More equal access to health care and safety net provisions across the life course could be key
By Rae Lynn Mitchell
We are just starting the decade of the 2020s and already are seeing a level of turmoil rivaling the dramatic social, economic and political changes seen in the roaring ’20s a century ago. With mass media at the ready, the public is bombarded with news about the killer opioid crisis, the lingering COVID-19 pandemic—which is now turning into a possible triple pandemic—and a growing recognition of social isolation and other mental health issues that have placed a heavy burden on older adults and their families.
In the past, despite the problems du jour, there was typically a steady march toward increased life expectancy in the United States. As a society we proudly touted the successes of medicine, public health, access to health care, rising living standards, and improved lifestyles and education as influencing the length and quality of life.
Yet, according to Regents and Distinguished Professor Marcia Ory, PhD, MPH, of the Texas A&M University School of Public Health, America is facing early warnings of a declining life expectancy at birth, having recently reached a sustained two-year downward turn for the first time in a century.
Life expectancy at birth is a demographic term reflecting the average number of years a newborn could be expected to live if they were to experience the age-specific death rates prevailing during a specific period throughout their life. The excess mortality associated with the COVID-19 pandemic led to an overall decline in life expectancy in recent years. But so did a burgeoning of other social and health problems such as accidents/unintentional injuries, heart disease, chronic liver disease and cirrhosis, and suicide.
As indicated by a recent CDC report, this decline is not constant across all groups but reflects underlying social vulnerabilities and targets for intervention.
“There have been declines for men and women, but the declines have been greater for men, resulting in a widening gender gap with women’s life expectancy now 79.1 years compared to men’s life expectancy of 73.2 years,” Ory said.
Similarly, being affiliated with a particular ethnic or racial group has different consequences. From 2019 to 2021 the non-Hispanic white population and non-Hispanic Asian population saw modest declines in life expectancy (about two years) while the non-Hispanic American Indian/Alaskan Native population, the non-Hispanic Black population, and the Hispanic population saw much larger aggregate declines from four to six years. One positive trend, however, is the life expectancy gap between Black and white populations is narrowing.
How to reverse the trend
What are some specific strategies that can be undertaken to increase life expectancy—both at birth as well as at an older age? Life expectancy at age 65 has increased on average from the 1960s to 2020, but there are also recent drops in how long someone who is already age 65 can expect to live, with women likely to live about 19.8 years longer and men about 17 years longer. Interestingly, there are many overlaps in the factors associated with life expectancy at any age, pointing again to the importance of medical innovation and public health infrastructure.
The big question is whether our life expectancy will continue to drop, plateau off, or begin to increase again.
“On the negative side, the United States has much lower life expectancy rates than other comparable high-income countries. This suggests that more equal access to health care and safety net provisions across the life course might be important,” Ory said. “On the positive side, Healthy People 2030 goals target reducing health disparities and improving access to preventive and curative treatments.”
Additionally, professional associations have started campaigns to reframe aging, which is likely to lead to a better quality of life as well as the overall length of life. As an example, one of the core strategic priorities of the American Society on Aging is to address ageism by reframing the conversation about aging and older people.
“This will go a long way to counter institutional, interpersonal and internal ageism, which has been associated with myriad negative health effects,” Ory said. “These activities are in line with the United Nations Decade of Healthy Aging (2021–30) where four action areas are relevant globally and particularly in the United States: combating ageism, promoting age-friendly environments, providing access to integrated care, and supporting good quality long-term care.”
Ory acknowledges we are living in tumultuous times with declining life expectancies; however, she cautions that this does not need to be our destiny and advises as we approach the new year, we should rethink challenges as opportunities.
“As a society, we should pay more attention to ensuring access to quality health care, shoring up our public health infrastructure, addressing social determinants of health, and reframing aging so that there is value to and respect for each stage of life,” she said. “Let’s hope that the current ’20s will roar in positive change, with accommodations to the growing number of older Americans expected this decade.”