America’s unhealthy lifestyles

Despite the remarkable improvements in U.S. mortality levels and longevity during the 20th century, America’s unhealthy lifestyles are undermining the nation’s wellbeing and imperiling its future.  

In addition to inflicting a sizable human toll, unhealthy lifestyles are exacting substantial costs from families, employers and the U.S. economy.

Over the last 40 years, America’s life expectancy has fallen behind those of other developed nations that culminated in an unprecedented decline in longevity since 2014. Recent declines in life expectancy were driven by increasing mortality rates among working-age adults, specifically those of lower socioeconomic status. Also, noteworthy differentials in life expectancy at birth have persisted among America’s major groups, namely, Hispanics (81.8 years), whites (78.8 years) and Blacks (74.7 years). 

Prior to the pandemic, America’s life expectancy at birth of 78.8 years lagged behind the levels of many other developed countries. Life expectancies at birth above 83 years, for example, were experienced in Australia, Italy, Japan, Spain and Switzerland. 

Many social, economic and political factors are behind the comparatively lower levels and recent declines in U.S. life expectancies, including the absence of universal health care, public health crisis, inadequate federal drug oversight, lower levels of educational attainment, deindustrialization of American jobs, systemic racism and unhealthy lifestyles. 

Particularly noteworthy, unhealthy lifestyles that are contributing to rising levels of preventable deaths are cigarette smoking, obesity, alcohol misuse and drug overdoses.

Cigarette smoking is the leading cause of preventable deaths in the U.S., with nearly 500,000 deaths per year and smokers dying 10 years earlier than nonsmokers. For every American dying from smoking, no less than 30 others live with a serious smoking-related illness, including cancer, heart disease, stroke and various lung diseases.  

The economic cost of smoking is more than $300 billion annually. Most of that cost, close to 60 percent, is for direct care, and more than $156 billion is incurred in lost productivity due to premature death. 

In 2018, approximately 14 percent of American adults, or 34 million people, aged 18 years or older were cigarette smokers. The proportion was higher among men than women, 16 versus 12 percent, respectively. If smoking continues at its current level among U.S. youth, nearly 6 million Americans below the age of 18 years are expected to die prematurely from a smoking-related illness. 

The second leading cause of preventable deaths is obesity. It is largely the result of poor diet and physical inactivity and related to reduced quality of life and various health conditions, including heart disease, stroke, type 2 diabetes, arthritis and joint disorders, clinical depression and some cancer types.  

Among OECD countries, America has the highest percentage of obesity among adults, approximately 42 percent in 2017-2018. In contrast, the rates of many countries are a fraction of America’s percentage, including Italy, Japan and South Korea, all at less than 10 percent.

America’s levels of obesity are estimated to account for about half of its shortfall in life expectancy compared to other developed countries. Also, obesity is associated with poorer mental health, greater difficulties with physical functioning and higher medical costs than people with healthy weight.

From 1999 to 2018, the prevalence of obesity in American adults increased from 31 to 42 percent, with severe obesity nearly doubling from 5 to 9 percent. While there are no significant differences between men and women, the adult obesity prevalence percentages among major groups varied considerably, with Asians 17 percent, Whites 42 percent, Hispanics 45 percent and Blacks 50 percent. 

Nearly 100,000 Americans, two-thirds being men, die from alcohol-related deaths annually. This level of mortality makes alcohol the third leading cause of preventable deaths in America. 

While the U.S. has one of the lowest alcohol use rates per capita among developed countries, with Australia, France, Germany and the United Kingdom having higher rates, America has higher levels of alcohol abuse than those countries. It is estimated that 6 percent of American adults, approximately 15 million, struggle with an alcohol use disorder, with men having twice the level of women. Among teenagers, more than 600,000 have alcohol use disorders.

Over the past 20 years, drug overdose mortality has more than tripled and reached unprecedented levels. According to the Centers for Disease Control and Prevention, drug overdose has become the leading cause of U.S. injury death, more numerous than motor vehicle deaths and homicides.

Mortality due to drug overdose has continued to rise. In 2017, drug overdose resulted in more than 70,000 deaths, an increase of 16 percent over the level in 2014. Approximately, two-thirds of those deaths were due to opioid overdose, now accounting for about 130 American deaths every day.

Due to mounting demand for drugs to address physical, mental and psychological pain and absent sufficient federal oversight, drug companies marketed pain relievers during the 1990s that fueled the overdoses of prescription opioids. As a result, America’s death rates from drug overdose increased markedly over the past two decades and are higher than European rates.

In terms of mortality levels, the United States, despite its wealth, resources and being the world’s largest economy, lags behind many developed countries. With respect to life expectancy at birth, America is not even among the top 20 countries. No amount of political rhetoric, partisan spin or party fealty can alter such demographic realities. 

To address America’s lagging mortality rates various recommendations have been offered by researchers, academies, foundations and other organizations. In addition, valuable lessons may be gained from the health experiences of leading developed countries.  

Among the many factors behind America’s comparatively high mortality rates, unhealthy lifestyles certainly play an important role. Much needs to be done by political leaders, the private sector, nongovernmental organizations and the public to modify America’s unhealthy lifestyles, particularly adopting more effective measures to address smoking, obesity, alcohol misuse and drug overdose. 

Failing to address America’s unhealthy lifestyles not only contributes to undermining the country’s current wellbeing, but it also imperils America’s future.

Joseph Chamie is a consulting demographer, a former director of the United Nations Population Division and author of numerous publications on population issues, including his recent book, “Births, Deaths, Migrations and Other Important Population Matters.”