Public Health

Alarming drop in life expectancy sparks call for study, action

Consistent improvements in life expectancy are an indication of effective public health and health care systems. This makes the recent drops in U.S. life expectancy and increases in premature mortality not only causes for alarm, but calls to action.

That was the message the AMA House of Delegates (HOD) sent at its most recent Interim Meeting.

The Centers for Disease Control and Prevention (CDC) reported that, between 2015 and 2016, U.S. death rates rose 10.5 percent for people between 25 and 34; 7.8 percent for those 15–24 years old; and 6.7 percent for people between 35 and 44. The trend puts the U.S. at odds with many other industrialized nations whose life expectancy rates continue to rise, according to data from the Organization for Economic Cooperation and Development.

A study published in Proceedings of the National Academy of Sciences of the United States of America found rising mortality in midlife among white Americans and quantified the impact. “If the white mortality rate for ages 45–54 had held at their 1998 value, 96,000 deaths would have been avoided from 1999–2013, 7,000 in 2013 alone,” the study’s authors concluded.

The AMA is calling on the federal government to further investigate the causes of this increase in death rates and to design multidisciplinary interventions to reverse them. The Association also is encouraging state and local medical societies to raise awareness of the alarming trend and advocate for local investigation of the causes and remedies.

Improving the nation’s health—which is ultimately reflected in its life expectancy—lies at the heart of the AMA’s advocacy efforts and strategic initiatives.

For example, the AMA is continuing its ambitious, innovative collaborations to help physicians and patients prevent chronic diseases such as diabetes and heart disease. Together, these two preventable conditions kill more than 700,000 Americans each year, according to the CDC. The Prevent Diabetes STAT and Target: BP™ have greatly helped identify patients at risk for type 2 diabetes and hypertension and assisted them in taking evidence-based preventive action.

Raising voices to protect coverage

The AMA’s commitment to the nation’s health also undergirded its successful effort to protect the 20-million plus people who gained health insurance coverage against misguided legislative overhauls that would have hampered access to care among the country’s most vulnerable patient populations.

“Physicians know that patients who do not have coverage live sicker and die younger. Any reform proposal must preserve those gains and move us closer to coverage for all Americans,” AMA Immediate Past President Andrew W. Gurman, MD, wrote in an AMA Wire® column last March. The column was just one of many ways in which the AMA consistently and fiercely made its case to the public and policymakers.

When legislation backing important health policy goals arose, the AMA showed its support. For example, the Bipartisan Budget Act of 2018 earned the AMA’s support with its inclusion of provisions extending the Children’s Health Insurance Program for another four years (on top of a previous six-year extension) and extending for two years the National Health Service Corps, Community Health Centers and Teaching Health Centers Graduate Medical Education programs. The budget deal also provided more Medicaid support for Puerto Rico and the U.S. Virgin Islands.

Removing barriers to care

The opioid and heroin epidemic appears to be a major contributor to the rise in premature deaths. Provisional data from the CDC shows that from September 2016 to August 2017, there were more than 67,000 drug overdose deaths in the U.S., a 13.3-percent rate change from the previous 12-month period.

So, the AMA welcomed the recently passed $1.3 trillion omnibus budget bill provisions that included nearly $4 billion to support a multifaceted approach to combating the opioid epidemic, including prevention, treatment and workforce development.

The AMA has consistently called for removing barriers to evidence-based treatment for opioid-use disorder. For example, on the federal level, the AMA issued comments on Feb. 26 commending Health and Human Services Secretary Alex Azar’s endorsement of medication-assisted treatment (MAT) for substance-use disorders.

At the state level, the AMA supported legislation in California and Vermont to broaden access to MAT. The AMA has also provided analysis of state policy interventions regarding the opioid epidemic to the state medical societies in Florida and Iowa, and to Virginia’s health department.

The AMA urges “increased emphasis on removing barriers to evidence-based, multimodal pain care and comprehensive treatment for substance use disorders,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in his letter to the Iowa Medical Society. “Unless and until these occur, we are very concerned that opioid-related overdose and death will continue to rise.” (Read more about the AMA’s efforts to end the opioid epidemic.)

The AMA has also supported Senate and House legislation that would help states create or support maternal mortality review committees to examine pregnancy-related and pregnancy-associated deaths and identify ways to reduce these tragic deaths. Deaths related to pregnancy have doubled in the U.S. in the past 25 years, with an estimated 700 American women dying of pregnancy-related causes annually.