Will the U.S. Follow Russia’s Health Decline After the Breakup of the Former Soviet Union?

By Stephen Bezruchka, M.D., M.P.H.

News reports abound about how life expectancy in the United States is at its lowest in two decades. In December, the Centers for Disease Control and Prevention released a report that showed, among other things, that life expectancy in 2021 was 76.4 years, a drop of 0.6 years from 2020. This followed a report in August 2022 that found that “U.S. life expectancy at birth for 2021, based on nearly final data, was 76.1 years, the lowest it has been since 1996. “What can we expect in the next few years?”

Lifespan or life expectancy in a given year are measures of the average length of life if mortality rates didn’t change. During the last century the world saw phenomenal gains in this health indicator that continue for many nations, but not the U.S. 

In the early 1950s, the United States was one of the world’s longest-lived nations. Since then, life expectancy has increased faster in a number of other countries. Many mortality measures for the U.S. have worsened over the last few years, beginning before COVID-19 struck. In 2019 some 35 United Nations countries had longer lives.  

The latest United Nations Human Development Report, issued last September, shows that for 2021 American length of life was behind that of 43 countries. These included all the rich ones and some not, such as Chile, Slovenia and Thailand. If we eradicated our three leading killers:  heart disease, cancer and COVID-19, we would still not be the healthiest nation. It may come as a surprise to some of us that the oldest person is never found in the U.S. We are also the only rich country to have seen continued drops in life expectancy from 2019 to 2021. What is going on?

We can find clues by looking to the former Soviet Union, where life expectancy fell after the 1991 breakup. Russia and Ukraine suffered profound rapid declines in lifespan that had only recovered to pre-breakup levels just before the pandemic. Men in both nations bore the brunt of the increased mortality, mostly due to a spike in alcoholism. A more upstream culprit was the massive increase in poverty and economic inequality that took hold in the wake of the breakup.

As state assets were sold to oligarchs at fire-sale prices, economic inequality soared leading to single middle-aged men dying in what are now termed deaths of despair. Today there are few men to sustain traditional marriage relationships and their divorce rates lead the world. The abrupt increase in inequality led to rapid declines in health that have not been reversed.  

The already soaring rates of American income and wealth inequality gained steam with the pandemic and our poor response to it, which encouraged profiteering over sound public health policy. Expected increases in length of life began faltering around 2015 and are now in free fall.  Will the United States follow the Russian example of continued health declines?  

Americans report some of the world’s highest levels of stress. We consume about three-quarters of the world’s opioids to treat our stress-induced social pain. This leads to staggering overdose deaths in addition to the causes of death listed above. 

Consider stress as the 21st-century tobacco. By creating awareness of the harms of second-hand cigarette smoke, most smokers were discouraged from their habit. Today only poorer people smoke, mostly to treat the social pain of poverty. Deaths of despair are clearly not limited to Russia and its former satellites. Can we expect to follow their pattern of continued decline? This seems likely unless we deploy the parachute of decreasing our record income and wealth gaps. 

We must begin to make the connection between income inequality and a shortened lifespan. As a physician and public health expert, I’ve spent decades looking at global inequities in health and lifespan. The pattern is clear: countries with less income inequality typically enjoy better health and longevity compared to nations with greater income inequality. When inequality widens, lives shorten. Our solution to our health crisis, then, is a political one. We must organize to close the chasm between rich and poor. We can begin by demanding that the rich return to paying their fair share in taxes. Consider that during the 1950s, when our overall health was significantly better compared to other nations, the highest marginal income tax rate was 91% and income gains were greatest for the bottom fifth of society. That money should be allocated to social programs that protect against poverty and despair and level off income inequality.

In a country that thinks of health as solely a matter of cultivating certain lifestyle habits, it may be a challenge to reframe our declining lifespan as a political issue, but real change always requires a shift in consciousness. We have more than enough evidence at this point, collected from societies around the world, to convince even the most skeptical American of the link between income inequality and premature death. 

Most Americans would rather live a longer healthier life than a shorter sicker one. A national campaign to create awareness of how inequality is killing us is the first step in reversing our declining lifespan and regaining our health as a country. 

Stephen Bezruchka, M.D., M.P.H., is the author of Inequality Kills Us All: Covid-19’s Health Lessons for the World. He is an associate teaching professor emeritus in the departments of health systems & population health and of global health at the School of Public Health, University of Washington.