Science
Opinion: The decline in American life expectancy harms more than our health
American life expectancy started dropping even before the pandemic. It’s a critical barometer of our nation’s health and a sign that all is not well in the U.S.
Much of the increase in preventable, premature death is attributable to drug overdose, which increased five-fold over the last couple decades. But this malaise is far broader, driven largely by growing chronic illness.
Rates of depression are reaching new highs. Obesity rates among adults have risen from 30% to 42% since the turn of the century, with severe obesity nearly doubling and driving up the risk of cardiovascular disease, diabetes and other serious health conditions. The return of vaccine-preventable illnesses has been a concern since the 2010s. Sexually transmitted infections have surged in the last decade. And for the first time since 1937, an infectious disease, COVID-19, became one of the top three causes of death in the country.
These health problems are alarming on their own. They also have a devastating impact on our economy. A one-year increase in life expectancy could boost economic output by 4%. On the other hand, as Americans’ health declines, our health expenditures continue to soar. As a country, we spend $4.5 trillion annually on health, representing 17% of GDP. Out-of-pocket healthcare costs have risen dramatically, straining workers’ finances and pushing people into bankruptcy. All this fuels a cycle of a sicker workforce and a weaker economy.
Policymakers acknowledged the link between the economy and public health at the height of the pandemic, providing federal relief programs such as cash assistance and paid sick leave designed to keep the nation’s workforce and economy as healthy as possible. But our abandonment of these efforts since getting COVID relatively under control sets our country up for mounting crises. We need to revive a historical source of support for public health measures: the business case for a healthy workforce.
In 1842, Edwin Chadwick argued in his landmark “Report on the Sanitary Conditions of the Labouring Population of Great Britian” that public health investments are crucial not only from a moral perspective, but also for economic productivity. Writing for the Atlantic in 1909, C.-E. A. Winslow, an American public health pioneer, wrote that employers who try welfare measures for workers “find that it pays.” And around that time, Wickliffe Rose, an American philanthropist, oversaw the Rockefeller Sanitary Commission to tackle hookworm disease as a controllable health problem, spurring economic productivity.
Hookworm, which can cause anemia and fatigue and impair development in children, was a significant problem in southern states in the late 1800s and early 1900s resulting from lack of access to clean water, poor sanitation and poor hygiene. Its symptoms were blamed on “laziness” — a stigma often attached today to symptoms of chronic illnesses, disabilities and mental health issues — and perpetuated cycles of poverty. Rose all-but-eradicated hookworm through education campaigns, expanding access to treatment and improving public sanitation.
Similarly, during World War II, the U.S. government invested in public health initiatives to curb the transmission of malaria in tropical and subtropical battlefronts; vaccinate against smallpox, typhoid fever and tetanus; and control sexually transmitted infections, which during World War I cost the U.S. Army more than 7 million workdays and 10,000 preventable discharges.
When it functions well, such public health infrastructure makes it easier for working people to lead healthy lives. The results have been dramatic, contributing in the last century to the average human lifespan doubling around the world.
Despite the impression given by COVID-19, public health has historically been about so much more than tracking disease outbreaks. It’s been about preventing disease. Access to healthcare and insurance play a role, but doctors and hospitals most often come into play after someone is already sick. Research shows that simple resources such as clean air and water, affordable healthy food, stable housing and safe workplaces are much better predictors of good health and longevity.
During the pandemic, programs addressing basic needs — eviction freezes, expanded food assistance and mandated paid sick and family leave for employees in smaller companies — enhanced housing stability, curbed COVID spread and protected Americans’ mental health. Since then, home affordability has plummeted; half of American renters spend more than 30% of their income on rent and utilities. In 2022, more than 40 million Americans lived in food-insecure households, adding to health issues in adults and children.
The U.S. is one of the only high-income nations that still lacks universal paid sick leave and family medical leave, forcing many people to go to work sick or risk losing a day’s wages. Interventions to improve workplace air quality, a vital component of a healthy workplace appreciated even by 19th and 20th century health reformers, have been overlooked.
The pandemic-era measures were dropped in part because of their cost. But what is much more expensive, and what is causing American workers needless suffering as our national health declines, is our current approach to health. Of our $4.5-trillion annual health spending in the U.S., the vast majority goes to treating people when they are already sick; only 4% supports programs to keep people and workers healthy in the first place. This focus on treating individuals after they have already fallen ill is much of the reason we pay dramatically more than other countries yet still have some of the worst health indicators in the world.
Once again treating public health as an economic imperative could help broaden support for the type of interventions that became polarizing during the pandemic — but have a long track record of improving wellbeing and productivity.
Céline Gounder (@CelineGounder), an infectious-disease physician and epidemiologist, is the senior fellow and editor-at-large for public health at KFF Health News. She is also the host of the podcast “Epidemic.” Craig Spencer (@Craig_A_Spencer) is an emergency medicine physician and professor of public health at Brown University.
Science
Cluster of farmworkers diagnosed with rare animal-borne disease in Ventura County
A cluster of workers at Ventura County berry farms have been diagnosed with a rare disease often transmitted through sick animals’ urine, according to a public health advisory distributed to local doctors by county health officials Tuesday.
The bacterial infection, leptospirosis, has resulted in severe symptoms for some workers, including meningitis, an inflammation of the brain lining and spinal cord. Symptoms for mild cases included headaches and fevers.
The disease, which can be fatal, rarely spreads from human to human, according to the U.S. Centers for Disease Control and Prevention.
Ventura County Public Health has not given an official case count but said it had not identified any cases outside of the agriculture sector. The county’s agriculture commissioner was aware of 18 cases, the Ventura County Star reported.
The health department said it was first contacted by a local physician in October, who reported an unusual trend in symptoms among hospital patients.
After launching an investigation, the department identified leptospirosis as a probable cause of the illness and found most patients worked on caneberry farms that utilize hoop houses — greenhouse structures to shelter the crops.
As the investigation to identify any additional cases and the exact sources of exposure continues, Ventura County Public Health has asked healthcare providers to consider a leptospirosis diagnosis for sick agricultural workers, particularly berry harvesters.
Rodents are a common source and transmitter of disease, though other mammals — including livestock, cats and dogs — can transmit it as well.
The disease is spread through bodily fluids, such as urine, and is often contracted through cuts and abrasions that contact contaminated water and soil, where the bacteria can survive for months.
Humans can also contract the illness through contaminated food; however, the county health agency has found no known health risks to the general public, including through the contact or consumption of caneberries such as raspberries and blackberries.
Symptom onset typically occurs between two and 30 days after exposure, and symptoms can last for months if untreated, according to the CDC.
The illness often begins with mild symptoms, with fevers, chills, vomiting and headaches. Some cases can then enter a second, more severe phase that can result in kidney or liver failure.
Ventura County Public Health recommends agriculture and berry harvesters regularly rinse any cuts with soap and water and cover them with bandages. They also recommend wearing waterproof clothing and protection while working outdoors, including gloves and long-sleeve shirts and pants.
While there is no evidence of spread to the larger community, according to the department, residents should wash hands frequently and work to control rodents around their property if possible.
Pet owners can consult a veterinarian about leptospirosis vaccinations and should keep pets away from ponds, lakes and other natural bodies of water.
Science
Political stress: Can you stay engaged without sacrificing your mental health?
It’s been two weeks since Donald Trump won the presidential election, but Stacey Lamirand’s brain hasn’t stopped churning.
“I still think about the election all the time,” said the 60-year-old Bay Area resident, who wanted a Kamala Harris victory so badly that she flew to Pennsylvania and knocked on voters’ doors in the final days of the campaign. “I honestly don’t know what to do about that.”
Neither do the psychologists and political scientists who have been tracking the country’s slide toward toxic levels of partisanship.
Fully 69% of U.S. adults found the presidential election a significant source of stress in their lives, the American Psychological Assn. said in its latest Stress in America report.
The distress was present across the political spectrum, with 80% of Republicans, 79% of Democrats and 73% of independents surveyed saying they were stressed about the country’s future.
That’s unhealthy for the body politic — and for voters themselves. Stress can cause muscle tension, headaches, sleep problems and loss of appetite. Chronic stress can inflict more serious damage to the immune system and make people more vulnerable to heart attacks, strokes, diabetes, infertility, clinical anxiety, depression and other ailments.
In most circumstances, the sound medical advice is to disengage from the source of stress, therapists said. But when stress is coming from politics, that prescription pits the health of the individual against the health of the nation.
“I’m worried about people totally withdrawing from politics because it’s unpleasant,” said Aaron Weinschenk, a political scientist at the University of Wisconsin–Green Bay who studies political behavior and elections. “We don’t want them to do that. But we also don’t want them to feel sick.”
Modern life is full of stressors of all kinds: paying bills, pleasing difficult bosses, getting along with frenemies, caring for children or aging parents (or both).
The stress that stems from politics isn’t fundamentally different from other kinds of stress. What’s unique about it is the way it encompasses and enhances other sources of stress, said Brett Ford, a social psychologist at the University of Toronto who studies the link between emotions and political engagement.
For instance, she said, elections have the potential to make everyday stressors like money and health concerns more difficult to manage as candidates debate policies that could raise the price of gas or cut off access to certain kinds of medical care.
Layered on top of that is the fact that political disagreements have morphed into moral conflicts that are perceived as pitting good against evil.
“When someone comes into power who is not on the same page as you morally, that can hit very deeply,” Ford said.
Partisanship and polarization have raised the stakes as well. Voters who feel a strong connection to a political party become more invested in its success. That can make a loss at the ballot box feel like a personal defeat, she said.
There’s also the fact that we have limited control over the outcome of an election. A patient with heart disease can improve their prognosis by taking medicine, changing their diet, getting more exercise or quitting smoking. But a person with political stress is largely at the mercy of others.
“Politics is many forms of stress all rolled into one,” Ford said.
Weinschenk observed this firsthand the day after the election.
“I could feel it when I went into my classroom,” said the professor, whose research has found that people with political anxiety aren’t necessarily anxious in general. “I have a student who’s transgender and a couple of students who are gay. Their emotional state was so closed down.”
That’s almost to be expected in a place like Wisconsin, whose swing-state status caused residents to be bombarded with political messages. The more campaign ads a person is exposed to, the greater the risk of being diagnosed with anxiety, depression or another psychological ailment, according to a 2022 study in the journal PLOS One.
Political messages seem designed to keep voters “emotionally on edge,” said Vaile Wright, a licensed psychologist in Villa Park, Ill., and a member of the APA’s Stress in America team.
“It encourages emotion to drive our decision-making behavior, as opposed to logic,” Wright said. “When we’re really emotionally stimulated, it makes it so much more challenging to have civil conversation. For politicians, I think that’s powerful, because emotions can be very easily manipulated.”
Making voters feel anxious is a tried-and-true way to grab their attention, said Christopher Ojeda, a political scientist at UC Merced who studies mental health and politics.
“Feelings of anxiety can be mobilizing, definitely,” he said. “That’s why politicians make fear appeals — they want people to get engaged.”
On the other hand, “feelings of depression are demobilizing and take you out of the political system,” said Ojeda, author of “The Sad Citizen: How Politics is Depressing and Why it Matters.”
“What [these feelings] can tell you is, ‘Things aren’t going the way I want them to. Maybe I need to step back,’” he said.
Genessa Krasnow has been seeing a lot of that since the election.
The Seattle entrepreneur, who also campaigned for Harris, said it grates on her to see people laughing in restaurants “as if nothing had happened.” At a recent book club meeting, her fellow group members were willing to let her vent about politics for five minutes, but they weren’t interested in discussing ways they could counteract the incoming president.
“They’re in a state of disengagement,” said Krasnow, who is 56. She, meanwhile, is looking for new ways to reach young voters.
“I am exhausted. I am so sad,” she said. “But I don’t believe that disengaging is the answer.”
That’s the fundamental trade-off, Ojeda said, and there’s no one-size-fits-all solution.
“Everyone has to make a decision about how much engagement they can tolerate without undermining their psychological well-being,” he said.
Lamirand took steps to protect her mental health by cutting social media ties with people whose values aren’t aligned with hers. But she will remain politically active and expects to volunteer for phone-banking duty soon.
“Doing something is the only thing that allows me to feel better,” Lamirand said. “It allows me to feel some level of control.”
Ideally, Ford said, people would not have to choose between being politically active and preserving their mental health. She is investigating ways to help people feel hopeful, inspired and compassionate about political challenges, since these emotions can motivate action without triggering stress and anxiety.
“We want to counteract this pattern where the more involved you are, the worse you are,” Ford said.
The benefits would be felt across the political spectrum. In the APA survey, similar shares of Democrats, Republicans and independents agreed with statements like, “It causes me stress that politicians aren’t talking about the things that are most important to me,” and, “The political climate has caused strain between my family members and me.”
“Both sides are very invested in this country, and that is a good thing,” Wright said. “Antipathy and hopelessness really doesn’t serve us in the long run.”
Science
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