What to Expect for 2020 Babies
Life expectancy at birth dropped by nearly a year. What lies ahead for the 2020 birth cohort depends on big changes to American society.
This week the CDC released new life expectancy calculations that showed a nearly one-year drop in life expectancy at birth in the United States during the first half of 2020. A drop in life expectancy due to the pandemic was, well, expected. But the relative size of the decline illustrates just how devastating COVID-19 has been in historical terms. This is the biggest decrease in U.S. life expectancy since World World II.
The most dismal finding from the CDC report was not the overall number, but the disparities in the drop. For Black Americans, life expectancy fell by nearly three years, and for Hispanic Americans the decline was nearly two years. Every aspect of the pandemic—ability to socially distance, access to testing and treatment, and now distribution of the vaccine—has been plagued by inequalities, and the life expectancy data illustrate just how severe.
The good news is that these numbers will rebound after the pandemic, and they don’t reflect actual expectations of lifespans for infants, like my youngest son, who were born in 2020 (more on that below). But that’s not as positive as it sounds, given the already dismal state of pre-pandemic trends. A simple return to “normal” does portend a troubling future for the 2020 birth cohort.
Although this is the largest drop in life expectancy seen in the United States in a long time, it’s not the first. After steadily increasing for decades, life expectancy began falling in 2015, and the United States has reported flat or falling trends in four of the last six years. Even before going into the negative, the rate of improvement had been slowing for decades. In the 1970s, the United States had a higher life expectancy than the OECD average.Beginning in the 1980s, improvements in life expectancy in the United States started to lag behind other OECD countries, and now U.S. life expectancy is more than two years lower than the OECD average.
To provide some context, the 2020 U.S. life expectancy estimate of 77.8 years is comparable to to what Japan, Iceland, and Switzerland—countries with some of the highest life expectancies in the world—experienced in the late 1980s. In those countries life expectancy at birth is now nearly 84 years. We were already three decades behind and headed in the wrong direction.
What life expectancy represents
Contrary to what the name implies, life expectancy at birth isn’t a great estimate of how long a person will live. At least not the version released by the CDC this week, which are estimates of period-based life expectancy. Period-based life expectancy is calculated using mortality patterns in a given period of time, with statistical assumptions that such patterns will continue going forward. In other words, if everyone continued to die at the same rate as in 2020, the number would reflect actual expectations for a lifespan begun last year.
That’s not how it actually plays out for a given birth cohort, who have historically experienced improvements in mortality risks throughout life, which can extend their life expectancy as they age. For example, in 1900 the period-based life expectancy at birth was around 49 years, reflecting mortality rates of 1900, but the actual cohort of Americans born in 1900 lived to an average of 58 years as living conditions improved in subsequent decades. These cohort-based calculations require data on how mortality risk changes as a cohort ages, which makes them tricky to estimate until some time has passed.
So while CDC’s estimate of 77.8 years doesn’t really tell us exactly how long a person born in 2020 can expect to live, period-based life expectancy calculations do tell us a lot about the conditions of a society and how they vary across time and place. Because it’s composed of deaths of all types—ranging from infant mortality to homicides to death at old age—the life expectacy number is more a reflection of who has already died, and why.
Every time a new decline of life expectancy in the United States is announced, I think of a passage from Michael Marmot’s Status Syndrome:
In the late 1970s [Daniel Patrick Moynihan] looked into the economy of all the Soviet republics and examined the interesting fact that the overall mortality figure was rising spectacularly. At the end of his study he announced in the Senate that the Sovient Union was a sickening society and Communism would collapse in the next decade. Gales of laughter roared through the Senate at this wishful thinker. Nine years later it happened.
Life expectancy serves as a barometer for the overall state of a society. When it starts to fall, it indicates something is off course.
A fractured, failing society
Recent declines in life expectancy in the 2010s, for instance, have been driven in part by the opioid epidemic and an increase in what are called “deaths of despair,” which are related to overdose, suicide, and alcohol abuse. When social scientists look at those fractional declines in life expectancy that began in 2014, they see the economic decline, frayed social fabric, and corporate malfeasance that fueled that epidemic.
Similarly, there’s a larger social and economic story about why the United States began falling behind in life expectancy gains in the 1980s. That’s around the same time we started to see trends like wage stagnation in relation to productivity, dramatic increases in income inequality to levels seen since before the Great Depression, and a political shift toward limiting or dismantling the social benefits of the welfare state. There is of course a more nuanced analysis of specific mechanisms and alternative explanations, but it’s no coincidence that the turn in life expectancy lines up with a broad shift toward letting individuals fend for themselves in the wilderness of the free market.
Life expectancy as a single number doesn’t even tell the entire story. These trends aren’t an issue for the wealthy, who live longer lives than the poor, with the rich-poor gap in life expectancy widening in recent years. And for as long as mortality data have been available in the United States, there have been dramatic racial disparities in life expectancy, a difference driven entirely by social factors in an environment of systemic racism that stretches from the country’s origins to today.
Recent commentary in the Journal of the American Medical Association offers some suggestions for how to reverse these trends in U.S. life expectancy. The authors’ answer: Social Policy Is Health Policy. Because so many of the causes of mortality lie in the social and economic conditions that shape exposure to health risks or treatment resources, the solutions lie in policies that address those underlying conditions. The authors recommend changes like increasing the minimum wage; expanding the Earned Income Tax Credit; increasing access to college and vocational training; reforming the criminal justice system; expanding Medicaid; and improving other welfare programs.
These may sound like uncharacteristically political recommendations for a medical journal if you’re not acquainted with contemporary public health conversations. But medicine, public health, epidemiology, medical sociology, and related fields have known for a while that the biggest determinants of a long and healthy life are the social and economic environments in which people live. And those conditions are shaped by the political decisions we make everyday.
The trends in life expectancy of the last 40 years reflect, in part, political decisions to prioritize wealth over wellbeing, just as the life expectancy decline in 2020 reflects the political mismanagement of the COVID-19 pandemic. Whether these trends will continue—and actually lead to shorter lifespans for those born in 2020 and after—will depend on bold political action to loosen the grip of the wealthy from key institutions, address systemic racism, and build a social safety net comparable to the social democracies of Europe. Given the recent state of U.S. politics, that may be too lofty an expectation.
The OECD is a group of 37 high-GDP countries, often considered the peer group to the United States.