America's Declining Life Expectancy: A Neglected Political Concern

By Danilo Ezequiel Carando, CNN Week

Updated 01:20 December 31, 2023

The commissioner of the Food and Drug Administration, Robert Califf, expressed concern about the decline in life expectancy in the United States, calling it a pressing public health problem. However, neither President Biden nor his Republican challengers have made it a political priority. While recent data shows a slight increase in life expectancy in 2022, there is no national strategy to reverse the years-long decline that has left the US trailing behind other countries. Many experts and officials believe that addressing this issue requires a long-term commitment that transcends political administrations. They compare the goal of improving life expectancy to the ambitious projects of the past, such as building a national highway system or sending a man to the moon. However, politicians have been hesitant to engage with this issue due to its complexity and lack of clear solutions. Despite the lack of political attention, Califf and others continue to urge action to address the declining life expectancy trend. The White House has stated that it is focused on combating the underlying factors contributing to the decline, such as drug overdoses and gun violence prevention.
According to an anonymous official, addressing the declining life expectancy in America could be a priority for President Biden's second term. The reasons for this decline are multifaceted and include chronic diseases, poor nutrition, lack of access to care, and political decisions. However, there is no consensus on how to reverse this trend. Some public health leaders advocate for comprehensive reforms to the healthcare system, while others focus on specific factors such as drug overdoses. The issue of declining life expectancy has not received much attention in Congress, with only a few lawmakers considering it a crisis. Senator Bernie Sanders has been vocal about the rise in premature deaths but has found little support from his colleagues. The Washington Post reached out to all 100 senators, and 48 of them acknowledged that declining life expectancy is a problem. However, despite introducing numerous bills related to healthcare, there has been little progress in improving life expectancy. Lawmakers have often worked against each other's efforts, with Republicans opposing Democratic initiatives aimed at expanding healthcare coverage and reducing access to guns. Some Republican senators did not have a view on the issue, while others claimed it was not within their jurisdiction. In the absence of national solutions, some officials have highlighted local initiatives, such as New York City's goal to raise life expectancy to 83 years through coordinated efforts.
Ashwin Vasan, the health commissioner of New York City, recently testified before the city council, urging them to pass a law that would require the health commissioner, as well as their successors, to work towards shared public health goals. Vasan expressed his hope that New York City would be able to meet this test. 
In the past, life expectancy in the United States was a point of pride, reflecting advancements in healthcare and other investments that set the nation apart. However, experts have warned about the emerging international gap in life expectancy, with the United States falling behind. James Vaupel, director of the Max Planck Institute for Demographic Research, emphasized the importance of prioritizing this issue and expressed concern about the United States' declining life expectancy.

Despite these warnings, policymakers were more focused on the growing cost of providing services to older Americans through programs like Medicare and Social Security. When the Affordable Care Act was being crafted in 2010, there was little concern about life expectancy declining. The focus was on expanding health coverage and making changes to the healthcare system.

It wasn't until 2013 that public health experts began issuing more prominent warnings about life expectancy, citing factors such as opioid overdoses, suicides, and other preventable deaths. However, senior officials across different administrations acknowledged these concerns but primarily focused on improving specific factors linked to life expectancy rather than addressing the overall number.

Health and Human Services Secretary Xavier Becerra acknowledged the decline in life expectancy and attributed it to serious problems like gun violence and drug overdoses. However, he downplayed the need for a national strategy and stated that his agency lacked the power to reverse the trend.
While President Biden hasn't directly addressed declining life expectancy, some of his rivals, like Florida Governor Ron DeSantis, have mentioned it on the campaign trail. DeSantis linked the decline to factors such as the pandemic and drug overdoses that have been ongoing for years.
The DeSantis campaign did not provide a response regarding how Florida Governor Ron DeSantis would address the declining life expectancy trend if elected president. Robert F. Kennedy Jr., an independent candidate in the 2024 campaign, expressed his concern about the increase in all-cause mortality in the United States and emphasized that these deaths are not solely due to COVID-19. Political commentator Matthew Yglesias has also highlighted the importance of focusing on life expectancy, stating that America's decline in this area indicates systemic problems that put the country at risk. However, Yglesias' appeals on this issue have not resulted in invitations from politicians to discuss it further. FDA Commissioner Robert Califf acknowledges the limitations of his agency in addressing life expectancy, as it cannot control factors such as how hospitals and doctors are paid or craft legislation on issues like gun control. Some members of Congress believe that addressing life expectancy should be a priority, while others do not see it as a pressing public health problem. There is a partisan divide on this issue, with Democrats from states with higher life expectancies more likely to view it as a crisis. Republican lawmakers representing states with lower life expectancies were less likely to comment on the issue or did not respond to inquiries. Senators offer different explanations for the decline in life expectancy, with some attributing it to drug overdoses, suicides, and alcoholism, while others argue for broader reforms in the healthcare system and political landscape.
Even within the Democratic party, there are differing opinions on the causes of America's declining life expectancy. Rhode Island Senator Sheldon Whitehouse believes that broken payment incentives for doctors and hospitals are the main cause, while Connecticut Senator Chris Murphy attributes it to loneliness. Other senators focus on the burden of chronic disease, which research has shown erases more years of life than overdoses, homicides, suicides, and car accidents combined.

In New York, officials are taking action to address these challenges. The City Council is considering supporting HealthyNYC, an initiative aimed at preventing premature deaths by reducing chronic diseases and other drivers of early mortality. The goal is for New Yorkers to live longer and experience more milestones in life. Former Mayor Mike Bloomberg implemented various measures during his tenure to improve public health, such as raising cigarette taxes, banning smoking in workplaces, and attempting to limit the sale of large sugary drinks. These efforts contributed to an increase in New Yorkers' projected life expectancy.

However, Bloomberg's initiatives faced opposition from food-makers, industry groups, and some elected officials. The backlash highlights the political challenges of implementing similar measures in other states. Despite this, Senator Bernie Sanders suggests that Washington can start by setting a goal to increase life expectancy and looking to countries like Norway, where life expectancy exceeds 83 years.
Overall, there are varying opinions on the causes of declining life expectancy in the United States, but there is a growing recognition of the need for action to address chronic diseases and improve overall public health.
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