty': 3 reasons why Americans die so young

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    Americans at every stage of life—infancy, adolescence, and adulthood —now die earlier than their counterparts in Europe, according to a new working paper from the National Bureau of Economic Research. Writing for The Atlantic, Derek Thompson shares the paper's three key findings on what might account for the disparity.

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    The 'American mortality penalty'

    Living in the United States comes with an "unsung death penalty," Thompson writes. In comparison to their European counterparts, the working paper found infants born in America are more likely to die before they turn five, teens living in America are more likely to die before their 20th birthday, and adults living in America are more likely to die before age 65.

    The result, Thompson writes, is Americans have shorter lifespans than individuals living in most Western European countries. He cites data that shows the average U.S. life expectancy at birth has never exceeded 79, while life expectancy in most Western European countries began exceeding 80 in the 2010s.

    And those disparities hold across race and socioeconomic statuses, according to the paper authors. European countries have "better life outcomes than the United States across the board, for white and Black people, in high-poverty areas and low-poverty areas," Hannes Schwandt, a Northwestern University professor and co-author of the paper, said.

    To better understand the "American mortality penalty," Schwandt and his colleagues assessed data on average American life spans by ethnicity and income at the county level and compared them with six European countries. The authors, Thompson writes, identified "three important findings."

    1. Life expectancy in America is tied to socioeconomic status—and that is not the case in Europe

    The working paper found almost no disparity in mortality rates between rich and poor European communities, meaning Europe's poorest residents roughly are living as long the wealthy. The same cannot be said for the United States, where a person's zip code "is much more likely to determine when you'll die," Thompson writes. For example, in the United States, Black teenagers in the poorest counties are about twice as likely to die before their 20th birthday when compared with teenagers in the richest counties. Meanwhile, in Europe, the mortality rate for teenagers is 12 deaths per 100,000—no matter how wealthy or poor the area.  

    The paper's authors attributed the difference between America and European countries to the way European countries implement health interventions. They wrote, "Health improvements among infants, children, and youth have been disseminated within European countries in a way that includes even the poorest areas."

    2. Europeans outlive the wealthiest Americans

    Even people in the poorest areas in Europe tend to outlive Black or white Americans in the wealthiest 10% of counties, according to the working paper. As Schwandt explained, "[E]ven after we grouped counties by poverty and looked at the richest 10th percentile, and even the richest fifth percentile, we still saw this longevity gap between Americans and Europeans." He added this finding suggests "something negative about the overall health system of the United States."

    3. The US saw the Black-white longevity gap lessen as insurance access and anti-poverty spending rose

    In the last 30 years, the average lifespan for Black Americans increased, across all ages and in both rich and poor areas. According Schwandt, this helped the Black-white life expectancy gap fall from seven to 3.6 years. But, he added, the phenomenon was not adequately investigated. "This is a really important story that we ought to move to the forefront of public debate," Schwandt said.

    According to Schwandt, several factors may have caused an increase in life expectancy among Black Americans, including developments in science and technology that helped reduce mortality rates from cardiovascular disease and cancer, policy changes that increased access to insurance and helped reduce both poverty and pollution, and a decrease in homicides. Schwandt posited that the United States needs to recognize and learn from those accomplishments.

    Overall, according to Thompson, all three findings from the working paper point to one important conclusion: "Our lives and our life spans are more interconnected than you might think." (Thompson, The Atlantic, 9/12)

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