What Ails America? The Answer Varies From State To State

The state of the union’s health is improving. But it is doing so very unequally, and recent signs of progress are in danger of being reversed by diseases of excess and despair, including obesity, depression, suicide and substance abuse.

Those are the broad conclusions of a new roundup of Americans’ vital signs published Tuesday in the Journal of the American Medical Association.

But those figures obscure substantial geographical variability in Americans’ health and quality of life. And the improvements could readily be swept away by some very dark clouds on the horizon.

California’s life expectancy at birth was also among the highest in the nation, coming in second at 80.9 years. Other states with a life expectancy above 80 were Connecticut, Minnesota, New York, Massachusetts, Colorado, New Jersey and Washington.

Hovering at the bottom alongside Mississippi were West Virginia, Alabama, Louisiana, Oklahoma, Kentucky and Arkansas. In none of those states did the average life expectancy at birth reach 76 years.

One key measure captured states’ unequal levels of health most dramatically: trends in deaths among people 20 to 55.

Thirty-one states and the District of Columbia saw this rate of such early death fall between 1990 and 2016. That includes 15 states – led by New York, California and Illinois – where the rate dropped by more than 10 percent.

Self-harm, opioid use disorders and alcohol-related liver diseases all zoomed up the cause-of-death chart. These scourges appeared to drive many of the increases in early deaths seen in states such as West Virginia.

Meanwhile, two perennial complaints – back pain and depression – remained the leading causes of disability among Americans.

In 2014, Americans’ life expectancy ranked 43rd in the world, despite the U.S. spending more per person on healthcare than any other country in the world. In their editorial, Koh and Parekh diagnosed a “disconnect” between the nation’s extravagant health care spending and its tenuous improvements in health.

They suggested a root cause: Compared to other affluent nations, the United States underspends on social services relative to its investment in medical care, they wrote.

The pair cited earlier findings by their Global Burden of Disease colleagues: that 60 percent of life-expectancy variation at the county level in the U.S. relates to socioeconomic and race/ethnicity factors.

Meanwhile, they noted, the country’s first-ever dedicated stream of funding for public-health programs – which was established by the 2010 Affordable Care Act – is under threat. The Prevention and Public Health Fund, “always short of its intended $2 billion annual budget, has just been cut again in the Bipartisan Budget Act of 2018.”

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