I was saddened to hear about a recent report published in the Journal of American Medical Association (JAMA) that life expectancy in the U.S. is declining and has been on a downward trend for three years. Perhaps more disturbing is the fact that the group experiencing the largest decline is from the ages of 25–34 years. These figures are shocking for several reasons, not least because the United States has the highest per capita health care spending in the world. Moreover, this downward trend is going in the opposite direction of America’s peer nations, which continue to experience rising life expectancy. These worrying facts have me asking, what’s wrong with America and why are midlife adults dying in what should be the prime of their lives?
Stall then fall
Unfortunately, living in America is contributing to the early death of its citizens. There clearly are systemic reasons for the decline in overall health. The study in question looked at 60 years of data related to mortality rates in the U.S., finding that life expectancy rose from a baseline in 1959, increased fastest in the 1970s, advanced more slowly in the 1980s, peaked in 2014, and dropped annually from 2014-2017. The question is then: what systemic shifts occurred in America within the last five years?
The study included reasons why midlife adults died in greater numbers, comprising increases in drug overdoses, suicide, alcohol-related diseases and obesity. Additionally, the study was able to identify which parts of America had the highest decline in life expectancy, with rural counties, the industrial Midwest, Appalachia and Native American Indian country having the greatest excess deaths. I know that the rate of suicide on reservations in my home state has dramatically increased in the last five years, with local news featuring stories like “Native American Teen Suicide Epidemic,” and “Opioid Epidemic On South Dakota’s Indian Reservations.”
The authors of the JAMA study further delve into what they believe are the underlying causes, such as unstable employment, psychological distress, social exclusion and poverty. In other words, the social determinants of health were found to be key to increases in Americans dying from self-damaging activities. In fact, another study conducted in 2015, which included 3.4 million individuals, connected social isolation to a 29% increase in the likelihood of death.
I was struck how similar the findings of these recent studies on mortality rates in the U.S. echoed arguments made by the famed Harvard political sociologist Robert Putnam, who was in Maastricht on the 25th of November. Putnam gave a masterclass at University College Maastricht, where I work, and a general lecture open to the first 500 who registered. I had the privilege to attend both and was not disappointed. Putnam, who is now 78 years old, could still inspire his audience and achieve his goal of making a contribution to the public sphere. That contribution largely comes from ideas in his best-selling book Bowling Alone: The Collapse and Revival of American Community, which came out twenty years ago but still resonates today.
Putnam’s main idea is that social networks have value; that a society’s levels of connectiveness, its norms and regimes that promote civic engagement, all relate to the effectiveness of society. Moreover, that civic virtue in individuals is most powerful when embedded in a dense network of reciprocal social relations rather than a society rich in virtuous but isolated individuals.
Of course, social capital is not an entirely new idea and even Alexis de Tocqueville after visiting in 1830 explained America’s egalitarian institutions and democratic practices by reference to the American propensity for participation in civic associations and a tendency to look out for their neighbors. De Tocqueville was struck by how Americans resisted the temptation to take advantage of each other.
However, it is also clear that the levels of social capital in society fluctuates and what Putnam drew attention to in the early 2000s is a precipitous decline in social capital in the U.S. starting in the mid-1960s. There were many indicators of this decline: including a 25-50% drop in membership of voluntary clubs and associations; a decline in attendance at public, town and school meetings; a fall in the membership in and work for political parties; and, even a decline in participation in faith-based institutions, which dropped by 10-12% in the last 25 years of the 20th century.
What would De Tocqueville say today?
Fast forward to today, when America is characterized by political polarization akin to that just before the Civil War in the 1860s, coupled with levels of economic inequality and social isolationism that echo the era right before the Great Depression, and it is easy to see that America’s levels of social capital are abysmally low. The many graphs that Putnam presented show a clear correlation between today’s levels of inequality and the Gilded Age—that time in America’s history recounted in F. Scott Fitzgerald’s The Great Gatsby, when the U.S. economy soared along with political corruption and excess-living by the wealthy few. An overall trend that Putnam calls the “I, We, I” century. And, a systemic shift that lands current U.S inequality levels similar to those in Brazil.
How does American get back to “we?” First, people need to makes connections with other liked-minded people, whether it be a shared loved of nature, sports, religion, food, theater, self-improvement, volunteering or whatever. Then, some individuals from the various groups must reach out to other associations—becoming bridges that bind people together and create social networks.
Will building social capital fix what is wrong with America? Certainly, the nexus between health policy, social policy, finance and tax policy is complex. It is difficult to create new policy that addresses lower socioeconomic challenges. It is difficult to address how income inequality and unstable employment affects disease and rates of depression for younger Americans.
But, it is comforting to know that when America experienced callousness and selflessness in the past, there were enough individuals who cared deeply about their neighbors and the American experiment with democracy to forge islands of camaraderie and trust. When it comes to the health of America’s citizens both Putnam and the authors of the JAMA study on life expectancy argue that social connection and community—even spirituality, which we all want for the holidays—are important causes of life.