Death is the biggest issue in the 2020 election

Death 2020: It’s Inevitable.
Death 2020: It’s Inevitable.
Image: Reuters/Jeff J Mitchell
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Apocalyptic political rhetoric in the US might not be that far off base: US life expectancy is falling for the first time since the 1950s, particularly where president Donald Trump and the eventual Democratic presidential nominee will contest the 2020 election.

The Journal of the American Medical Association published a new analysis of current mortality rates that shows Americans born in 2015 are expected to live shorter lives than those born in 2014. This makes them the first cohort of Americans not to benefit from nearly 60 years of rising life expectancy. The trend is also contrary to the experience of other wealthy countries, where life expectancy has been rising.

And more to the nub of the national discourse, the largest increases in mortality have taken place in the states that could be determinative in next year’s presidential elections, including Ohio, Pennsylvania, Michigan, and Florida.

Estimated Excess Deaths From Increasing Midlife Mortality, United States, 2010-2017
Estimated Excess Deaths From Increasing Midlife Mortality, United States, 2010-2017
Image: JAMA/Woolf/Schoomaker

The reasons for decreasing life expectancy are complex and overlapping, but the authors of the study say the change has been driven by an increase in mortality rates among middle-aged people from drug overdose, alcoholism, suicide, and diseases associated with obesity and smoking, like heart disease and diabetes.

This trend of increasing prime-age mortality was first publicized by research from Anne Case and Angus Deaton in 2017, and dubbed “deaths of despair” by some pundits. The shocking data was incorporated into a narrative of social collapse that helped explain Trump’s 2016 victory. This new research helps complicate that story: While the much-publicized increase in drug overdoses among non-Hispanic white people was higher in rural counties than in metropolitan counties, reflecting a common narrative, the largest increase in drug overdoses actually occurred in the suburbs of large cities.

The overlap between mortality measures and other statistics—particularly estimates of the effects of trade with China—suggest that material explanations may be at the root of both phenomena. Indeed, rising American mortality encompasses most of the hot-button issues being contested in the Democratic presidential primary and, soon enough, the 2020 general election.

This paper notes that the five states where gun suicides fell or held steady were those with the strictest gun control laws. The authors cite another study (pdf) that finds evidence that increases in the minimum wage and the earned income tax credit reduce non-drug suicides. Increases in opioid deaths are connected to the increasing availability of cheaper, more powerful drugs from legal manufacturers and drug cartels rather than economic distress. And all of these increases correlate strongly with economic distress and the broader deficiencies of the US health care system.

The complex interaction of mental health with economic situation, access to health care, and personal choices make it hard to pin down any one cause for the falling US life expectancy. But the authors note that any explanation should explain why the US is different from other advanced economies. “Social protection policies deserve special attention: countries with higher life expectancy spend more of their budgets on social services,” they write.

The Democrats challenging Trump will certainly draw a contrast with their plans for the government to tackle the increase in mortality, from treating drug addiction like a public health problem to gun safety legislation. Whether that will connect with voters as viscerally as Trump’s calls for the death penalty remains to be seen.