Life expectancy: How can we address uneven declines?

Not long ago, during pre-pandemic 2019, the reported life expectancy at birth for non-Hispanic Black, non-Hispanic White, and Hispanic populations was approximately 75, 79, and 82 years, respectively. The higher life expectancy of Hispanic people compared to others in the United States may come as a surprise to some.

This phenomenon, known as the “Hispanic paradox,” was first noted in the 1980s, and its legitimacy has been debated since. A host of explanations have been proposed, including hypotheses about the “healthy immigrant” (people who migrate to the US are healthier than those who stay in their native countries) and “salmon bias” (less healthy US immigrants are more likely to return to their countries of origin). Other experts note that Hispanic communities have lower rates of smoking and greater levels of social cohesion, which certainly may contribute to their presumed higher life expectancy. In the end, this difference remains poorly understood, and is further complicated by research noting US-born Hispanic individuals may have lower life expectancy compared to their foreign-born counterparts.

Now, recent estimates for life expectancy from the Centers for Disease Control and Prevention (CDC) show an alarming change that highlights the disproportionate impact COVID-19 has had on communities of color. Between 2019 and 2020, life expectancy dropped more sharply among Black and Hispanic populations compared to their White counterparts, by three years, two years, and one year, respectively. In fact, the gap in life expectancy between Black and White populations widened from four to six years, the largest gap since 1998. And the advantage in life expectancy previously held by Hispanic populations over Whites decreased from three to two years. In other words, the COVID-19 pandemic has led to a decrease in life expectancy among all individuals in the US, but this impact has been felt most by communities of color.

Many reasons for greater vulnerability to COVID-19

Many factors contributed to this uneven drop in life expectancy. But these remarkable numbers remind us of the vulnerability of Black, Indigenous, and People of Color (BIPOC) in the US, the result of longstanding unequal access to health care and resources needed to achieve upward economic mobility. Many BIPOC populations in the US live on the brink of collapse. With little health or financial reserves, these communities are increasingly vulnerable to sudden events, like the financial collapse of the early 2000s or a global pandemic.

Racism functions largely through structural barriers that advantage some groups and disadvantage others. Rather than causing new disparities, the COVID-19 pandemic simply unmasked chronic failings in our social policies and healthcare delivery for our BIPOC communities. Recently, the CDC acknowledged this and declared racism a public health threat that harms the health and well-being of BIPOC populations.

Longstanding systemic failings lead to poor overall health

Abnormally high and sustained exposure to stress during pregnancy and early childhood leads to sustained release of inflammatory and stress-related hormones such as cortisol, which results in toxic levels of chronic stress. Racism causes chronic stress, which detrimentally affects the development and well-being of BIPOC children. Moreover, many BIPOC children have less overall opportunity to thrive. They live in neighborhoods plagued by pervasive poverty caused by longstanding discriminatory policies such as redlining and residential segregation. These factors compound, ultimately resulting in higher levels of cardiovascular disease, mental illness, and health-risk behaviors. Known as weathering, this contributes to both decreased lifespan and healthspan (the period of a life during which a person is in good health).

Further, BIPOC individuals in the US persistently face barriers in access to quality health care. Examples include higher rates of no insurance and underinsurance, and lower health care literacy. Pervasive bias and discriminatory policies are deeply embedded into our healthcare delivery infrastructure. So, the results of the CDC report should come as no surprise: a population chronically deprived of accessible preventive services would be expected to fare poorly during a pandemic.

Moving forward: What changes could help?

We can all raise our voices to persuade and support the efforts of government officials at every level, and healthcare leaders, to address immediate disparities related to the ongoing pandemic and the chronic flaws that leave BIPOC communities increasingly vulnerable. Below are several measures that could get our system moving in the right direction.

Regular citizens can

• Vote in all elections — especially local elections. Local elected officials, such as a city mayor, town manager, city council members, and county sheriff, can affect the lives of citizens even more personally than state or federal officials. Local news media and websites may have information on policy views and track records to help you choose candidates.
• Be wary of fake news promoted on social media. Social media places a wealth of information at our fingertips, yet also offers ways to spread false information that can greatly affect our decisions. Try to maintain a healthy level of skepticism. Check information with trusted sources. These common-sense tips can help keep you from falling victim to fake news.
• Support local organizations. Local nonprofits and community organizations play a major role in helping to address COVID-19 disparities affecting BIPOC communities and fighting for testing and vaccine equity. If you’re financially able, consider donating to local nonprofits, food banks, and community organizations so that they can keep helping in times of need.

Policy makers and government leaders can

• Fix unemployment insurance. Inject federal funds into refurbishing crumbling state unemployment insurance infrastructures, and pass legislation mandating that standard minimum benefits be provided by all states.
• Make universal healthcare happen. Ensure universal health insurance is achieved, whether via a public option, single payer, or a host of other alternatives. Americans deserve equitable access to quality healthcare, especially preventive care.
• Eliminate historically racist and discriminatory policies. Eliminate discriminatory practices like gerrymandering that contribute to ongoing disempowerment of voters, residential segregation, and pervasive poverty, leaving communities of color in destitute circumstances without a voice.

Editor’s note: At the request of Dr. Perez, terms used to describe all races and/or ethnicities are capitalized in this post, to reflect his view of identity and racial equity.

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