Americans are living shorter lives. The nation’s life expectancy at birth dropped nearly a year from 2020 to 2021, according to the Centers for Disease Control and Prevention – from 77.0 to 76.1 years.
Non-Hispanic American Indian-Alaskan Native people saw the biggest drop in life expectancy – 1.9 years. Non-Hispanic white people in the U.S. had the second biggest decline in 2021 -- a full year. Non-Hispanic Black people saw the third biggest decline — a 0.7 percent drop from 2020. And Hispanic people in the U.S. had a decline of 0.2 years.
The U.S. life expectancy at birth is the lowest it’s been since 1996.
And it’s even lower in Missouri than in the nation as a whole at 74.6 years. That’s a large drop from 77.8 years in 2012.
What's behind the drop in life expectancy?
“So, always topping the list are heart disease and cancer as leading causes of death, but we’ve had some challenges of recent in Missouri, including, obviously, the COVID-19 pandemic, which I think has toggled between the third and fourth leading cause of death," said Lynelle Phillips, vice-president of the Missouri Public Health Association. The opioid epidemic has also impacted cause of death in terms of unintentional injury death and then, for younger people, we are looking at violent deaths and suicides and firearm injury-related deaths.”
While COVID-19 itself killed 20,766 Missourians – 987 in Greene County alone – the pandemic and the need to social distance impacted overall health.
“We saw an increase of 11,000 more deaths in 2020 compared to 2019. Only like 7500 of those were listed as COVID deaths, so almost every other category except cancer had an increase between 2019 and 2020," said Andy Hunter, bureau chief for healthcare analysis and data dissemination at the Missouri Department of Health and Senior Services. "So I do think it’s a lot of residual situations where they weren’t getting the care or treatment that they normally would have.”
And that includes care for people addicted to opioids.
More deaths than births
Hunter said 2020 was the first year since DHSS has been recording vital statistics that there were more deaths than births. The year before – in 2019 – there were 10,000 more births than deaths. In 2020 and 2021 there about 4600 more deaths than births, and, while provisional numbers are looking better for 2022, deaths still outpace births by nearly 3000, according to Hunter.
Dr. George Turabelidze, state epidemiologist at the Missouri Department of Health and Senior Services, said, while COVID-19 definitely impacted Missouri’s life expectancy, it doesn’t explain the whole picture. That’s because the state’s life expectancy has been dropping for awhile.
“And the reason is the same is it is overall for the United States. Mostly we are funding care of sick people, and we do not fund care and prevention for healthy people. And we need to create a culture of health and improved prevention through better primary care, more access to primary care, more physicians," he said. "Right now, rural health is experiencing big health problems with a deficit of healthcare providers.”
Funding for public health
Per capita funding for public health in Missouri is one of the lowest in the country. Turbelidze said the state legislature is working to improve that, but there’s a long way to go to keep up with other states. According to the website, publichealthmaps.org, 2019 state-provided funding ranged from $7 per capita in Missouri to $363 in the District of Columbia. And Missouri was one of eight states that occupied the bottom five funding spots at various times over a five-year period from 2015 to 2019.
Phillips said public health needs more funding to be able to provide the services needed to prevent deaths from a variety of health issues.
“If heart disease is your number one killer in your state, every health department should have blood pressure monitoring and cholesterol screening, etc. And, if diabetes is contributing to all of that, then every health department should have a diabetes prevention program, and we should have smoking cessation in every single health department. We should have those services, and we don’t have that because we haven’t had the funding to do that,” she said.
And not everyone in the state has the same chances of living a long life.
Phillips said the biggest determinants of a person’s life expectancy have to do with where they live.
“We know that where you live is connected to your ability to access healthcare, your ability to access healthy food, to access prescriptions, jobs, etc. etc.," she said. "So, it’s all tied together, so it’s actually a lot more complicated to tackle these issues than people might realize.”
Turabelidze said it’s their job as public health employees to work on issues of overall health and improving life expectancy. But they can’t do it alone.
"You are not exposed to public health 24 hours a day," he said, but you are exposed to your workplace for a big chunk of your time during the day. The workplaces, schools, universities, retirement communities — we all need to join together to create this culture of health, which unfortunately is lacking in Missouri."
Phillips urged people to get vaccinated to prevent death from infectious diseases like influenza and COVID-19.
