Dear reader,
In the five years I’ve spent exploring the world’s challenges through the lens of progress, there’s one figure I have always used to advance the case that progress exists despite momentous challenges: the doubling of human life expectancy over the past 150 years. This achievement reflects those in countless frontiers — science, medicine, agriculture, education, gender equity, infrastructure and every other domain and subdomain in between.
But after generations of fairly steady growth, the unthinkable happened. Life expectancy in the U.S. plateaued, and then declined. Since the Covid-induced decline from 2020 to 2022, it has rebounded back to its highest level on record. But the U.S. is now several years behind our global peers in how long residents can expect to live, a pattern that predated Covid by decades and has mostly deepened over time.
There’s no easy explanation for why American life expectancy is flatlining. The specific factors that have restrained life spans in recent years are well known, and many of them are threats we’ve faced and bested before. But there has been a seeming change in where those threats are coming from, and our collective will and capacity to overcome them.
This week will be the last of our weekly deep dives. Next week, we’ll have a special send looking back at some of the threads and patterns that underlie what we’ve found over the course of the year. Then after a short pause, we’ll bring you a new, briefer format featuring journalism from across The Times that reflects Headway’s mission.
For now, read on for an exploration of life expectancy — the indicator that rules them all — and what its halting progress reveals about American achievement, and where the U.S. is today.
What’s happened to life expectancy?
There’s good news: As of 2024, life expectancy in the U.S. stands once again at its highest-ever point, now 79 years. But the average person in populous countries with similar wealth could expect to live 3.7 years longer than an American does, even though the U.S. spends nearly twice as much as comparable countries on health care per capita. (For a review of the numbers underpinning these estimates, see the Peterson-KFF health system tracker.)
Life expectancy is a potent measure of progress, because it reflects nearly every other advancement in the human condition. When we feed hungry children, cure diseases, make roads safer, discourage smoking, extend health care coverage, improve school lunches, reduce air pollution, spread vaccines for widespread killers, increase happiness, invent effective medicines — all of these achievements and many more have an impact on how long people live.
Let’s rewind for a moment to how we extended human lives so significantly in the first place. In the middle of the 19th century, the average American life expectancy was below 40. It wasn’t that people never lived to 70 and beyond. But infancy and childhood were much more lethal, and that a person’s chances of surviving to adulthood were much smaller. Advances in science and medicine toward the turn of the 20th century — such as the development of the germ theory of disease and the use of antibiotics, cleaner water and medical facilities — helped make childhood safer.
Success in lengthening life spans required an interplay between the public health system and people everywhere. Scientists and doctors became increasingly adept at seeking out and vanquishing drivers of early mortality, and society embraced each wave of new advances. The first successful demonstration of the polio vaccine happened in 1950; by September 1961, more than 85 percent of boys and girls from 5 to 14 years old had been given three doses.
By then, we’d achieved much of the rise in life expectancy that we now enjoy today. But we continued to see steady increases in the average life span because of our increasing success at tackling conditions that grew more lethal as we aged.
The life expectancy gap between the U.S. and other comparable countries wasn’t the case in the ’60s. While the U.S. has never had the highest longevity in the world, as recently as the ’70s, it was solidly in the middle of the pack. That began to change in the ’80s.
As the researcher Eileen Crimmins laid out last year in a paper for Demography, by 1985, life spans in the U.S. had begun to lag those in similarly positioned countries. By the 2000s, the U.S. was hovering at the bottom of the list. When the long rise in life expectancy halted in the 2010s, a sizable gap emerged between Americans and residents of other wealthy countries in expected years of life.
“The United States is now below the group once considered our peers,” Dr. Crimmins wrote. “In fact, our ‘peers’ in life expectancy have changed: The 2023 life expectancy rankings show the United States at 43rd, below many countries formerly not considered our peers — including Singapore, South Korea, Israel, Slovenia, Qatar, Costa Rica and Chile.”
Why are life spans in the U.S. so far behind?
Many of the forces that slowed the rise in American life spans were deeply embedded in the way people lived, like higher rates of smoking and obesity. National policy choices such as a weak social safety net and the lack of universal health care also play a role in the disparity, experts told me.
Smoking is a telling example of what it takes to improve the health of a population. The U.S. already differed from European countries in rates of smoking, Dr. Crimmins said in an interview. For one thing, women smoked here nearly as much as men. As we came to understand the long-term lethality of tobacco use, it took a herculean effort spanning all of society — insider leaks, lawsuits, physician awareness, public health messaging, intrusive policies — to change everyday public behavior. Then it took years to see the impact.
To Dr. Steven Woolf, who wrote about the growing life expectancy gap for The American Journal of Public Health, that is the nature of the long-term quest to improve the human life span. He described it to me as “a tug of war between progress in lowering death rates from certain causes and setbacks due to rising death rates from other causes.” Our success in extending human life has come from going after the biggest killers — the most significant drivers of early mortality — while advancing on a steady tide of rising threats.
Since the 2010s, though, that tide has threatened to overwhelm us. The nation reached a grim threshold in 2015, when the long climb in life expectancy started to reverse. Then Covid came, reducing the average American life span by more than a year from 2020 to 2022.
A big factor in our recent struggles against mortality comes from one consequential shift: We’ve gotten worse at protecting the lives of the young.
Where do we go from here?
“It’s hard for the public sometimes to get animated about a change in life expectancy from, you know, 79 years to 78 years,” Dr. Woolf said. “The image is that some elderly person is not going to live as long. That’s, of course, a misunderstanding of what the life expectancy metric actually means.”
Humankind’s success in doubling our life span relied on saving the lives of the young. Today, our quest to build on that achievement requires us to confront forces that are becoming deadlier to children. “The chances of an American child surviving to age 20 are now decreasing.” Dr. Woolf said.
Falling birth rates, which we explored in the first edition of this newsletter, suggest a future in which youth are more scarce and, consequently, more precious. A key part of continuing our progress against mortality requires redoubling our efforts to protect children after they are born.
Regular readers of this newsletter will recognize some of the forces shortening young lives, like rising traffic fatalities and infant deaths. We’ve looked at positive signs, too, like the significant decline in murder rates; but firearm violence is one of the leading killers of children and one of the factors, like opioid deaths, that have widened the nation’s life expectancy gap.
But we have to contend with something else, too: the widespread decline of public trust in institutions, which has been coming for public health for more than a decade.
Dr. Sandro Galea, dean of the newly established Bursky School of Public Health at Washington University in St. Louis, reckoned with what the field had learned from the response to Covid in his book “Within Reason.” He argues there have been three failures in the interaction between public health professionals and the public. “Public health has not listened effectively to what people want,” he said in an interview. “Public health has not handled well the tension between the needs of the public and communities and of autonomous individuals. And No. 3, that public health has mixed science with ideology, and that is to the detriment of competence in the field.” To address these missteps, Dr. Galea and his colleagues have embarked upon the Purple Public Health Project, an effort to recalibrate how the field engages the public in a time of political division.
The thing about life expectancy is that each of our lives is reflected in the figure. The interplay between science and society required to extend and improve human life rests on us all.
What can I check out next?
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In 2021, Steven Johnson wrote for The Times Magazine about the past century of efforts to improve life expectancy in a piece called, How Humanity Gave Itself an Extra Life.
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Emily Baumgaertner Nunn covers U.S. health for The Times. In November 2024, she wrote about the deadliest factors for children for The Morning.
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Scientists never expected the global rise in life expectancy to last forever, but the question of how long the human life span can extend continues to move us. This past April, Susan Dominus wrote for the magazine about the emerging frontier of cellular longevity — how much aging can be reversed.
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The human struggle against mortality links us all. But each of us also faces it alone. In February, John Leland wrote about a man confronting a terminal diagnosis with a poignant choice of how to live.
— Matthew Thompson
Your turn
Test your knowledge: In January, the Environmental Protection Agency stopped assessing the monetary value of lives saved from reduced air pollutants. Researchers at the University of Chicago have found that since 1970, reductions in PM2.5 pollutants have added how much to the average American life span?
Tell us your thoughts: What does the growth in life expectancy reveal to you about progress? What insights do you take from the recent challenges in the U.S. to continue that growth? Please email your thoughts to [email protected].
Following up: Speaking of falling birth rates, in July, Sabrina Tavernise and Jeff Adelson explored this decline in Utah, which once had the nation’s highest fertility rate, but has had the steepest drop in births of any state in the country.
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One more force affecting the lives of the young that we’ve recently explored in this newsletter is the decline in third places. Our partners at Chalkbeat Philly recently reported on the connection to teen takeovers, and what people in Philadelphia are doing about it.
Matthew Thompson contributed reporting.
The Headway initiative is funded through grants from the Ford Foundation, the William and Flora Hewlett Foundation and the Stavros Niarchos Foundation, with Rockefeller Philanthropy Advisors serving as a fiscal sponsor. The Woodcock Foundation is a funder of Headway’s public square. Funders have no control over the selection, focus of stories or the editing process, and they do not review stories before publication. The Times retains full editorial control of the Headway initiative.
The post The Quest to Extend Human Life appeared first on New York Times.
