Americans Can

By Marshall Loeb

COMPARED with many other peoples, Americans do not live very long. Though the U.S. leads the world in most measures of material success--personal income, production, profits--in life expectancy it ranks only 24th for men and ninth for women. American men live an average 67.1 years,* and American women 74.6 years. Men survive longer in most Western European nations, as well as in Japan, Israel, Greece, East Germany, Australia and some other countries. Indeed, in Norway, Denmark and The Netherlands, men live longer than 70 years on the average; in Sweden, the world's leader, male longevity is 71.9 years--almost five years more than in the U.S. While U.S. women do appreciably better, they still rank behind women in Sweden, The Netherlands, Iceland, Norway, Denmark, France, Canada and Britain.

People almost everywhere are living longer than ever before. Because of pestilence, war and famine, plus a dreadful rate of infant and maternal deaths, the ancient Romans survived to an average age of only 22. By the Middle Ages, longevity in Western Europe had risen to 33 years; a century ago it was up to 41. In the U.S., life expectancy has jumped dramatically since 1900, when it was only 47 years. But practically all the gains were made between 1900 and 1950, as medical advances defeated the great killers of the young. The average length of life rose about four years in each of the first five decades of this century (see chart). In the two decades since 1950, however, it has gone up only 1.5 years for men and 3.5 years for women.

One reason that the world's richest nation ranks so low is that, unlike Denmark or Japan, it is a huge and heterogeneous country. Many of its people, particularly nonwhites and rural folk, do not receive the benefits of sound nutrition and medical care. For much of the rest of the population, the good life does not contribute much to long life simply because Americans tend to overdo things. They consume too much in the way of calories and cholesterol, nicotine and alcohol. Overeating causes high blood pressure and strokes. Oversmoking contributes to arteriosclerosis and lung disease. Overdrinking leads to cirrhosis and brain deterioration. In addition, Americans often work too hard. The harddriving, competitive, demanding life of the meritocracy brings many insults to the body, and particularly the heart. The death rate for men from cardiovascular disease is 50% higher in the U.S. than in Western Europe and 25% higher than in Canada.

Numerous studies of nationalities show the high price of American overworking, overworrying and overconsuming. For example, Jews in the U.S. have a higher rate of heart disease than Jews in Israel; the same is true of Japanese in the U.S. compared with Japanese in their homeland. The rate of heart disease runs highest in the nation in Rhode Island, New York and Pennsylvania--all heavily urbanized states that have much stress, crowding and pollution. The rate is lowest in Hawaii, Alaska and New Mexico, where the living tends to be slower and easier.

A person's profession has much to do with life expectancy. Clergy, scientists and teachers live longer than the average. Supreme Court Justices often live beyond 80, and their mortality rate has been 29% lower than the national average for men. The reason seems to be that these jobs offer regular hours and a minimum of pressure and tension. By contrast, a study of journalists listed in Who's Who showed that their mortality rate was almost twice as high as the others in that compilation of achievers. Whatever their jobs, people generally stay alive longer if they are allowed to work beyond 60 or 65, instead of being forced into idle retirement. Says Professor Erdman Palmore, an associate at Duke University's center for the study of aging: "If an aging person maintains a worthwhile social role, it keeps him physically and intellectually stimulated. He is motivated to take care of himself." The Soviet Institute of Gerontology states that "man could live longer if he were allowed to work longer." Yet the trend in the U.S. is toward earlier and earlier retirement.

There are all sorts of indications that people live longer when they have a feeling of belonging and being loved as well as a sense of purpose and direction. When the British in World War II united closely to face a common enemy, the death rate from suicide and alcoholism dropped to almost zero. Everywhere in the world today, married people live longer than those who are single, divorced or widowed. For example, the coronary thrombosis death rate in Britain is 40% higher among widowers than among married men of the same age.

Clearly, Americans as a people should strive to live longer. This notion does not contradict the rising cries for population control; even the most zealous advocates of Zero Population Growth would hardly dispute that those already alive should realize the biblical promise of threescore years and ten, or even fourscore. Nor does the idea of adding years to life in the immediate future have much to do with the longer-term efforts of biologists and gerontologists to extend life by vastly altering man's body through the injection of steroids, enzymes or other medical marvels.

It is easy to say that life in the U.S. could be extended if people would only eat, drink and smoke less; work for more years but at a slower pace; find a sense of purpose and direction; and get at least a little love. All of that is desirable --and some of it attainable for many--but to accomplish it for the country as a whole would demand a difficult if not impossible reordering of American society and its priorities, not to mention a considerable shift in the individual American psyche. Certainly the Government should seek to extend longevity by attacking poverty, increasing the quality and availability of medical care, and educating the public about the dangers of overindulgence. At the same time, however, there are other immediate and practical steps that can be taken to increase the life span of many Americans.

These steps involve a national assault on three kinds of death for which U.S. rates are shockingly high: homicides, accidents and infant mortality. All three exercise a particularly cruel and unneeded form of population control that debilitates the nation. Reason: they strike the young, people who otherwise would have their most productive and creative years ahead of them. To make the nation a healthier, safer place in which to live the U.S. could:

REDUCE THE RATE OF HOMICIDES. Homicides are more common by far in the U.S. than in any other industrial nation except France; there were 15,800 in 1970 alone. Many of the victims were young; homicide is the second highest cause of death among people aged 15 to 24. Psychologists can argue over the reasons for the large number of U.S. homicides: the frontier tradition, the explosive tensions of the ghetto, the fanning of violence through TV and film. But one fact is indisputable--most homicides involve guns. And guns are shockingly easy and cheap for any murder-minded malcontent to buy. Since the turn of the century, more than 800,000 Americans have been killed by privately owned guns. The yearly toll is now 21,000, which includes 8,000 homicides by handguns as well as suicides and gun accidents. Certainly if the U.S. adopted a strict and sensible federal gun-control law, homicides would decline substantially.

IMPROVE ITS INDUSTRIAL SAFETY. The U.S. has a scandalously bad record in this area. On-the-job accidents caused 14,200 deaths last year; in addition, 2,300,000 workers suffered disabling injuries on the job, and some of the victims will undoubtedly die prematurely as a result. These numbers could be reduced if the Government forced the states to adopt stricter laws to prevent such accidents. Federal law should control not only dangerous tools and machines but also cancer-inducing chemical fumes and asbestos particles. Congress last year put into effect a new Occupational Safety and Health Act. While the act is a move in the right direction, it is underfunded and underenforced, and should be toughened.

REDUCE ITS AUTOMOBILE FATALITY RATE BY AT LEAST ONE-HALF. Auto accidents are the leading cause of death of American children, teen-agers and adults under 25, and the third highest cause of death among people aged 25 to 44. Since the auto was invented, it has killed 1,800,000 Americans, more than in all the nation's wars. Last year's toll was 55,000. At present rates, one out of 40 living Americans will some day be killed by a car.

That rate could be cut if the states would pass laws making the wearing of seat belts obligatory. Local police would enforce the law, passing out summonses to drivers or riders caught unbelted. Crash-injury experts estimate that auto deaths could be reduced by at least one-third if everybody used seat belts all the time. Only a minority of drivers do so now. Further, tough federal standards should be enacted for the licensing of drivers. Some states and localities are inexcusably casual in granting licenses to obvious incompetents. Children of 14, mental defectives, drug addicts and even people collecting aid-to-the-blind payments can get licenses in many states. Most drivers are tested only once in a lifetime, under ideal conditions at low speeds. Undoubtedly a federal law should require periodic tests and stricter standards.

In addition, Congress should pass a law that would at long last crack down on drunken drivers, who get away with long last crack down on drunken drivers, who get away with murder. Half of all fatal accidents involve drivers who have been drinking. The U.S. would be wise to emulate the Scandinavian countries. In Sweden, police routinely stop drivers and test suspected drinkers. Anyone with more than .05% alcohol in his blood (about one cocktail or two strong beers for a 165-lb. person) is sentenced to as much as six months in jail, usually at hard labor. That is more than many a U.S. drunken driver gets for causing a serious accident.

DO MUCH MORE TO SAVE THE LIVES OF NEWBORN CHILDREN. Infant mortality is higher in the U.S. than in 20 other nations and territories. Indeed, the U.S. rate is almost double that of Sweden or The Netherlands, where high-quality, state-supported medical services are easily available to all people, whether rich or poor, urban or rural. Last year 75,000 American infants died within one year of birth. A disproportionately large number of these were born to mothers who were young (under 20), poor and/or black. Either because of lack of education or lack of money, such women often get little or no prenatal or postnatal care. The infant mortality rate among American nonwhites--31 per 1,000 live births--is nearly twice as high as for whites.

Surely the nation's record would improve if Congress adopted a national health-care program, which has been proposed in varying forms by leaders as disparate as President Nixon and Senator Kennedy. Beyond that, a state-supported medical program would raise the nation's life expectancy by providing health care for millions who cannot now afford it.

These steps are only a beginning, but they would have immediate benefits. If the number of homicides in the U.S. were reduced by half, average life expectancy would rise by .1 year. If the overall rate of auto, industrial and other accidents were also cut in half, bringing it down to the lowest level now recorded in industrial countries, average life expectancy would rise by .65 year. If the infant mortality rate among nonwhites could be reduced to that of U.S. whites, life expectancy would rise by .15 year.

Taken together, these actions could quickly increase average longevity in the U.S. by about a year. More than that, they would add up to whole lifetimes for many of the young, who now die or are killed prematurely. Certainly the expansion of life is well within the reach of a people who like to think that they can accomplish anything they set out to do--and it is well worth setting as a national goal.

Marshall Loeb

* There is a great gap between races. U.S. life expectancy for white males is 68.1 years, for nonwhite males a distressingly low 60.5.

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