The first trend is the most grim and extraordinary. Life expectancy is not supposed to go down in prosperous developed countries that aren’t suffering from some kind of plague or insurrection. America’s peer nations have virtually all seen steady increases in longevity in recent decades. Yet a new report in The Journal of the American Medical Association suggests that life expectancy in the U.S. declined for the third consecutive year in 2017 (the most recent year for which we have the necessary data).
The opioid epidemic is a major contributor to this development. Between 1999 and 2017, an American woman’s risk of dying from a drug overdose in midlife increased by 486 percent; for American men, that figure was 351 percent. Opioid overdoses also helped fuel a harrowing 29 percent spike in the death rate among Americans ages to 25 to 34 since the start of this decade.
But Purdue Pharma is not the sole author of our public-health crisis. Rates of suicide and liver disease have also been on the rise. Further, the researchers found that America’s progress in increasing longevity began to slow in the 1980s — long before the onset of the opioid crisis — while its average life expectancy has lagged behind that of other wealthy nations since 1998.
A dramatic increase in the prevalence of obesity appears to be one driver of the phenomenon. The average American woman weighs about as much as the average American man did 50 years ago, while the contemporary American man is 30 pounds heavier than his late-1960s predecessor. Altogether, more than 70 percent of Americans ages 20 and older are overweight.
Although some aspects of the crisis may be rooted in cultural practices that are difficult for policy-makers to address, our government could be doing far more to provide its citizenry with access to science-based addiction treatment, nutritious food, and, of course, basic health-care services.
Meanwhile, new data from the Centers for Disease Control and Prevention confirm that America’s birth rate fell for the fourth consecutive year in 2018, hitting a three-decade-low. The nation’s total fertility rate is now insufficient to maintain our existing population in the absence of immigration.
Together, the fact that so-called “deaths of despair” are rising while birth rates are falling would seem to paint a dire picture of our national well-being. But the latter development is decidedly more ambiguous than the former. The falling birth rate appears to reflect a decline in unwanted teenage pregnancies as well as women exercising greater autonomy over their own bodies. One manifestation of that agency is a rise in the average age of new mothers: Fertility rates among American women in their late 30s and early 40s increased last year. But that uptick was overwhelmed by a decline in births among women in their 20s. College-educated women are overrepresented among mothers having their first child in their 30s, which suggests the underlying trend is driven largely by women making the conscious choice to delay reproduction until they can gain a more secure foothold in the labor market.
Yet because the structure of our economy incentivizes couples to delay reproduction — and penalizes those who have children early in their careers — this is only to some extent a choice. In the abstract, it may be preferable for men and women to start families in their 20s when they tend to be slightly healthier and more likely to have the aid of grandparents. The problem is it’s increasingly difficult for young Americans to attain a relatively stable, middle-class existence until later in life. Surveys suggest that, were it not for this fact, America’s fertility rate would be higher: A significant percentage of American women say they would like to have more children but only if they could afford to do so. The misalignment of a human being’s prime reproductive years and a worker’s prime earning years is impossible to resolve (at least under capitalism), but the U.S. government could do more to mitigate the issue through pro-natal social policies. Regardless, the CDC’s findings confirm the utter inviability of the nativist right’s vision for America. Although child allowances and public day care may facilitate marginal increases in birth rates, all available evidence suggests that such policies would be insufficient to ward off demographic (and thus economic) decline in the absence of a robustly expansionary immigration regime.