Life expectancy: How can we address uneven declines? – . Health Blog

Not so long ago, during the 2019 prepandemic, reported life expectancy at birth for non-Hispanic black, non-Hispanic white, and Hispanic populations were approximately 75, 79 and 82 years, respectively. The higher life expectancy of Hispanic Americans compared to others in the United States may surprise some.

This phenomenon, known as the "Hispanic Paradox," was first noted in the 1980s, and its legitimacy has been debated since then. Numerous explanations have been suggested, including hypotheses about the "healthy immigrants" (people who immigrate to the US are healthier than those who stay in their home countries) and the "salmon bias" (less healthy US immigrants are more likely to return ) their countries of origin). Other experts note that Hispanic communities smoke less and have higher social cohesion, which can certainly add to their perceived higher life expectancy. Ultimately, this difference remains poorly understood and is further complicated by research that has found that Spanish-born people in the United States may have a lower life expectancy compared to their foreign-born counterparts.

Recent estimates by the Centers for Disease Control and Prevention (CDC) on life expectancy now show an alarming change highlighting the disproportionate impact of COVID-19 on color communities. Between 2019 and 2020, life expectancy among Black and Hispanic populations fell three years, two years and one year more, respectively, compared to their white counterparts. Indeed, the life expectancy gap between black and white populations widened from four to six years, the largest gap since 1998. And the life expectancy advantage that Hispanic populations previously enjoyed over whites narrowed from three to two years. In other words, the COVID-19 pandemic has reduced life expectancy for all people in the United States, but that impact has been most felt by color communities.

Many reasons for a greater susceptibility to COVID-19

Many factors have contributed to this uneven decline in life expectancy. However, these remarkable numbers remind us of the vulnerability of blacks, indigenous peoples, and coloreds (BIPOC) in the US stemming from the long-standing inequality of access to health care and resources necessary for upward economic mobility. Many BIPOC populations in the US are on the verge of collapse. With little health or financial reserves, these communities are increasingly vulnerable to sudden events like the financial collapse in the early 2000s or a global pandemic.

Racism works largely through structural barriers that benefit some groups and disadvantage others. Rather than creating new differences, the COVID-19 pandemic has simply exposed chronic shortcomings in our social policies and in the health care of our BIPOC communities. Recently, the CDC recognized this and identified racism as a public health threat that affects the health and wellbeing of the BIPOC population.

Long-term systemic deficiencies lead to poor overall health

Unusually high and sustained exposure to stress during pregnancy and early childhood leads to sustained releases of inflammatory and stress-related hormones such as cortisol, leading to toxic levels of chronic stress. Racism causes chronic stress that is detrimental to the development and wellbeing of BIPOC children. In addition, many BIPOC children have fewer overall opportunities to thrive. They live in areas plagued by ubiquitous poverty caused by longstanding discriminatory measures such as redlining and residential segregation. These factors are aggravated and ultimately lead to higher levels of cardiovascular disease, mental illness and harmful behaviors. Known as weathering, this contributes to both a shortened lifespan and a decreased health span (the length of time in a life that a person is in good health).

In addition, BIPOC individuals in the US continue to face barriers to accessing quality health care. Examples of this are higher rates without insurance and underinsurance as well as lower literacy in health care. Pervasive prejudice and discriminatory measures are deeply embedded in our healthcare infrastructure. The results of the CDC report should therefore come as no surprise: a population chronically deprived of accessible prevention services is expected to perform poorly during a pandemic.

Going on: Which changes could help?

We can all speak out to convince and support the efforts of government officials at all levels and health leaders to address immediate inequalities related to the ongoing pandemic and chronic shortcomings that make BIPOC communities increasingly vulnerable. Below are a few things you can do to get our system moving in the right direction.

Regular citizens can

• Vote in all elections – especially local elections. Local elected officials, such as a mayor, city administrator, city council member, and county sheriff, can influence citizens' lives even more personally than state or federal officials. Local news media and websites may provide policy view and track record information to help you select candidates.
• Be wary of fake news advertised on social media. Social media provides a wealth of information, but it also offers opportunities to spread false information that can greatly influence our decisions. Try to maintain a healthy level of skepticism. Check the information with trusted sources. These common sense tips can keep you from falling victim to fake news.
• Support local organizations. Local nonprofits and community organizations play an important role in eradicating the COVID-19 disparities affecting BIPOC communities and in combating testing and vaccine equity. If you are financially able, consider donating to local nonprofits, food banks, and community organizations so they can help out in times of need.

Policy makers and government leaders can

• Repair unemployment insurance. Use federal funds to rehabilitate crumbling state unemployment insurance infrastructures and pass laws that require all states to provide standard minimum benefits.
• Make universal health care possible. Make sure you get universal health coverage, be it through a public option, an individual payer, or a variety of other alternatives. Americans deserve fair access to quality health care, especially preventive care.
• Eliminate historically racist and discriminatory policies. Eliminate discriminatory practices like gerrymandering that contribute to persistent voter disempowerment, residential segregation, and ubiquitous poverty, and leave color communities without a voice in destitute circumstances.

Editor's note: At the request of Dr. Perez uses terms throughout this post that are used to describe any race and / or ethnic group to reflect his view of identity and racial justice.