Covid-19 Isn’t the Only Thing Shortening American Lives

(Bloomberg Opinion) -- As the U.S. reaches the half-million mark on deaths from Covid-19, it may seem unsurprising that life expectancy, in the first half of 2020, dropped by one year. But shrinking American longevity is startling for reasons that extend beyond the pandemic.

As I wrote in December, “it seems quite likely that 2020 will be another year in which average U.S. life expectancy declines — perhaps by a significant amount.” That is unfortunately proving true, as shown by provisional life expectancy estimates based on mortality patterns from January to June 2020. The estimates, published by the National Center for Health Statistics, show a decline in life expectancy at birth of 1.2 years for males and 0.9 years for females, compared with 2019. Life expectancy for Black men fell by 3 years and for black women by 2.3 years.

These declines stand to grow larger when the full-year data become available, because deaths from Covid-19 nearly doubled in the second half of 2020, with almost 250,000 from July to December compared with about 125,000 from January to June.

The size of the declines in life expectancy highlight the dire consequences of the pandemic. Overall, this has been the biggest drop since 1943. And for Black Americans, the decline is the largest since 1936 and roughly twice the largest experienced since then, in 1940.

The 2020 life expectancy numbers also underscore longer-term health challenges that were already alarming. For two to three decades, life expectancy has been improving much more rapidly for higher earners than for lower earners, and 2020 has probably made these gaps worse. The one bright spot in the differential trends before the pandemic had been a narrowing of racial differences. These new estimates show a dramatic reversal of that hopeful pattern. From the early 1990s to 2016, the racial gap in life expectancy for males at birth shrunk from more than 8 years to about 4.5. During the first half of 2020, it widened to more than 7 years.

This lowering of life expectancy deviates from the pattern of previous recessions. In other downturns, deaths rates have fallen as unemployment rates have gone up. A recent study of the 2008-09 financial crisis, for instance, shows that it surprisingly boosted life expectancy. As I wrote in 2012, recessions are often oddly good for health.

Even the Great Depression seems to have had this unusual effect. As Jose Tapia Granados and Ana Diez Roux of Drexel University have written, “The evolution of population health during the years 1920-1940 confirms the counterintuitive hypothesis that, as in other historical periods and market economies, population health tends to evolve better during recessions than in expansions.” Some more recent evidence from one of the leading scholars in this field, Christopher Ruhm of the University of Virginia, suggests a weakening of the effect, but still suggests that today’s recession should have either had little impact on longevity (outside Covid itself) or brought a modest improvement.

On the contrary, 2020 mortality data indicate that death rates from non-Covid causes rose, despite the economic recession. More Americans than expected died from diabetes, high blood pressure and pneumonia. Some of these deaths may have been misreported, and actually caused by Covid. But a large number may also reflect the challenges in providing non-Covid health care during the past year, as people have avoided hospitals, and government mandates have restricted discretionary medical procedures. The pandemic will provide hard lessons on which types of medical care truly improve health, and which ones can be safely skipped or delayed.

The only good news in this otherwise heartbreaking landscape is that, in 2021, the Covid-19 death rate has been declining sharply, and is about a third lower than at the beginning of the year. Ideally, a combination of precaution, vaccination and care will continue to drive the coronavirus mortality rate lower — and other kinds of deaths will also fall as more normal health-care delivery returns. After an extraordinarily deadly 2020, a dramatic reversal would be a relief in 2021.

One technical note is important here, because these figures effectively assume Covid will be here forever. National data on life expectancy are based on so-called period life tables, rather than cohort life tables. To see the difference, imagine trying to figure out how long a baby born in 2020 will live. That requires estimating the child’s chances of dying at each year of age. A period life table does this simply by considering today’s mortality rates at each age. For example, the baby’s chances of living from age 70 to 71 equals whatever proportion of today’s 70-year-olds survive the year. The aggregate number basically looks at the new baby as a hybrid of the existing population. In contrast, a cohort life table would attempt to project what the world will be like in 2090, and use that to estimate the chances of living from age 70 to 71. The period table approach is simpler, but the cohort approach is closer to how most of us think about life expectancy.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Peter R. Orszag is a Bloomberg Opinion columnist. He is the chief executive officer of financial advisory at Lazard. He was director of the Office of Management and Budget from 2009 to 2010, and director of the Congressional Budget Office from 2007 to 2008.

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