The number one health story from 2022 is the alarming decline in life expectancy

The biggest health story from 2022 is not Covid-19. It’s neither RSV nor the flu. It’s not cancer, diabetes or heart disease. It is something that includes all these diseases and more. It’s the alarming decline in life expectancy in the US.

Life expectancy in the US is at a 26-year low. Blaming this solely on Covid-19 is a mistake. Life expectancy in the US remained stagnant between 2012 and 2019. And, before 2012, starting around 1990, the upward slope was much flatter in the US than any of our peers. Washington, we have a major life expectancy problem that needs to be taken much more seriously.

These are not health care costs per se. The US spends far more per person on health care than any other large wealthy country, yet its residents die on average at least four years younger. For decades the gap has been widening. That damn statistic”It never seems to sink in with the public and policy makers.”

Health care is not the only determinant of life expectancy. But it is certainly a key factor. Here, affordability and availability are much bigger problems in the United States than our peer nations.

In addition to a fragmented system, there is government indolence when it comes to public health issues. Take an example of how the federal government’s shortsightedness gets in the way of a rational approach.

In 2022, Covid-19 remains the third leading cause of death. However, the US government has decided to drastically scale back its Covid-19 preparedness, even as a massive surge is underway across China, which could have far-reaching effects beyond its borders. Congress’s recently passed Omnibus bill has no new funds for Covid-19 vaccines, tests and treatments.

The laundry list of neglected areas in US public health is long. Below is a list of just some of the issues that US public health is not doing well.

  • Obesity, for example, is a public health crisis in this country to a degree not seen among our peers. The association between obesity and many diseases is well documented. These include diabetes, cardiovascular disease, stroke, hypertension and cancer. Wegovy (semaglutide) and other newer weight loss agents will help. But none is an elixir. And, to be effective they all require a parallel concerted effort to control diet and exercise. In addition, obesity prevention is critical. While genetic predisposition to obesity may be a factor, diet and exercise can counteract this tendency. But judging by federal investment in nutrition research, the federal government appears indifferent. The share of federal research dollars allocated to nutrition has remained largely stable for at least 30 years. Funding for nutrition research from the National Institutes of Health and the Department of Agriculture — the two largest entities that fund nutrition studies — pales in comparison to many other areas of research.
  • The US is the only industrialized nation in the world where maternal mortality is on the rise. And, the US already has nearly the highest maternal mortality rate among high-income countries. Yet an inexplicable 17 states refuse to cover postpartum care through Medicaid.
  • Gun violence is a public health issue in the U.S. For purely political reasons, it has never been addressed head-on in Congress. After each mass shooting — more than 660 occurred in 2022 — “thoughts and prayers” ring out. Still, offering thoughts and prayers is the most many in Congress are doing in response to gun-related deaths.
  • Underinsurance it is a public health issue in the US when people with health insurance still cannot afford to use health care. And it’s more than just access to prescription drugs. Mental health coverage, for example, is inadequate in the US
  • Illegal fentanyl is currently the biggest public health problem in the US. However, federal and state policy responses have been and continue to be woefully inadequate.

Hopefully, we Americans will start caring more about life expectancy and public health in 2023. But it’s unrealistic to think we will. Part of that is politics. As mentioned in my 2023 predictions, many politicians have railed against public health for years and seem determined to undermine any power left in our public health agencies. But part of the problem is the large role of money and profit in our health care system. There just isn’t enough money to be made in public health. And money drives health care in the US to a degree unmatched among our peers. from investment and research funding decisions to the vested interests of important stakeholders.

On the part of the pharmaceutical industry, investments should be made in therapeutic areas where the chances of clinical, regulatory and commercial success are comparatively high. This generally does not include areas focused on public health, such as drug addiction, bacterial infections, and even cardiovascular disease. So, despite the fact that women are ten times more likely to die from heart disease than breast cancer, there is far less funding for cardiovascular health (for men and women) than for breast cancer.

Perhaps we invest a disproportionate amount in rare diseases*, as Peter Bach believes. It might make more sense socially if more were invested in other diseases that greatly affect Americans. Here, of course, public investment would not focus exclusively on prescription drugs. Public awareness campaigns and prevention efforts will also feature prominently.

If the US is to stem the tide of declining life expectancy, it will have to re-prioritize its health care. At the moment, this seems like an unrealistic proposition.

A quote from a book published ten years ago by authors at the Institute of Medicine sums up the issue at hand: “To society’s detriment, its preoccupation with clinical care and delivery overshadows attention to population-based activities that deliver effective and effective approaches to improving the nation’s health’.

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