US life expectancy no longer catastrophic, now merely bad

US life expectancy increased this past year, from 76.4 to 77.5 years, according to a report published Wednesday by the Centers for Disease Control and Prevention (CDC), after declining for two years in a row.

It’s not exactly a cause for celebration. America’s life expectancy has been lower than that of other wealthy countries for decades, and declined more than other nations’ during the pandemic. The trends were bad before the pandemic, and awful during it. Now they’re on their way back to being merely bad.

As a measure of a nation’s well-being, life expectancy is useful, but its meaning is sometimes misunderstood. Life expectancy isn’t about individual people — it’s about the moments they’re born into. The metric doesn’t refer to the number of years a baby born today can expect to live. Instead, it reflects how long a baby born today would live if nothing in their environment changed over their lifetime. It’s like saying: If every year of this child’s life was like the year 2023, how long would they live?

That means that if a baby is born during a period when lots of people are dying at relatively young ages — e.g., during a pandemic or a war — their estimated life expectancy would be lower than if they were born during happier times. And obviously, the baby’s individual life expectancy will change if their environment and conditions change — if the pandemic or war ends, for example.

The point is that life expectancy changes in response to the social, cultural, environmental, and political environments countries create. That makes it a helpful tool for tracking the health of nations’ populations over time, and for comparing the health of different countries’ populations.

A closer look at this year’s figures offers some pointed reminders that the US’s life expectancy curve isn’t an accident, but a response to choices its elected officials have made.

Here are four takeaways from the report.

1) Covid-19 killed fewer people in 2022 than it did in 2021 — but it still killed a lot of people.

The historic drop in life expectancy that occurred in the first two years of the pandemic was the worst the US had seen since World War II. The CDC estimates 375,000 Americans died due to Covid-19 infection in 2020, and about 460,000 in 2021 — an almost incomprehensible loss of human potential.

In 2022, there were fewer Covid-19 deaths, but still a lot: ​​244,000.

This is the main reason for the increase of life expectancy in the CDC report: Covid-19 is killing fewer people.

But Covid-19 may also help explain why the US is not yet all the way back up to its pre-pandemic life expectancy of 78.8 years.

Most other countries around the world also saw big dips in their life expectancies during the first year of the pandemic. But the US’s decrease was bigger than other countries’ and its rebound has been slower.

The authors of a study assessing pandemic-era life expectancy changes across a range of countries hypothesized that US mortality due to Covid-19 was higher than that in European countries due to higher rates of underlying conditions like obesity and diabetes. A recent analysis by the Washington Post suggests that stalled progress on preventing and treating chronic illness is responsible for the majority of deaths among Americans in their prime.

“We’re starting from a lower spot, and we sunk faster than other countries,” said Joshua Sharfstein, a physician and epidemiologist who directs the Bloomberg American Health Initiative at Johns Hopkins University’s Bloomberg School of Public Health. “And now we’re trying to crawl our way out.”

2) Racial/ethnic groups that lost the most when Covid was at its most lethal had the most to gain as the virus got weaker.

The figures in the report suggest certain racial and ethnic groups made particularly big gains in life expectancy. For example, life expectancy went up by 2.3 years for American Indians and Alaska Natives; by 2.2 years for Hispanic Americans; and by 1.6 years for Black Americans.

Does this mean the US has fixed health disparities?

No. This reflects that those groups that had the highest rates of pandemic-related deaths had the most to gain when Covid-related mortality went down. “Groups had a little bump that was in proportion to the loss that they had,” said Sharfstein.

Over the course of the pandemic, American Indians and Alaska Natives died of Covid-19 at more than twice the rate of white Americans, and Black and Hispanic Americans also died at much higher rates.

The disproportionate increase in life expectancy in these groups just indicates they were further from their baseline during the worst of the pandemic.

3) Infant mortality rose. It’s likely due to abortion bans and failing maternal health care.

Another factor holding down US life expectancy, according to the report, is infant mortality.

In 2022, rising death rates due to perinatal conditions (that is, fetal deaths later in pregnancy or newborn deaths ) and congenital malformations kept the topline numbers from creeping higher.

That hadn’t been the case in 2021, or in 2020. In fact, in those years, death rates due to these types of conditions actually decreased.

This is likely a consequence of ending the constitutional right to abortion, said Sharfstein. “There’s a very strong relationship between access to abortion and infant mortality — and infant mortality went up,” he said. (Multiple studies have linked restrictions to abortion access with higher infant death rates. According to the Society for Family Planning, there were about 32,000 fewer abortions in the six months after the Supreme Court overturned a national right to the procedure in June 2022.)

Some of this is related to changes in how doomed pregnancies are managed in the face of criminalized abortion. When OB-GYNs cannot safely provide a full spectrum of medical care, they cannot provide the abortions that would prevent pregnant people from carrying nonviable pregnancies to term. That means pregnancies that previously would have ended long before labor and delivery are instead progressing to birth — and the infants who result from those pregnancies are dying shortly thereafter.

But it’s also likely related to the impact of abortion restrictions on the availability of prenatal care — and that directly affects both infant and maternal mortality. As I wrote earlier this month, maternal care providers are leaving states with abortion restrictions, and medical trainees are avoiding these states because they know that in states that don’t permit abortion, they won’t get training in a key part of pregnancy care.

Prenatal care reduces the risk of infant death and may also reduce risks to mothers, and a lack of prenatal care increases the risk babies will die.

“There’s no question that the reduction in reproductive health care access has implications for population health,” said Sharfstein.

4) Our baseline compared to other countries — both before and after peak pandemic — is low, and we haven’t taken any steps to address the root causes.

In 1980, US life expectancy was among the highest in the developed world; now, it’s one of the lowest. There are many possible reasons for this: Compared with other countries, the US’s health care system is one of the most difficult to afford and navigate, and invests less in preventive care than in high-tech treatment. The nation wildly underfunds public health, has a high prevalence of processed foods, and promotes overwork and underrest. And access to guns and opioids has made high rates of death due to both a uniquely American problem.

The prevalence of many chronic health conditions — along with smoking cigarettes, another important contributor to premature death and Covid-19 mortality — can be changed by policy choices.

“Improving the public health system, rebalancing the health care system more toward prevention, thinking about the social drivers of health more intensely, addressing major social challenges that sometimes are right in front of our eyes and associated with a lot of death,” said Sharfstein, “all of those things are going to be necessary” to improve Americans’ overall health.