College of Public Health students graduating

Life Expectancy in the US is down. What do we do?

Has our lifestyle finally caught up with us?

Life expectancy for Americans decreased from 78.9 years in 2014 to 78.8 years in 2015.
Source: National Center for Health Statistics, December 2016

This decrease averages out to about 1.2 fewer months in a lifetime. While this seems like a small decrease, the fact that this is the first time United States life expectancy has gone down in 22 years is significant.

People seem to be getting sicker earlier, despite advances in medical technology. Heart disease was the number one killer in the U.S. in 2015. Heart disease, with its many lifestyle-related causes, is linked with diabetes, hypertension, obesity, and metabolic syndrome. 

How did we get here?

Before World War II:

  • A majority of Americans lived in either city centers or rural areas.
  • Farmers grew and ate their own minimally processed foods.
  • City-dwellers frequented small markets in neighborhoods.
  • Sugar was expensive.
  • People walked a lot and did physical labor.

After World War II:

  • The American market was flooded with goods to help people live a more “modern” lifestyle.
  • Canned and processed goods gained popularity.
  • Labor-saving appliances meant less time doing physical labor, and more time in front of new televisions.
  • As people fled city centers for new suburban communities, they abandoned walking commutes and daily trips to grocers in favor of driving cars and making once-a-week trips to supermarkets for shelf-stable processed goods.

Post mid-century:

  • Canned goods remained popular.
  • TV dinners evolved from freezer-case novelties to staples of the American diet.
  • Processed lunch meats, white bread, canned vegetables, boxed mixes, and sugary drinks fed a generation.
  • Fast food restaurants flourished, providing cheap food to hungry people.

Where we are today:

  • Midcentury promises of increased leisure time gave way to economic forces that meant Americans work more hours than ever, at more sedentary jobs than ever.
  • The early 21st century brought a renewed interest in eating fresh foods.
  • But, fresh food is expensive and harder to access, and processed food is cheap, filling, and available on every corner.
  • Food deserts exist throughout the country.*

[*Food deserts are defined as areas, often with high poverty levels, that are short of of fresh fruit, vegetables, and other healthful whole foods. While food deserts do not have whole food providers such as supermarkets and farmers markets, they are heavy on convenience stores that provide a wealth of processed sugar- and fat-laden foods that are known contributors to the obesity epidemic. A map of food deserts is available from the USDA.]

If we’re going to create population-level change, we need to think big.

At the local, state, and national levels, public health leaders should support bold policies to improve life expectancy:

Rethink subsidies for processed foods. At my local grocery store, a small bag of Brussels sprouts is about $3, while a frozen pizza comes as cheap as 99 cents. The lowest price on frozen chicken breasts at Costco is $2.50 a pound, while the McDonald’s down the street from the College of Public Health offers an array of one dollar specials. Processed foods are cheap partly due to subsidies for commodities – most notably high fructose corn syrup. Those subsidy policies can be changed.

Support regular and reasonable work hours. Preparing fresh food at home takes time. People who have little control over their work schedules are not able to commit to preparing healthy meals at regular intervals.

Support a living wage. People who make a living wage are able to afford better food, and have more time to prepare it as they do not have to work multiple jobs.

Improve community infrastructure for fitness. Both urban and rural areas should invest in providing safe areas for walking, recreation, and exercise.

Provide economic incentives to improve food accessibility. Communities should offer incentives for grocery stores to locate in food deserts, and invest in transportation options to allow citizens to reach them. Fresh produce has a short shelf life, so frequent trips to a nearby store are essential to healthy eating.

Encourage lifestyle interventions for patients. Instead of prescribing medication for patients suffering from pre-hypertension, pre-diabetes, or other risk factors for heart disease, health care providers should provide counseling and referrals to dietitians, fitness programs, and other resources that may reverse the course of disease before it occurs. Stress management and mental health care should also be part of the available resources for preventive care. This is something that Congress and the new Trump administration must consider as they evaluate health insurance regulations in this country.

What else can we do to change the tide of lowered life expectancy before it’s too late?