Oh unhappy land

Add "pervasive unhappiness due to daily assaults on everything humane and decent in our society" to the list of social determinants holding down U.S. life expectancy.

The latest annual World Happiness Report rankings show the U.S. slipping to 24th place in 2024, down from 23rd in 2023 and 17th in 2012, the first year of the survey. By way of contrast, the stock market (as measured by the S&P 500) has gone up in 8 out of the last 10 years with an average annual return of 13.3% including dividends.

Call this the money can’t buy happiness or health report.

In 2011, Bhutan, a tiny, forested country of fewer than one million people nestled in the Himalayas, sponsored a United Nations resolution that called for replacing gross domestic product (GDP) as a measure of national wealth with a new measure called gross domestic happiness (GDH). A team of academics from across the globe, bolstered by an international poll conducted by the Gallup organization, responded by creating a composite measure that added healthy life expectancy, social support, perceptions of corruption, press and political freedom, and willingness to donate and help others to traditional measures like per capita GDP. It also included a handful of measures of peoples’ psychological states.

The top of last year’s most happy list was dominated by Scandinavian countries, which score high on social support for their people. Universal health care, child care and family leave for mothers and fathers. You know, the things those countries do that are scorned by the barbarians destroying the U.S. safety net.

And what dragged down the U.S. rating? It scored 4th in per capita GDP, no surprise there. But last year it stood at 37th in corruption, 51st in negative emotions and 115th in freedom, the latter being based on a survey question that asks people across the globe whether they were satisfied with their freedom to choose what to do with their lives.

On the heels of that news comes a new study in JAMA Internal Medicine taking a closer look at both the extent and the causes of the U.S.’s lagging longevity. It has long been known that people in other industrialized nations live longer on average than the U.S. despite those countries spending far less on health care. But why?

The overall findings by lead author Irene Papanicolas, director of the Center for Health System Sustainability at Brown University, and two colleagues from Harvard were shocking. First, they found that avoidable mortality, defined as deaths that could be avoided by some combination of either more effective public health interventions or more timely and effective health care, grew from 25% higher in the U.S. compared to other OECD countries in 2010 to 51% higher in 2019.

Fully 60% of that excess mortality was preventable through public health measures, the authors found. To address the issue, they offered:

“Policies promoting access to healthy foods, limiting exposure to harmful products, and combating obesity can significantly reduce the risk and incidence of chronic diseases. Legislative measures addressing gun violence can lower injury-related deaths. Regulations on motor vehicle safety can prevent collisions and deaths. These broader determinants of health require coordinated efforts across various sectors and highlight that improvements in preventable mortality can extend far beyond the realm of clinical care.”

More health care?

It’s not as if expenditures on direct health care services are irrelevant to promoting longer and healthier lives. Most OECD countries saw their avoidable mortality rates decline and their longevity rise during the last decade, even as their health care expenditures rose.

But the U.S., which spends more than any country on earth on health care, saw just the opposite. Its avoidable mortality rose and longevity fell. The U.S. clearly isn’t getting much bang for its big bucks.

“If health expenditures in other countries was related with a decrease in avoidable deaths, why was there not a similar correlation in 2009 and 2020 in the U.S.?” Papanicolas asked. She answered her own question: “To me what that says is that higher prices don’t appear to be translating into better population health.”

The U.S. has big differences between states. The study also looked at those differences and compared states to other nations. Many states, mostly in the Northeast and Hawaii, rank among the highest performing nations in the OECD. States hard hit by the opoid epidemic and other “deaths of despair” (Mississippi, West Virginia, Oklahoma, New Mexico, Alabama, Tennessee) are nestled near the bottom between Mexico, Bulgaria and Latvia.

Fortunately, the deaths of despair that are driving those results finally appear to be coming down. The Centers for Disease Control and Prevention reported late last month that in the year that ended September 2024 (before the last election), opioid overdose deaths fell by an estimated 24% to 87,000.

"It is unprecedented to see predicted overdose deaths drop by more than 27,000 over a single year," said Allison Arwady, Director of CDC's National Center for Injury Prevention and Control. "That's more than 70 lives saved every day.”

The former head of Chicago’s Public Health Department (Mayor Brandon Johnson fired her in a highly controversial move) credited the CDC’s investment in gearing up its laboratories to respond to overdoses and stepped up state efforts to identify emerging drug threats. The state efforts are largely dependent on federal grants.

However, soon-to-be-announced cutbacks at HHS threatens to undermine this promising trend. Recent news reports say Robert F. Kennedy Jr. is planning to eliminate 30% of agency employees, including massive cuts at CDC. He’s now taking orders from Amy Gleason, a Department of Government Efficiency official who has been embedded in HHS. Gleason was a key player in first Trump administration’s disastrous Covid-19 response.

Finally, back to Bhutan. It hasn’t been ranked in the World Happiness Report since 2019. The country is suffering from high unemployment and a surge of youth outmigration. Press and political freedoms are limited. The Covid-driven collapse of its tourist economy has yet to recover. “That Bhutan is a particularly happy place is just that – a fiction,” the Guardian reported last fall.

One could say the same about the U.S.