The Decline in U.S. Life Expectancy: Exploring the Role of Guns, Germs, and Drugs

America has a life expectancy crisis, said a recent headline in The Washington Post. For the past decade, the average life expectancy in the country has been basically flat or declining. The Centers for Disease Control and Prevention (CDC) reported in November that U.S. life expectancy at birth in 2022 was 77.5 years, down from its 2014 peak of 78.8 years. This change in 2022 came after a pandemic-related decrease from 76.1 years in 2021, with a 1.1-year increase attributed to decreases in deaths from COVID-19, heart disease, accidents, cancer, and homicide. However, these recent increases in life expectancy still do not eclipse the large dip caused by the COVID pandemic.

The United States has been falling behind other nations in life expectancy, even before the pandemic. While many members of Congress acknowledge that the drop in life expectancy is a serious issue, it is not currently a political priority. It has been pointed out that there is no single strategy to turn around this trend. Public health efforts, such as improving sanitation, food safety, and widespread vaccination against infectious diseases, have been mainly responsible for the increase in average American life expectancy from just 47 years in 1900 to the mid-70s in the late 20th century.

The leading causes of death for older Americans include heart disease, cancer, accidents, lung diseases, and diabetes. Politicians cannot do much at this point in biomedical history to significantly increase average life expectancy, and public health officials and lawmakers are concerned about the health-care payment system that does not reward preventive care. However, studies like the 2021 JAMA review have found that general health checks were not associated with reduced mortality or cardiovascular events. In addition, lack of health insurance is associated with only a slightly higher risk of death.

The rate and number of firearm deaths in the U.S. have been increasing over the past decade, and firearm mortality remains high. Lack of health insurance and gun violence are only a small part of the problem. Drug overdoses have also been increasing and contribute to the decline in life expectancy. Opioid overdose deaths between 2019 and 2021 reduced U.S. life expectancy by 0.65 years, and obesity is perhaps cutting life expectancy by 1.7 years. A recent study identified that “mortality falls with rising educational attainment” while “increasing mental distress contributed to the stagnation of mortality improvement.”

Despite these challenges, there is little evidence that any policies to reduce gun violence have worked effectively. Overall, improvements in life expectancy are influenced by many complex factors, including education, mental health, and obesity. Any efforts to improve life expectancy in the U.S. would likely require a comprehensive approach.