T

he economy may be growing and the stock market booming, but Americans are dying younger — living shorter lives than previous generations and dying earlier than their counterparts around the world.

It is easy to place the blame squarely on our nation’s opioid epidemic, but if we do that we miss seeing the abysmal new life expectancy data from the Centers for Disease Control and Prevention for what they are — an indictment of the American health care system.

According to the CDC, the average life expectancy at birth in the U.S. fell by 0.1 years, to 78.6, in 2016, following a similar drop in 2015. This is the first time in 50 years that life expectancy has fallen for two years running. In 25 other developed countries, life expectancy in 2015 averaged 81.8 years.

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There’s no question that a big culprit is the opioid epidemic, which contributed significantly to an increase in death rates for Americans aged 15 to 64 years. At first glance, substance abuse would seem more a social and economic problem than one of health care, and there is no question that socioeconomics are a major player in causing the so-called deaths of despair associated with substance abuse.

But, we cannot let our health care system off too easily.

The epidemic of drug abuse and overdose deaths has not affected other developed countries the way it has ours. With 4 percent of the world’s population, the U.S. accounts for 27 percent of the world’s overdose deaths. The European Union, with a population of 507 million, reported 6,800 overdose deaths in 2014, compared to 47,055 in the U.S. That disparity exists even though many other developed countries have faced even greater economic challenges than we have. In 2016, France and Spain had unemployment rates of 10.1 and 19.6 percent, respectively, compared to 4.9 percent in the U.S.

Why has it been it so much worse here? One reason is that the U.S. doesn’t have strong social safety nets that buffer the effects of recessions and job loss as other nations do. Another reason is the way the U.S. health care system functions.

The profitability of drugs in the United States, a result of sky-high and skyrocketing drug prices, has made the aggressive marketing and sale of new prescription opioids an almost irresistible temptation for American pharmaceutical companies. Bombarded by clever advertising, U.S. physicians have, in turn, become quicker on the draw in prescribing opioids than physicians in other developed nations. The role of pharma is most clearly illustrated in the case of Purdue Pharma, which has been sued thousands of times over OxyContin, a prescription painkiller. The company settled one case for $600 million after the federal government accused it of making false claims about the drug’s risk of addiction and denying its potential to be abused. A raft of new suits by cities and states claiming that drug companies have profited from a product they knew to be dangerous are now pending.

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The opioid epidemic is not the only area in which the U.S. health system lags. In 2015, life expectancy at age 65 in the U.S. ranked 26th among the 37 members of the Organization for Economic Cooperation and Development, which includes most developed nations. It is widely accepted that the accessibility and quality of medical services strongly affect life expectancy among the elderly and elderly Americans fall behind their counterparts overseas when it comes to being able to get and afford the health care they need.

This may seem surprising given that Americans over 65 enjoy universal health insurance coverage under Medicare. But as valuable as Medicare is, it provides far less protection against the cost of illness, and far less access to services, than do most other Western countries. In a recent cross-national survey, U.S. seniors were more likely to report having three or more chronic illnesses than their counterparts in 10 other high-income countries. At the same time, they were four times more likely than seniors in countries such as Norway and England to skip care because of costs. Medicare, it turns out, is not very good insurance compared to what’s available in most of the western world.

We are the wealthiest nation on earth, but far from the healthiest, and things are getting worse, not better. The CDC report is yet another call to action for fundamental health system change that should include, among other things, reforming our pharmaceutical markets and making good health insurance available to all Americans. These need to be urgent priorities in 2018 for a government that should care as much about the health of Americans as their wealth.

David Blumenthal, M.D., is president of the Commonwealth Fund.

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  • During the 1990s, FDA approved Perdue’s aggressive marketing campaign urging doctors to widely prescribe oxycontin (which FDA deemed as safe and effective), and more than a decade later FDA approved a non addictive alternative that forced hundreds of thousands of oxycontin users to switch to even more harmful heroin, which is now laced with exponentially more harmful fentanyl.

    The federal government continues to legally classify marijuana as the most hazardous of drugs (along with heroin), refuses to acknowledge that marijuana is far less harmful and far more acceptable alternative for many cancer, HIV, pain and other patients because Big Pharma and anti marijuana activists have colluded to keep marijuana banned. Marijuana also is a harm reduction alternative to opioids, alcohol and other drugs.

    Since 2009, Obama’s FDA, CDC and all other DHHS agencies have committed public health malpractice by preventing and discouraging addicted cigarette smokers from switching to exponentially less harmful vapor products (that have helped several millions smokers quit smoking) by FDA unlawfully banning them in 2009, and then banning their sale again in 2016 (that was set to go into effect 2018, but Gottlieb delayed the ban till 2022) and by falsely claiming vapor products are addicting children, are gateways to cigarettes, may be as harmful as cigarettes, and don’t help people quit smoking.

    DHHS has been saying the same lies about very low risk smokeless tobacco producgts since 1986, while Congress banned the sale of new smokeless tobacco products in 2007, banned truthful claims that smokeless is less harmful than cigarettes, and required false fear mongering warnings on smokeless products.

    And during the last half of the 20th century, many Congresses and Administrations protected cigarette companies instead of public health
    (while the cigarette industry paid off the AMA to denounce the 1964 SG Report on cigarette smoking).

    Obesity is now the biggest public health problem in America, largely due to policies enacted by Congress and promoted by DHHS (to encourage and then treat obesity instead of encouraging individual responsibility to prevent obesity). Meanwhile, many decades of Congressional sugar industry subsidization, USDA promotion of meat and dairy products, and subsequent DHHS demonization of fat consumption fueled and helped create the diabetes and obesity epidemics.

    Finally, the 18% of US GDP that is spent on healthcare services (twice that of any other developed country) has had relatively little impact on public health and life expectancy.

    But don’t expect Big Medicine, Big Healthcare, or Big Government to acknowledge these facts, or to take corrective actions (as there’s a whole lot more money to be made from creating and treating diseases than from disease prevention).

    And don’t get me started on the “climate change” hypocrites who continue to emit exponentially more carbon than 80% of the world’s population (with their air travel, mansions, second homes, SUVs, air conditioning and daily consumption of meat), while demanding and lobbying for absurd “climate change” policies that would destroy America’s economy, the coal, oil and natural gas industries (after they spent decades lobbying to destroy America’s nuclear industry).

  • We overeat the wrong things, drink too much of the wrong stuff and not water. People still smoke, don’t exercise enough, sleep enough. Drugs have become a way of life it appears.

    These are choices. We patients can use the system to help us get better.

  • The US lacks a precautionary principle that is more prevalent in Scandinavia, Europe, and Japan.
    Things that are questionable or harmful, from food additives and products to medical and dental devices to chemicals etc, are approved earlier and persist longer on the market here after side effects are found. The regulatory system requires proof of harm, instead of proof of safety, especially for devices and dental materials.

    We also lag behind other nations in recognizing and fully integrating dental care, diagnosis, insurance, records, research, treatment and Big Data fully into healthcare, and ensuring use of the safest dental materials with the fewest long term side effects and health risks. As a wise physician said, When the latest medical therapies fail. think dental. Instead, our physicians are flying blind.

  • It’s as much an indictment of the political and economic system as of the medical system (though I agree with a lot of what the article says, especially about high Medicare costs as I see my elderly neighbor with cancer struggle with co-pays). Without a safety net, people on the bottom struggle so hard that it for many of them will shorten life. Education is a buffer that often helps people manage well mentally even though poor, but we have made it much harder for people to gain that buffer with high expenses. Mental health help is hard to find too.

    • Sadly, Andy, I think you are right (as some of the other comments here kinda show, like well we should blame lower life expectancy on “diversity”). In that case, the real problem is that we include poor people in the life expectancy stats. (snark) Just a few statistical adjustments can solve this “problem.”

      Move along, people. Nothing to see here. Poor people don’t count.

    • Modern poverty is rarely sufficient to reduce life span. In fact, some of the countries with higher life expectancy than the US have median incomes below the US poverty line. The behaviors of some impoverished people reduces their life spans, and often leads to a condition of poverty.

    • Nicholas, absolutely one might have less money in toto (live in a country with a lower median income) and be healthier than the US poor. But that’s not because poverty doesn’t diminish the lifespan. The US poor are terribly insecure and struggle terribly, they are also disrespected. If one lived on no more money but with more security in an environment which has stronger social support, obviously yes then one may be much healthier. One might have a low-level but secure income and a good community and a much easier life than someone who has more income elsewhere (but is not in reality “better off”). Poverty shortens life. Period.

      I made the point also about education, as well as social support, being a buffer to help with health effects of poverty.

      The poor are not to blame for the crappy contingent jobs that stress them and make their lives harder: https://www.politico.com/magazine/story/2018/01/04/future-work-independent-contractors-alternative-work-arrangements-216212 This is something that has changed over the years for the much worse in US society. And I think a factor in diminishing lifespan.

      Used to be a nursing home ombudsman and most of the CNAs had to work two jobs to make ends meet. Several had auto accidents because of their tiredness. Not healthy! (but had nothing to do with their habits, it had to do with poverty and work conditions)

    • Poverty of some sorts — but not all sorts — leads to adverse physical effects. However, the reduction of life expectancy among lower-income persons is due to very specific behaviors. These include excessive drink and drugs, poor diets, risky sexual activities, and higher levels of homicide and accidents. All of these are largely avoidable risks, and if avoided would bring those in lower income to near parity with the non-poor for life expectancy.

      It’s important to note, also, that there is a great deal of mobility among income groups. For instance, over half of the taxpayers in the lowest income quintile in 1996 had moved to a higher quintile by 2005. I don’t know of research about whether they then ate better food and engaged in less risky behavior.

  • Americans are overweight compared to people of other developed countries. Since caloric restriction extends life better than almost any other intervention, obesity may play a major role in lowering US longevity.

    • There is no proof that caloric restriction by humans increases life span. To calorically restrict is an almost impossible task for most people, and leads to considerable emotional stress.

      I used to work with Roy Walford, who, more than anyone else, is associated with caloric restriction. He died younger than he had expected of ALS, and some research has shown that a reduced calorie diet is associated with increased risk for ALS.

  • It would be interesting to compare the disease burden of seniors entering the Medicare insurance system to the disease burden of seniors in other western countries. Many of the chronic diseases of seniors in the US are preventable, or at least mitigable, with appropriate life-style modifications, such as healthy diets, avoiding smoking and excess alcohol consumption, and clean environments. Once people are chronically ill, it is a lot to expect of the health care system to make them better.

  • DB, if you segment the life expectancy rates by race, does the white population still experience earlier mortality than civilized Europe ?

    • “does the white population still experience earlier mortality than civilized Europe?”
      Yes. (Though I don’t know about uncivilized Europe. Where is that?)
      “The scientific evidence pointing to a “U.S. health disadvantage” relative to other high-income countries has been building over time. Several studies using comparable data sources in the United States and United Kingdom have reported that Americans have higher disease rates and poorer health than the British…

      “The investigators also reported that this health disadvantage persisted even when the comparison was limited to people in the highest socioeconomic brackets, whites, the insured, and those without a history of tobacco use, drinking, or obesity.”
      https://www.ncbi.nlm.nih.gov/books/NBK154486/
      This poorer health is matched by higher mortality.
      “In short, in terms of sheer physical survival, people living in the United States fare worse than their counterparts in peer countries except at the very oldest ages… This finding is not simply a reflection of the racial and ethnic diversity of the U.S. population. When the analysis was limited to non-Hispanic whites in the United States, the poor U.S. ranking hardly changed.”
      https://www.ncbi.nlm.nih.gov/books/NBK154489/

  • Cost effective approaches to improved health care include better education of the public on the role of nutrition and exercise in health, leaning on people (How?) to practice healthy life styles, and leaning on doctors to get away from the “pill for an ill” practice of medicine. But the medical-congressional complex (e.g., pharma and Orrin Hatch) will not allow those approaches to be encouraged by the federal government.
    (in the USA) almost impossible to create any federal aid program that doesn’t depend on incompetent federal employees, invite massive fraud, cost the taxpayers, unveil some pay-to-play congressman [apology for the repetition] serving the industry that bribes her, enrich some corporation, and actually disserve those it was intended to aid.
    Example – student loans [LBJ administration]. Colleges raised tuition, students graduated with debt they can’t pay off . . . Why doesn’t Australia have a student loan crisis?
    see “who got rich off student loans [www.revealnews.org] (note the mention of a certain congressman)
    Example – War on Poverty has increased number on welfare, created the poverty industry – see Legacy
    Example – medicare – robbed the middle class, diminished the quality of health care, opened the way for massive fraud
    Example – medicaid – runaway waste of taxpayers money
    Example – ObamaPhones – riddled with fraud, enriched corporations
    Example – Nixon’s War on Drugs – filled the prisons, cost millions in law enforcement, made drug dealers rich, killed thousands, still thousands on drugs

    Example – the Equal Opportunity Loan program that helped bring fast food to, and destroyed the health of, those in low-income areas https://newrepublic.com/article/144168/fast-food-chains-supersized-inequality?utm_source=nextdraft&utm_medium=email&mc_cid=2b0e7e79c4&mc_eid=f09afc3f69
    “You can always count on the Americans to do the right thing after they have tried everything else.” Churchill was wrong . . . Congress never does do the right thing.

    • Eric, your observation about lifestyle change is on the mark. But when will the medical community look away from scientific methods and re-embrace the humanistic side of medicine in a serious manner. The National Board of Medical Examiners came along side the International Consortium for Health and Wellness Coaches and created a standard and test to certify health and Wellness coaches. With 75% of chronic disease and 1/3 ($1 trillion) of the US healthcare spend behavior/lifestyle related, why are there very few hospitals with coaches on staff, save the Mayo Clinic who provides coaching for healthcare workers and patients who need “transformation” not information. Even the greatest teacher, Marva Collins would have agreed that the healthcare community needs to educate people, but the content must be geared to self-reliance and self-respect. If we simply supply more information to patients, we will come up short again and again. Low hanging fruit everywhere.

    • Erik Kengaard,
      Before presenting your above examples as objective truth, you need to cite legitimate evidence in support of your assertions. Your examples appear to target the social safety net in this country, a focus that is easily construed as politically motivated. These examples do not stand alone as you have stated them.

    • The “pill for the ill” comment is on the mark. What most people don’t realize is alot of those pills are creating illness, not curing it. We are in a prescription drug epidemic, it’s not confined to opioids. When the first prescription causes horrible ‘side effects’, more drugs are prescribed to cure the consequences. People are being turned into a toxic stew of chemicals. The majority of doctors have very little knowledge of what the drugs they prescribe are capable of doing to the human body. They, and the public, were somehow convinced they are “safe”.

  • Why is opioid use more lethal in the United States? Because drug prohibition is enforced more stringently, safe drugs are less available, and more people resort to the dangers of bootleg opioids. Most opioid deaths are due to illicit products and drug/alcohol mixing. The indictment of medicine should rest on the fact the physicians act as state agents enforcing drug restrictions.

    After Portugal decriminalized all drugs, overdose deaths plummeted.

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