For most of my life, I rejected the assertion that America is a “sick society.” This judgment seemed too broad and lacking in nuance. Yes, there was regress in some areas, such as the surge of gun-related crimes in the 1980s. But there was progress on other fronts. Life expectancy increased steadily, and a rising share of Americans had access to healthcare. The rate of smoking among young people declined sharply, as did teen pregnancy. Many gaps among racial and ethnic groups were narrowing.
These positive developments gave me hope that the U.S. was moving in a healthier direction. Over the past two decades, however, I’ve increasingly questioned my earlier confidence. Now, in the wake of the pandemic, I’ve concluded that I was wrong.
It’s no secret that life expectancy in the U.S. is much lower than it should be. In 2019, before the Covid-19 pandemic struck, we ranked 29th among the 38 member nations of the Organization for Economic Cooperation and Development. U.S. life expectancy trailed Germany’s by 2.5 years, Canada’s by 3.2 years, and France’s by four years.
Some of this disparity reflects the U.S.’s terrible performance in infant mortality. It ranked 33rd, behind every European and Asian country in the OECD. Some of it reflects huge geographical disparities within the U.S. The life expectancy gap in 2019 between America’s best state (Hawaii) and its worst was about seven years. Still, even Hawaii trailed 25 OECD countries. (West Virginia would have placed dead last, behind Mexico.)
The pandemic made things worse, because the Covid death rate in the U.S. was much higher than in most other high-income countries. The U.S. suffered 332 deaths per 100,000 population, compared with 240 in France, 194 in Germany, and 128 in Canada. U.S. life expectancy fell to 76.4 years in 2021, the lowest since 1996, erasing a quarter-century of progress. By the end of 2021, the life-expectancy gap between the U.S. and Germany had widened to 4.3 years, and between the U.S. and France to six years.
Some of this damage may reverse as the pandemic recedes. But another trend is moving in the opposite direction—the alarming surge in drug-related deaths.
During the final three decades of the 20th century, deaths from overdoses rose slowly from a low base. In 2000 about 17,000 Americans (62 per million) died from drug overdoses. By 2020 this figure had risen more…
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