This post was originally published at the UK-based New Scientist,and is reprinted with permission.

Five years ago, a groundbreaking report showed people in the US in worse health and dying younger than those in other rich nations. Today, despite the alarm the report generated, we learned that life expectancy in the country declined for a second year in a row – astonishing by any standard.

The original report, released by the US National Research Council and Institute of Medicine and subtitled Shorter Lives, Poorer Health, documented a large and growing US “health disadvantage”. As my New Scientist commentary at the time explained, widespread evidence showed that compared with people in other wealthy democracies, people in the US under the age of 75 – men and women, rich and poor, of all races and ethnicities – die younger and experience more injuries and illnesses.

Even a cursory look at developments over the past five years reveals why the country is still so unwell. Public policies and poor living conditions all play a part.

The US is also in the midst of one of the worst drug epidemics in the nation’s history. It is a public health crisis that has been unfolding over two decades but only recently garnered urgent national attention. Drug overdoses, often from opioid use, now surpass road accidents as the leading cause of death from injury (as opposed to disease), for people in the US aged 25 to 64. More than 175 people die every day as a result of overdoses, the equivalent of two full 747 jumbo jets crashing every week somewhere in the country.

Along with deaths attributable to alcohol and suicide, the overdoses have been branded “deaths of despair“. Compared with other rich nations, the US also continues to experience much higher rates of infant mortality and gun deaths.

Life expectancy falls

Taken together, such trends have led to a US life expectancy that essentially stagnated after 2012, dropped for the first time in two decades in 2015, and dropped again in 2016. All this is taking place against a backdrop of growing inequality in income and wealth and, of course, in health itself.

Despite these dismal health outcomes, the evidence continues to show that the US outspends other countries on health care: in 2016, it spent $9364 per person on this compared with $4094 in the UK. US spending on social welfare programs is comparable to that of many other rich nations. What distinguishes it from other countries is how that money is spent: it is much less redistributive, with less going on children, families and people with lower incomes.

As the Shorter Lives study argued, a key barrier to improvements in health is “limited political support among both the public and policymakers to enact the policies and commit the necessary resources”. On this front, too, the US is continuing to slip. Despite its imperfections and needed reforms, the Affordable Care Act (ACA) was a landmark piece of legislation that by 2016 was providing millions of uninsured people with access to health insurance for the very first time.

Under the Trump administration, the US Congress has repeatedly tried to repeal the ACA and is poised to weaken it through its recently passed tax bill. It has even allowed the much less controversial Children’s Health Insurance Program, which provides low-cost health insurance to 9 million children across the country, to go unfunded.

As Americans continue to debate a host of policies in an increasingly divided and polarized country, a health disadvantage decades in the making continues to grow. Until the country starts to bridge some of these divides and act on the evidence, its people will continue to pay a steep price: shorter lives and poorer health.

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