COVID-19 and the Racial Disparities in Decreased Life Expectancy (2021)

at Arizona State University. A troubling news study has found that between 2018 and 2020, U.S. life expectancy decreased by the biggest margin since World War II. And as William Brangham reports, the COVID-19 pandemic took an outsized toll in the United States compared to other similar high-income nations. Judy, as a whole, life expectancy in the U.S. dropped by nearly two years. But for black and brown Americans, the toll was even worse. Among white Americans, life expectancy dropped by 1.4 years. But for black Americans, it fell by 3.2 years. And for Latino Americans, life spans dropped by almost 3.9 years. And what's more, when you compare these declines to other similar nations, like France or Israel or the Netherlands, the drop in the U.S. was more than eight times higher. Dr. Steven Woolf is the lead author of the study, just published in the British Medical Journal. He's Director Emeritus of the Center on Society and Health

at Virginia Commonwealth University Enrichment. Dr. Woolf, very good to see you. We're really a striking study that you have put out. For people who don't follow longevity trends the way you have, a nearly two-year decline in lifespan. How significant is that? It's massive. That level of decline for people like us who study these data is so large that we haven't seen this kind of decline since World War II in 1943, to give people some perspective. A few years ago, there was a fair amount of press coverage about declining life expectancy in the United States. We had a period of three consecutive years where life expectancy was declining at the same time that it was climbing in other countries. When that decline was happening, it was declining by 0.1 years each year. And it was very worrying. 0.1, and now we're talking about 1.9. Yeah, exactly. So this is considerably more. As you said, that's about eight and a half times the average decrease

that we've seen in peer countries. I want to get to that comparison about peer countries in a second. But first off, as I mentioned, the racial disparities, again, are just seem so glaring in this report. What do you attribute that to? Well, we've been tracking racial disparities in health for generations now. We anticipated a difference in the decrease in life expectancy for people of color, but we were really horrified by the magnitude. 3.3 years in African Americans, 3.9 in Hispanic Americans. And what jumps off the page when we see data like this is systemic racism. This is at the heart of why it is that generation after generation, people of color have experienced different health outcomes. Skin color is not a biological reason for people to have higher death rates and race is really a social construct. So really what we're seeing is the effect of decisions in policy society has produced that limit opportunities for good health among people of color.

And certainly we saw that during the pandemic play out, but as you're describing that happens even prior to the pandemic, about those comparisons to those other countries. These are countries that have similar health systems. They are wealthy countries. They are affluent and comparable to us in so many ways. And yet we are doing so much worse than they are. How do you explain that? Well, it's a trend that's been underway for many years, actually began in the 1990s. And it's not for lack of spending on health care. We spend an enormous amount of health care on health care in this country compared to other countries and have so for a long time. But as a doctor, I will tell you that health care only accounts for about 10 to 20 percent of our health outcomes. Our health is really shaped by our social and economic conditions where we live in our environment. And that's what we're falling short compared to other countries. Our health care system could be better, but what's really driving this gap between the United States and other countries

is really a lack of investment in our people and in social capital. Can you tease that out a little bit more? Because I think that that's a connection that people often forget. The term of art, I know, is social determinants of health. But for a lay audience, what do you mean by that? We mean things like access to education, income, stable jobs, a livable wage, stable housing, and being in a neighborhood environment that's good for your health. That actually matters far more to our health than what doctors and hospitals do. The public doesn't typically think of those as public health issues, but some of the topics in earlier segments about infrastructure and human capital investments. And even the housing instability are, in our view, public health policies. And it certainly seems that remedying those is more than just a vaccine that will help us put this particular virus at bay. I mean, I know we talk about getting back to normal all the time, but it sounds like maybe normal is not the best thing to be.

Yeah, we're delighted to see the pandemic receding into the rearview mirror. But normal is not a good place for us. As I've already said, Americans are dying earlier than people in other countries. We're sicker than people in other countries. And that gap is widening. So not doing anything about it is only going to make matters progressively worse. And the legacy of systemic racism is with us still, regardless of whether the pandemic is over with. We talked to, touched about this briefly,