But that news reflects only one side of the story. Other estimates, such as model-based work from the Institute for Health Metrics and Evaluation (IHME), show that even with this rebound the United States has suffered one of the most severe peacetime declines in longevity among wealthy nations and continues to lag far behind its peers. Taken together, the data suggests that while life expectancy has recovered relative to recent American history, America is experiencing the most dramatic peacetime decline in longevity when judged against other high-income countries.
While our peer nations continue extending the lives of their citizens, America is moving in the opposite direction. And we’re barely talking about it.
If the United States had mortality rates comparable to other wealthy nations, we would have prevented more than one million deaths in 2020 and 1.1 million deaths in 2021, according to Bor’s findings. These aren’t deaths at the end of long lives—about half occurred in people under age 65, those who should be in the prime of their lives, raising families, contributing to communities, building careers. In 2021 alone, Bor and his colleagues noted, these preventable early deaths represented more than 25 million years of lost life.
And that doesn’t include the years preceding these deaths when people were hobbled by disabilities, illness, and despair that stopped them from fulfilling their potential and robbed us as a society of what they might have contributed. There is a ripple effect across communities and generations—the effects these early deaths have on children who grow up without a parent, families that become mired in poverty after the untimely death of their primary breadwinner. We’re talking about millions of missed soccer games, high school graduations, camping trips and anniversary celebrations, all the unrealized milestones of fully lived lives.
This reveals something we’ve been missing. “Using the experiences of white Americans as a benchmark in studies renders the trends in the white population invisible,” Bor said in a recent interview. “In addition, it woefully underestimates the grim circumstances of Americans of color, in terms of their mortality shortfalls, because the baseline you’re using is already sub-standard.”
How did we get here? This crisis began more than forty years ago, when our peer countries recovered from World War II and began surpassing us in building social safety nets, providing universal health care, and enacting policies that protected their most vulnerable citizens. We went in the opposite direction. Our mortality numbers began to diverge sharply from other wealthy countries in a downward slide that coincides with the dismantling of the social safety net that began in the 1980s and continued throughout the 1990s and 2000s, according to Bor and colleagues.
Princeton economists Anne Case and Angus Deaton identified one critical piece of this puzzle in their landmark 2015 paper on the so-called “deaths of despair.” They found that working-age white men and women without four-year college degrees were dying at astonishing rates—more than 600,000 excess deaths between 1999 and 2017 among Americans aged 45 to 54. Death rates from suicide, drug overdoses and alcohol-related illnesses were directly correlated with chronic joblessness in regions hit hardest by globalization, communities set adrift by the export of once-stable jobs in mining, manufacturing and heavy industry.
Now, at precisely the moment when we should be mounting an aggressive response to this mortality crisis, the current administration is moving in the opposite direction. Proposed cuts to Medicaid and food assistance programs will strip healthcare and nutrition support from millions. Attacks on the Affordable Care Act threaten to eliminate coverage for tens of millions more. The dismantling of public health agencies and the sidelining of scientific expertise leave us more vulnerable to the next pandemic and less equipped to address ongoing health threats.
Other wealthy nations have proven that a different path is possible. Countries with strong social safety nets, universal healthcare, investments in public health infrastructure, and policies that reduce inequality consistently see their citizens live longer, healthier lives. They spend less on healthcare and get better results. The solutions aren’t revolutionary—they’re already working elsewhere.
Every year we wait, another million people die who shouldn’t. Another 25 million years of human potential—of birthdays and graduations, of art and innovation, of love and laughter—vanish. These aren’t statistics. They’re our neighbors, our colleagues, our families. They’re us.
We can accept this slow-motion catastrophe as the price of American exceptionalism, or we can recognize it as the moral emergency it is. The question isn’t whether we know how to save the Missing Americans. We do. The question is whether we care enough to try.
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