life expectancy

A grim retrenchment is under way in America. A government report recently showed that life expectancy in the US took a steep drop in 2021, after another dip in 2020. On average, Americans can expect to live 76 years, the fewest since 25 years ago – and on a level with the latest recorded level in much less wealthy countries, such as Brazil or Vietnam. Why are Americans dying so young? The major immediate cause of the drop in the last two years – the pandemic – is clear enough, but discrepancies date back to before the pandemic. By 2019, Chileans and Slovenians were already living longer than Americans. Life expectancy in the US was flat for almost a decade before the recent drop, as citizens of other rich countries continued to live longer and longer each year. This fact represents a stunning – if largely unacknowledged – rebuke of the dominant view in some circles, especially in the tech and business sectors, that indicators like GDP and life expectancy show constant historical improvement in America thanks to technological progress, and will continue to do so (that is, if only regulators will cut taxes on capital gains). Even reliably boosterish US pundits such as Matthew Yglesias – known for extolling America’s civilising improvements, such as tumble dryers – have had to admit the situation is bleak. “We are earning like Norwegians but dying like Latvians,” Yglesias writes in a recent post on his Substack. The US may have a higher GDP per capita than even wealthy countries in western Europe. But what good is that money – or a tumble dryer, for that matter – if the lifestyle it supports, far from keeping death at bay, seems only to hasten its coming? Possible explanations for the retrogression in American lifespans are not scarce. At the top of the list is a healthcare system that spends freely and yet achieves disappointing results. In Texas, the second-most populous state in the nation, nearly 20 per cent of the population lacks health insurance. Even those who do have insurance can be prevented from receiving the necessary care by a byzantine system of fees that often extract a steep toll from those who fail to navigate it adeptly enough – in the form of "out of network" costs and a panoply of other nasty surprises. This is despite the fact that the highest echelon of medical care in the US is the best in the world and that – due in part to a certain national hypochondria? – it screens more aggressively and more effectively for some cancers than Europe. The US healthcare system has played a role, too, in another factor pushing American life expectancy downward: opioid and other drug overdoses, from which more than 100,000 died in 2021 alone. [See also: American sociologist Dylan Riley: “Justice cannot be the lodestar of a new society”] Lifestyle is also often cited as a killer – specifically, the national penchant for driving to places instead of walking, and for consuming too much sugary food and drink. Cars reduce the amount of exercise that people get and, especially when combined with alcohol, are deadly to pedestrians and drivers, too. While sugary foods contribute to obesity and a range of health problems. Could this be solved with a government campaign to tax sugary goods and get people out of cars? This may depend on whether Americans want to consume less and drive less. Imploring the nation to restrain its love for material things like these is best done advisedly. As president during the energy crises of the 1970s, Jimmy Carter tried to do so in his famous “crisis of confidence” speech in 1979 – telling Americans that “piling up material goods cannot fill the emptiness of lives which have no confidence or purpose”. Days later, he reshuffled his cabinet; in little over a year, he lost re-election to Ronald Reagan who promised a return to supercharged consumption. Joe Biden noticeably opted not to take a similar line this year when petrol prices spiked – and despite his own well-known history of commuting by train (the national train service has received lavish funding under his watch), the president seems more supportive of electric cars than expanding public transit as a next-generation transportation solution for the nation. Despite the slowly increasing influence of civil-society advocates for walkable cities, Americans’ love affair with the automobile seems just as passionate as ever. The rise of the electric car has made clear that even in the case where the US transitions to a low-carbon economy, it seems wholly possible for the car to maintain its dominance. It is little wonder why Americans love cars with a special intensity. The automobile is a piece of private property that is movable. Unlike a train or bus, it operates on no fixed schedule or route set by an outside authority. It is a bubble that separates and protects the individual (or the nuclear family) from a potentially hostile outside world. In a word, it promises atomised freedom, safety and spontaneous mobility. [See also: Is this America’s last real election?] Even placing to one side the inexhaustible American mythos of the car, from the road trip to the high-speed chase to the fast food drive-through, the automobile captures so much of what so many Americans long for, and fear, that it is difficult to see how it could ever be abandoned – even if it exacts a mortal toll on the country. On the topic of encouraging Americans to drive less or eat better, it is possible to debate the merits of public policy interventions that target individual behaviour – for example, the sneaky “nudges” that the Harvard scholar Cass Sunstein advocates, things like putting unhealthy food in harder-to-reach spots in stores. But it is also worth interrogating the assumptions of such policies. The idea is that enlightened officials can and should change the way people live to achieve for them outcomes the public desires but is incapable of realising, either because of personal weakness or structural forces arrayed against them. But the best way to tackle structural forces that present Americans with a set of bad choices – and there are many – is head-on rather than indirectly. Instead of devising financial instruments that help Americans save money to defray unexpected health expenses, for example, it would be more effective, and simpler, to create a healthcare system that does not generate such expenses. And in the case where individuals seem unable to choose what is better for them, we must ask, better according to whom? After all, people are owed the chance for a long and full life, but they are also owed the chance to live pleasantly. One does not have to hew to the “live fast, die young” school of thought to admit that what the philosopher Giorgio Agamben calls “bare life” – mere existence, bereft of considerations about how life is lived – is not worth fighting for alone. When life is good, prolonging the human lifespan becomes a much more worthy goal. And who can judge the good life except those seeking to live it? There are undoubtedly people who would accept endless controls on their behaviour (or “nudges”) in exchange for a life longer in years if not fuller of joy. But there are also many, in the US and elsewhere, who would refuse such a trade. No discussion of the material reality of dying in America would be complete without considering the complex and contradictory valence of mortality in American culture. Mortal violence is a conspicuous presence in its society, from dramatised gun battles in action movies to the real violence on city streets and, most horribly, in the nation’s schools. Homicide – having dropped significantly since the 1990s but having risen in 2020 and 2021, and still far above European levels – is another drag on the American life expectancy, its relative rarity set against the reality that its victims are often young. And unlike most of Europe, where capital punishment has been abolished, death can still come in the US from the state. These dynamics have drawn extreme claims from commentators – that American society worships the gun as the Canaanites worshipped Moloch, the biblical god of child sacrifice; or that American society is motivated by Freud’s notion of the “death drive”, described as a deeply buried psychological urge to seek death as a return to the remote era before the dawn of multicellular life itself. But such claims would seem to make the country out to be in some sense primitive, pre-modern – when it is anything but. In fact, the reality of death in America co-exists with a deep-seated, and distinctly modern, cultural refusal to reckon with its very imminence. In the Mexican Nobel Prize-winning poet Octavio Paz’s controversial Labyrinth of Solitude – a 1950 essay in the Mexican national character – Paz juxtaposes Mexican culture, which he says embraces death, with American culture, which “not only does not want to familiarise itself with death but actively avoids the idea”. Why is this? Hollywood certainly incubates a sinister cult of youth, while a celebrity class terrified of death would rather make themselves carnivalesque with copious plastic surgery than accept the outward signs of ageing. But a deeper cause might be found in the long-term cultural effects of a Protestantism that connects purity with health and godliness. In this model, illness becomes the mark of those not favoured by God: witness the unhinged response of Donald Trump to contracting Covid-19 in 2020, broadcasting a freakish positivity, downplaying the extent of his illness, and then insisting on being discharged prematurely from hospital to publicly pump his fist. Such behaviour, besides being odd, is probably unhealthy. Culture is, of course, hard to quantify – and, luckily, not all Americans have the attitude of Trump or other celebrities to ageing and illness. But, counterintuitive as this might sound, it may still be the case that a greater societal sense of comfort with the prospect that all life comes to an end would represent an important step towards reversing the shrinking of American lives. For the time being, however, the loudest voices seem to be pushing in the opposite direction. Americans have long been tempted by the misbegotten idea that, instead of dying, humans might simply be able to live forever. And as real-world life expectancy erodes, in tech circles the dream of eternal life has gained momentum in recent years. Tech billionaires from across the political spectrum, from the Democratic-aligned Bill Gates to the conservative PayPal founder Peter Thiel, have become taken with the idea of extending the human lifespan. “There are all these people who say that death is natural, it’s just part of life, and I think that nothing can be further from the truth,” Thiel said a decade ago. The Amazon founder Jeff Bezos has reportedly funded a Silicon Valley lab investigating “longevity” technology. The effort to cheat death by tech and venture-capital circles has been punctuated by the occasional bump in the road: a start-up offering rejuvenating infusions of young people’s blood shut down in 2019 after the government issued a warning against the procedure. Technology does have an important role to play in producing improvements both to the quality and length of human life. But there is obvious hubris in the way Silicon Valley’s captains of industry are pursuing their goal – any reasonable person knows that denying death is no way to live well. And even putting that aside, a lack of attention to social considerations threatens to hamstring the positive effects of whatever technology might emerge from their investments. Americans shouldn’t be fooled by Silicon Valley’s enticements of eternal life. Not only are humans inevitably mortal, the retrenchment of recent years proves beyond a doubt that further progress to living standards is by no means assured. Instead of falling victim to the dreams of cheating death that are emanating from villas in the Palo Alto hills of California – even as the country around them decays – what is needed is attention to the real economic and social structures that cheat Americans of life. [See also: Bruno Latour and the philosophy of life]

life expectancy

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