The USA has many of the world’s finest educational institutions. It is home to the world’s largest number of Noble Prize winners in different fields (400). Such intellectual capacity is paradoxically juxtaposed with the fact that the US seeks to remain as the world’s sole superpower by continuing to flex its military might. It is aggressively aiming to contain Russia and China in order to retain its numero uno status in international affairs. Yet, in one fundamental respect the United States is not a nation worthy of emulation.
Take, for example, the record of the USA on a basic health indicator, namely, life expectancy at birth. Indeed, this is regarded as such a pivotal measure of the well-being of nations that the UNDP has incorporated it as one of three components in its well known Human Development Index.
One can draw on the demographic data of the UN’s population division to compare long run trends (1950-2021) in life expectancy at birth (both sexes) in the United States relative to another rich region, Western Europe. There is a significant difference in life expectancy between the USA and Western Europe. In 2021, life expectancy in the USA was 77.2 years while in Western Europe it was 84.1 years. More importantly, life expectancy in the United States has fallen significantly in recent years. Indeed, life expectancy in 2021 in the USA was equal to the value prevailing in 2003! As one analyst notes: “It is hard to communicate just how disquieting that trend is.“
How can one explain this adverse trend in a basic health indicator in one of the world’s most affluent and powerful nations? Nobel Laureate Angus Deaton and his co-author Anne Case wrote, as Harvard economist Kenneth Rogoff has observed, an ‘extraordinarily’ influential paper in 2015 that can shed light on changes in life expectancy in the United States. In 2020, the authors published a major book on the topic.
Case and Deaton discovered ‘deaths of despair’ rising sharply in the 2000s among middle aged, non-Hispanic, white men. The term pertains to rising mortality due to suicide, drug overdose and alcoholic liver disease. Case and Deaton argued that this was primarily concentrated among white males without a college degree. Since then, Case and Deaton have done an update of their original thesis. They lament:
“Deaths of despair, morbidity, and emotional distress continue to rise in the United States, largely borne by those without a college degree—the majority of American adults—for many of whom the economy and society are no longer delivering.”
The authors have blamed the dysfunctional US healthcare system (‘pharma and its political enablers’) for this sorry phenomenon. As the authors suggest, the inadequacies of the US healthcare system is in turn a reflection of a deeper malaise in the US political system. Indeed, political polarization has played an important role in the inept handling of COVID-19 with the United States earning the unenviable distinction of having the largest number of COVID-19 related deaths (over million) in the world. The tragically large number of COVID-19 deaths have reinforced the declining trend in life expectancy in the United States.
Reflections on development and governance 