How to reduce American carnage
AT HIS INAUGURATION in 2017 Donald Trump rejected the uplifting vision of America that such ceremonies usually extol. Instead he warned of American carnage, painting a picture of industrial devastation and lives stolen through crime, gangs and drugs. In office Mr Trump hardly managed to change the country for the better. But on American carnage he had a point: too many Americans are dying too young. The numbers are shocking (as our article describes). A study last year of life expectancy in 18 rich countries showed that America fell from a middling position in the 1980s to last place in 2018and that was before the covid-19 pandemic took a disproportionate toll on Americans. To some extent this reflects striking gains in life expectancy elsewhere. Take Portugal, the next-from-bottom country in the ranking, which has thrived within the European Union. In the 1960s the average American could expect to live at least seven years longer than the average Portuguese; by 2018 it was a year less. It is stunning that on such an important measure America has fallen behind a country that remains only a third as rich per head. In terms of life expectancy, America may even have been overtaken by China. By far the biggest killers in America are heart disease and cancer, despite some of the worlds best cancer care. That reflects unhealthy lifestyles as well as shortcomings in disease prevention and unequal access to health care. Obesity is a global problem, but Americas rate is double the rich-country OECD average. The most striking divergence between America and its peers, however, with an outsize impact on life expectancy, is in violent deaths, especially of young men. The countrys death rate among 15- to 24-year-olds is three times that in England and Wales. Two of the causes are familiar. In 2019 the murder rate from guns was fully 22 times that in the EU. A 25-year opioid epidemic has killed more than 650,000 Americans. But there is more to Americas outlier status than guns and fentanyl. Road deaths, which killed nearly 43,000 people in America last year, are about four times the rate in Germany. Pick almost any type of calamitous deathdrowning, fire, work accidentsand Americas relative record looks dire. One way to explain this is that, collectively, Americans have come to a different conclusion about the proper balance between individual freedom and state protections. This is overly fatalistic. Yes, Americans are a rugged lot, fond of individual responsibility and wary of government intervention. But that has always been so. It does not explain the slippage of recent years. Moreover, not all Americans are equally at risk. The poor are particularly vulnerable. Startling falls in life expectancy have occurred mostly in left-behind parts of the South and the central heartlands, rather than on the coasts. Such variation is not unique: in Britain, life expectancy for men between a posh and a poor part of London just 10km (six miles) apart varies from 92 years to 74. In richer areas of America, whether on the coasts or in the more prosperous counties of Colorado, people have typically experienced the same sort of gains in life expectancy as Europeans. It makes little sense to draw sweeping conclusions about peoples preferences when outcomes are so unequal. What can be done? Some big things are politically hard but worth arguing for nonetheless. From serious gun controls to more enlightened drugs policies (less war, more decriminalisation), Congress could make a difference. Liran Einav and Amy Finkelstein, two health economists, argue in a new book for basic universal health insurance financed by income taxes that would bring coverage for the 30m Americans who still lack itin the hope that one day politicians will be ready to consider them seriously. That would help, too. Many ways to save many lives In the meantime, Americans could do lots of small things that, added together, would amount to something bigger. On health care, there is no good reason why ten states, including poor ones such as Alabama and Mississippi, should keep rejecting Obamacares incentives to extend Medicaid coverage to some of their most vulnerable residents. To reduce the slaughter on Americas roads, why not ensure that more people wear motorcycle helmets or seat belts? Half of Americas passenger deaths involve people who are not strapped in. At the very least, troopers should enforce speed limits. Some policies, like building roundabouts instead of intersections, cost little and hardly impinge on personal liberties. As for the opioid crisis, local government should expand access to treatments for addicts and make test strips for fentanyl widely available so that people know if theyre about to take a potentially lethal substance (absurdly, several states, including Texas, still treat such strips as illegal drug paraphernalia). For such things to come about, Americans need to recognise just how many of their compatriots lives are being squandered. Too often politicians have been slow to do so and, as a result, America has come to tolerate an obscene level of early deaths. Only after the shock and shame of yet another mass shooting, at an elementary school in Uvalde, Texas, last year, did Congress muster the will to pass modest new gun controls. A proper sense of alarm at other kinds of needless loss may help bring about measures to keep more Americans alive for longer. That way the country could start to curb the carnage.