We should be ashamed.

In 2013, a report showed that people in the US were in worse health and dying younger than those in other rich nations. Despite the alarm generated, five years later things look worse. The report, subtitled Shorter Lives, Poorer Health, documented a large and growing US “health disadvantage”. Evidence showed that compared with people in other wealthy democracies, those in the US under the age of 75 – male or female, rich or poor, of all ethnicities – die younger and suffer more injuries and illness.

Recent figures show life expectancy falling for two years in a row. Policies and poor living conditions play a part. As does the worst drug epidemic in US history – a long-term public health crisis that only got urgent national attention last year. Overdoses, often from opioids, now top road accidents as the leading cause of non-disease death for those aged 25 to 64. The US also continues to see higher rates of gun deaths and infant mortality. Such trends led life expectancy to drop for the first time in two decades in 2015, and again in 2016.

Despite this, the US outspends on healthcare: $9364 per person in 2016, compared with $4094 in the UK. US spending on social welfare is akin to that of many rich nations. The difference is US spending is less redistributive.

A key barrier to better health is “limited political support among both the public and policymakers to enact the policies and commit the necessary resources”. On this, too, the US continues to slip. While not perfect, the Affordable Care Act was, by 2016, providing millions of people with health insurance for the first time. Congress has tried to repeal it and aims to weaken it, while also allowing the Children’s Health Insurance Program, which provides low-cost cover to 9 million children, to go unfunded.

The American health disadvantage continues to grow. Until the nation starts to bridge some of its divides and act on the evidence, its people will continue to pay a steep price. (Laudan Aron, study director of the Shorter Lives, Poorer Health report, Institute of Medicine and US National Research Council. Aron is a senior fellow at the Urban Institute)

The opiod death crisis has to be one of the most egregiously shameful things of all. Why do we allow Chinese and pirated opioids into the US? Why do we not disbar any doctor seen to prescribe over-large amounts of the stuff? Why don’t we tackle the American manufacturers who are churning out huge quantities of pills (no, I am not naive. I know why, like you know why). Think of the huge amount spent on police, the FBI, intelligence generally, and tell me why the perpetrators cannot be rounded up and put out of business. Some states are taking it seriously. Congress needs to, but it should also attend to the other side of the coin – rehabilitation, without which other measures are only half the answer. This is a huge social issue whose resolution should be on the minds of caring Epicureans.

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