American Exceptionalism

Know Your Square Inch

Editor’s note: This article is one in an occasional series entitled “Know Your Square Inch,” Roberto Rivera’s nod of the head to Abraham Kuyper’s famous claim that every square inch of creation belongs to Jesus Christ. That being the case, Roberto seeks to inform American Christians of important global issues that may be unfamiliar to them.

For the second year in a row, life expectancy in the United States dropped. In 2015, it dropped to 78.7, down from 78.9 in 2014. Prior to 2015, the last time life expectancy in the United States had declined was in 1993 at the peak of the AIDS epidemic. The last time it declined two years in a row was 1962 and 1963, when an unusually virulent influenza outbreak drove the decline. Driving the decline are accidental deaths. i.e., drug overdoses, suicide, and Alzheimer’s.

This kind of decline is not supposed to happen in a developed country such as the United States. Bob Anderson, the Head of the Mortality Statistics Branch at the National Center for Health Statistics, pointed out that “If you look at the other developed countries in the world, they’re not seeing this kind of thing. Life expectancy is going up.” It’s not just developed countries. Costa Ricans have a higher life expectancy than Americans and theirs is continuing to rise. The same is true of Puerto Rico.

While a few tenths of a year may not sound like a big deal, it adds up. Bill Gardner, a professor of epidemiology at the University of Ottawa, ran the numbers at The Accidental Economist blog and the results were startling. A decline in life expectancy of 0.1 years equals 400,000 “lost years” over the lifetimes of the approximately four million children born in a given year. That’s nearly twice the number of “lost years” represented by American troops killed in the Iraq War (243,000 “lost years”). Gardner estimates that the economic cost of those “lost years” is $4 trillion. (Credit Where Credit is Due Department: Vox Media’s “The Weeds.”) No wonder Anderson told NPR that while “I’m not prone to dramatic statements . . . But I think we should be really alarmed.”

The chief culprit driving the decline is, as you probably guessed, the opioid epidemic. “At least 66,324 people died of drug overdoses during the 12-month period ending in May 2017, up 17 percent from the 56,488 who died between May 2015 and May 2016,” according to the National Center for Health Statistics. It will probably get worse before it gets better, if it gets better. By one estimate, the mid-range figure for opioid deaths over the next decade is 500,000. The “optimistic” forecast is half of that.

This is a cursory look at what journalists call the “What?” of the story. That leaves us with the “Why?” Ann Case and Angus Deaton, who first brought attention to the rise in mortality rates among middle-aged whites in this 2015 paper, coined a memorable phrase in their 2017 follow-up paper: “Deaths of Despair.” The “despair” referred to is manifested in the rising number of deaths from “drugs, alcohol, and suicide.”

That prompts an obvious question: Despairing about what? Case and Deaton offer what they call a “tentative but ‘plausible’ explanation:  write “Ultimately, we see our story as about the collapse of the white, high-school-educated working class after its heyday in the early 1970s, and the pathologies that accompany that decline.”

As Case put it, “You used to be able to get a really good job with a high school diploma. A job with on-the-job training, a job with benefits. You could expect to move up . . .” Not anymore. Instead, disappointment after disappointment seems to be your life story. As Deaton adds, “Your family life has fallen apart, you don’t know your kids anymore, all the things you expected when you started out your life just haven’t happened at all.” In response, people either “self-medicate” with drugs and/or alcohol or they kill themselves, slowly through poor personal habits, or suddenly through weapons or substances.

Case and Deaton’s “story” is definitely plausible, and it has the added advantage of working for both the economically-minded and social conservatives. The former can point to the loss of good-paying jobs and the latter can speak about the need for meaning and purpose and the void created by a lack of faith.

The problem is that however well the “story” works in the United States, people in other developed countries facing the same challenges and disappointments are not reacting in the same way: life expectancy isn’t going down, suicide rates aren’t nearly as high as ours, and they don’t face an opioid crisis anywhere near as catastrophic as ours.

Greece’s unemployment rate is five times as high as ours and its per capita is less than half of ours. No developed country was hit harder by the 2008 financial crisis than Greece. Yet its life expectancy is higher than ours and is increasing. Its drug overdose rate is about one quarter of ours. The same is true of Spain (17.1 percent unemployment rate) and France (9.8 percent unemployment rate). Both are, economically-speaking, worse off than the U.S., yet both rank near the top in life expectancy and near the bottom in drug overdose rates.

Likewise, there’s little evidence of a connection between “deaths of despair” and religious observance, at least outside of the United States. Scarcely-churched countries like the President’s beloved Norway and the rest of Scandinavia are hardly the paradises of the liberal imagination, but their secularism hasn’t produced “deaths of despair” on anything near the magnitude of the United States.

Whatever is causing Americans to engage in behavior that has led to dropping life expectancy seems to be unique, at least among developed countries, to the United States. Somehow, I don’t think that this is what people have in mind when they talk about “American exceptionalism.”

What is it? Here is one suggestion: loneliness. More Americans are living alone than ever before. It’s the logical outcome of our individualism and insistence on autonomy.

We’re only beginning to understand the public health consequences of this isolation. A meta-analysis done by a Brigham Young University researcher found that “people with social connections had a 50% lower risk of dying early compared to people who did not have strong social circles,” and that the “that the impact [of loneliness, isolation, and living alone] was similar to the effect that obesity has on mortality rates.”

This may partly explain why people in countries that are poorer than us, but are also much more family-centered, e.g., Greece, Italy, Spain, Costa Rica, etc., tend to live longer than us. Family, by which I mean your extended family, makes us more resilient.

This kind of resilience is, to put it mildly, vital. None of us are going to get everything we expect and a lot of us will get very little of what we expect. But disappointment doesn’t have to be a ticket to an early grave. There are far better ways to be exceptional.

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