Good morning. Covid is a terrible health crisis. It’s not the country’s only health crisis.

- NEW YORK TIMES - JULY 22, 2021 - David Leonhardt -

Planting flags at the Washington Monument to honor victims of the pandemic.Anna Moneymaker for The New York Times

No modern precedent


Covid-19 has caused the largest decline in U.S. life expectancy since World War II, the federal government reported yesterday. But Covid is not the only reason that life expectancy in this country fell last year to its lowest level in almost two decades.


Even before the pandemic, the U.S. was mired in an alarming period of rising mortality. It had no modern precedent: During the second half of the 2010s, life expectancy fell on a sustained basis for the first time since the fighting of World War II killed several hundred thousand Americans.


Deaths of despair


It’s hard to imagine a more alarming sign of a society’s well-being than an inability to keep its citizens alive. While some of the reasons are mysterious, others are fairly clear. American society has become far more unequal than it used to be, and the recent increases in mortality are concentrated among working-class Americans, especially those without a four-year college degree.


For many, daily life lacks the structure, status and meaning that it once had, as the Princeton University economists Anne Case and Angus Deaton have explained. Many people feel less of a connection to an employer, a labor union, a church or community groups. They are less likely to be married. They are more likely to endure chronic pain and to report being unhappy.


These trends have led to a surge of “deaths of despair” (a phrase that Case and Deaton coined), from drugs, alcohol and suicide. Other health problems, including diabetes and strokes, have also surged among the working class. Notably, the class gaps in life expectancy seem to be starker in the U.S. than in most other rich countries.


Covid, of course, has aggravated the country’s health inequalities. Working-class Americans were more likely to contract severe versions of Covid last year, for a mix of reasons. Many could not work from home. Others received lower-quality medical care after getting sick.


Since vaccines became widely available this year, working-class people have been less likely to get a shot. At first, vaccine access was playing a major role. Today, vaccine skepticism is the dominant explanation. (All of which suggests that Covid will continue to exacerbate health disparities beyond 2020; yesterday’s report on life expectancy did not include data for 2021.)


Race and sex


Covid has also caused sharp increases in racial inequality. As a Times article on the new report explains:


From 2019 to 2020, Hispanic people experienced the greatest drop in life expectancy — three years — and Black Americans saw a decrease of 2.9 years. White Americans experienced the smallest decline, of 1.2 years.


I exchanged emails with Case and Deaton yesterday, and they pointed out that racial patterns contain some nuances. Hispanic Americans live longer on average than non-Hispanic Americans, both Black and white — yet the impact of Covid was worst among Hispanics. “This is not simply a story of existing inequalities just getting worse,” Case and Deaton wrote.


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