The US is probably the richest country in world history but its citizens are dying earlier than those in both poor and wealthy peer countries. Life expectancy is falling rather than rising although the US has state-of-the-art medical and medical research facilities and spends more on health per person than any other country. But most individuals do not benefit from this expenditure. Overall life expectancy is 76.4 years; 76.1 years for men and 81.1 years for women. Wealthy Monaco enjoys the world’s highest life expectancy at 87. Hong Kong, Japan, South Korea, Switzerland, and Italy are in the top ten.

The Washington Post reports that “life expectancy for men has increased in developed countries since 1980”, but not in the US where cancer, diabetes, and heart and liver disease are killing people of both genders between the ages of 35 and 64. There are many reasons for the decline in US life expectancy.

First and foremost, the divide between rich and poor has deepened and widened. Nevertheless, the Post proclaims, “The best barometer of rising inequality in America is no longer income. It is life itself.” Money is, however, the root of US inequality whether medical, economic, or social. Survival depends on money. Medical care in the US is expensive but the US spends less than peer countries on health care. The elderly and the poor are partially and fitfully covered by federal programmes, but there is no national health system. Doctors, insurers, hospitals and pharmaceutical giants (“Big Pharma”) strongly reject national health and have long lobbied politicians and mounted popular campaigns opposing “socialised medicine.” The operative word being “socialised,” identifying it as socialist or, terror-of-terrors, communist. US citizens are sensitised from birth about “Reds” who would take away their freedoms and prosperity. Like comrades elsewhere, US politicians cannot exist without an enemy or enemies. “Reds” have long filled this role.

The price of medical care is prohibitive for all but the wealthy. Middle class citizens struggle to obtain care and coverage from insurance firms which do not accept all contingencies. An ambulance ride to hospital and treatment in emergency could cost thousands of dollars. Practitioners can also be difficult to access unless prospective patients are “in the system.” Many have been left out.

Consequently, most US citizens avoid going to doctors and buying costly medications until their ill-nesses are chronic or too far advanced to treat.

While the US has adopted advanced interventions for acute ailments, other countries focus on preventing illness. Since they are poorly paid, there is a shortage in the US of doctors providing primary care and working as general practitioners. Many of these posts are being filled by foreign doctors but even they cannot overcome the shortages. Homegrown doctors prefer to be specialists and command high wages. The Washington Post summed up the situation in an editorial: “Building a healthier population doesn’t pay as well as treating a sick one does. Pharmaceutical companies profit when they create drugs that treat disease, rather than the drivers of it.

The more patients a private medical facility sees, the more money it makes.” The Post argues “people living in the wealthiest areas of the United States don’t live longer lives than people in the poorest parts of France, where health outcomes are far more equal.” Indeed, France has a national health programme. Life expectancy is set before birth by the state of health of a child’s mother, father, and immediate forebearers. Healthy backgrounds make healthy children and adults. Conditions of life play a determining part in human development and fate. This is as true in the US as in India, France, China, or Mexico. How a person fares often depends on where he or she lives.

In the US, there are huge divisions between East and West, the coasts and the middle, and North and South. People living in the South and rural areas across the country are likely to face deficient health care. Divisions are regional, local, racial, religious, educational and right down to the family level. Divisions have developed between Republican- and Democrat-governed states. The former are generally more conservative and resist state and federal intervention in citizens’ affairs. For example, in Republican-run states politicians and officials often shrugged off Covid, resisted lockdowns, vaccinations, and masking. People fell ill and died from Covid denial, Covid infected Donald Trump who survived and was the chief Covid denier. Democrat-governed states are more inclined to look after the wellbeing of their citizens and did better than Republican states when Covid arrived.

Other lifestyle factors that determine US health include processed and fatty foods, sugary drinks and snacks, lack of exercise, tobacco, and alcohol. All these contribute to the unhealthy “American lifestyle” which is, unfortunately, spreading around the world. To these factors must be added the specifically US factors, guns and opioids and other drugs which are taking a huge toll but have not, so far, been widely exported. The Mediterranean diet — said to be the among the most healthy in the world — depends on fresh vegetables and fruit, little red meat, fish, chicken, whole grains, yoghurt, and cheese. In the Mediterranean island of Cyprus, where I live, there is a large population of elderly folk in their 80s and 90s. The Covid vaccination campaign revealed just how many there were as the injections began with the over 80s and went on for weeks as old men and women lined up at the vaccination centres and under 80s waited for their turns. Impatient to be inoculated against the newest global scourge under the recently introduced national health programme. It has been a great success and a lifesaver.