The economist Louis Johnston didn’t answer a question about American economic competitiveness on a panel discussion this month the way you might expect, like by talking productivity growth or trade policy.
“When I hear that kind of a question my first response is always ‘compared to what?’ ” Johnston said. “One of things that I think is really important is to just literally ask, ‘How are we doing in things like life expectancy, maternal mortality, stuff like that?’ And the data there are just astonishingly bad right now.
“Over the last three years the average life expectancy in the United States has actually fallen,” he continued. “In certain age groups the rate of mortality is just skyrocketing. And that’s not happening in other places. This is a uniquely American phenomenon. That tells me that, yes, we are falling behind.”
Johnston’s sobering answer followed only by about a week the release of a report in the Journal of the American Medical Association (JAMA) that offered the latest confirmation of the distressing trends about life in America that Johnston was talking about.
The JAMA report was even more discouraging in discussing how the life-expectancy rate has slipped. It’s not a typical end-of-life situation, people expiring at 84 rather than living until age 86. It’s that more Americans are dying who are far younger and who should be in the prime years of their working lives.
The authors, Steven H. Woolf of Virginia Commonwealth University and Heidi Schoomaker of Eastern Virginia Medical School, showed that the story goes back much further than the 2010s, to trends building since the 1980s.
By 1998, life expectancy in the United States had for the first time slipped below the average life expectancy among developed nations, the so-called OECD countries.
Since then life expectancy in the OECD group as a whole has continued to increase, but it stopped increasing in the United States in 2010 and has been decreasing since 2014. As of the latest ranking among OECD nations, the United States is ranked down the list just behind the Czech Republic, and miles from the leaders in life expectancy like Switzerland, Japan and Spain.
Of course, the United States is also notable among developed countries for the staggering amounts it spends on health care, easily exceeding any other country.
In looking through the data and what the authors called cause-specific mortality, the numbers show increases in drug overdoses, alcoholic liver disease and people dying of suicide. These are some of the deaths of despair people have been talking about since the release of a 2015 study by economists Anne Case and Angus Deaton, one that focused on the premature deaths of middle-aged white Americans.
Yet the new JAMA report also pointed out that, between 1999 in 2017, midlife mortality rates also surged because of factors such as high blood pressure and obesity.
Another takeaway is that these mortality trends have been showing up all over, not among just one ethnic group or gender. Things are much worse in some states than in others, like in the Ohio River Valley, but mortality trends worsened even in states with generally healthy populations and a high life expectancy — like Minnesota.
In one of the JAMA authors’ charts, they labeled a column simply “Excess Deaths, 2010-2017,” an estimate of people who died who would have otherwise been expected to live had the mortality rate not been ticking up. In Minnesota the number was 496.
I caught Johnston’s remarks on slipping life expectancy on Minnesota Public Radio, broadcasting a year-end economic roundup panel from St. John’s University in Collegeville. Johnston is on the faculty at St. John’s and the College of St. Benedict, and he was joined on stage by Chris Farrell, senior economics commentator for public radio’s Marketplace show and a contributor to the Star Tribune.
Farrell didn’t give an optimistic response to the question about whether America is losing ground economically, either. It’s not a particularly easy question to answer, though, in part because economic competitiveness is one of those concepts that can’t be readily defined. Business leaders seem to care more about it than economists do, too.
If you want to look at economic competitiveness of a region or country, however, there are few obvious things to consider. Financial capital should be both plentiful and free to move, for example, in part to fund the kind of technological innovation that boosts productivity, great for economic growth.
A flexible labor market seems good, too, as skilled workers can move to better opportunities as they emerge. Policies that make it easier to participate in paid work, like affordable child care, make sense, too, as does investing in training and education to help the workers produce more.
The World Economic Forum, best known for hosting a conference of global swells at a Swiss resort every year, looks at measures like these when it publishes its report on economic competitiveness. As of the latest ranking, the United States was near the top.
Another well-known competitiveness project has been launched by the Harvard Business School, where the professors reached more worrisome conclusions. One of the big contributions of the Harvard Business School’s approach to this thinking is how an economy stays competitive actually matters.
The country’s business sector has to be competitive in global markets, selling products and services that both make money and find customers. But the success of business can’t rely on driving down the wages of workers. If not everybody gets a fair share of the successes, the economy can’t really be competitive over the long term.
There’s a little of this kind of thinking in looking at mortality rates and healthy life spans when talking about economic competitiveness. There’s an obvious cost to losing people to disease in middle age when they should be in the most productive periods of their lives, but that doesn’t begin to tell the whole story.
It seems certain that there’s going to be a lot more research on this, looking for more precise answers to why more people are dying. On the other hand, an increasing death rate in a society as wealthy as ours is the kind of indicator that really needs no further explanation.
If more Americans are dying years before reaching retirement age, something here must have gone very seriously wrong.