A Tale Of Two Countries

What a life expectancy map tells us about the state of the US right now. And some news about an upcoming series on radical life extension.

A number of you may have seen this map that has been doing the rounds of social media and op-ed pages over the past few weeks:

It tells a stark story of health inequality—”the most shocking and the most inhumane” form of injustice, as Martin Luther King, Jr. once said, with almost twenty years of expected life separating the coastal states from the red belt in the South and Appalachia. The fact that the map’s designers decided to represent the spectrum of life expectancy on a red-blue gradient gave it an implicit—and not entirely inappropriate—political spin. Blur your eyes a little and the red regions could be a map of Trump support, or—more consequentially—states that have refused the Obamacare Medicare expansion.

Politics aside, you will not be surprised to hear that I was delighted to see this map go viral. The power of data visualization as a tool for making sense of what, quite literally, ails us is an old obsession of mine, dating back to John Snow’s map from 1854, and William Farr’s country-vs-city life tables from the early 1840s. New ways of seeing patterns in health data can be as lifesaving in the long run as new therapeutic drugs or clinical treatments. And of course, I am a big believer in the utility of the life expectancy unit of measurement, having written an entire book (and co-produced a TV series) about that particular datapoint. I think you can make the case that life expectancy at birth is the single most revealing datapoint for measuring how well a nation or region is functioning—more revelatory than GDP or educational attainment, or any other yardstick. If you’re trying to get a sense of how well a given society is doing, asking how long people live on average is a great place to start.

Viewed by that standard, the life expectancy map of the US tells a tale of two countries. The gap between the US county with the highest life expectancy—Summit County, Colorado, with an LE of nearly 87—and the lowest—Oglala Lakota County in South Dakota—is a full twenty years. Overall, the United States ranks about 50th in life expectancy worldwide, but if coastal, urban America broke off and formed its own country, it might well rank in the top ten. If Appalachia formed its own country, it would be about 70th in the world rankings, roughly in the same league as Algeria and Iran.

If you know something about the history, the map is an extraordinary display of one of the most important demographic trends of the past two centuries: the great reversal of urban/rural health outcomes—a transformation that began with Snow and Farr’s work in the middle of the 19th century. A century and half ago, the most deadly places to live in industrialized countries were the big cities. Today it’s the countryside that kills you. Here in Brooklyn, for instance, average life expectancy is about five years higher than the overall US average—that’s not affluent brownstown Brooklyn, mind you, that’s all 2.8 million residents of Kings County.

There’s one other important point that should be made about the life expectancy map that is not immediately visible from just looking at it: the striking disparities you see there are not exclusively reflecting an underlying problem with our healthcare system. A huge part of what is driving the historic decline in life expectancy over the past few years is the spike in deaths in teenagers and young adults, thanks to opioid overdoses, suicide, gun deaths, and traffic accidents. (As I was writing this post, David Wallace-Wells published an excellent op-ed diving into this point in more detail.) Overall LE expectancy numbers can be dramatically altered when young people die. (The high rate of infant and childhood mortality for most of human history is why LE was so shockingly low—somewhere in the low to mid-30s—for so long.) The same principle applies when a large cohort of 20-year-olds start dying. Even though the map also happens to roughly coincide with vaccination rates, COVID is less responsible for the variation in LE here, because COVID mortalities are so skewed towards the elderly. The closest thing that I can think of to what we are seeing with young people in the red zone on this map is what the US lived through in 1918-1919, when the combination of the war and the Great Influenza (which for complicated reasons was disproportionately lethal for young people, and relatively mild for older folks) killed a significant number of otherwise health young adults. That comparison should be a wake-up call for all of us.

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It’s somewhat ironic contemplating a map like this in light of the many new studies that have been released over the past few months suggesting that we are on the verge of some significant breakthroughs involving our understanding of the aging process itself—including the possibility of slowing it down significantly. This is something I touched on a bit in Extra Life, but only at the very end of the book—most of it was focused on health innovations that prevented illnesses like smallpox or the reduction of catastrophic events like automobile crashes. But for the past year or so, I’ve been working on a project that looks specifically at the prospects for radical life extension, and what the societal and ethical implications of such a project might be. (In many ways, this investigation parallels some of the questions I raised in “The Man Who Broke The World,” my Times Magazine piece from last month.) I’ll have more to say about this in the next installment of the newsletter, but I’ve written a long essay—almost a pamphlet, really—on these issues, and I’m going to serialize it here for paying Adjacent Possible subscribers over the next few months. I’m really excited about both the format—longer than a magazine article, but shorter than a proper book—and the subject matter. I think we may well be on the verge of a significant societal conversation about the implications of anti-aging interventions; this series should be helpful in getting you all up to speed for that debate. Or at least help you decide if you really want to live forever!