The US could have averted 40% of the deaths from Covid-19, had the country’s death rates corresponded with the rates in other high-income G7 countries, according to a Lancet commission tasked with assessing Donald Trump’s health policy record.
Almost 470,000 Americans have died from the coronavirus so far, with the number widely expected to go above half a million in the next few weeks. At the same time some 27 million people in the US have been infected. Both figures are by far the highest in the world.
In seeking to respond to the pandemic, Trump has been widely condemned for not taking the pandemic seriously enough soon enough, spreading conspiracy theories, not encouraging mask wearing and undermining scientists and others seeking to combat the virus’ spread.
Dr Mary T Bassett, a commission member and director of Harvard University’s FXB Center for Health and Human Rights, told the Guardian: “The US has fared so badly with this pandemic, but the bungling can’t be attributed only to Mr Trump, it also has to do with these societal failures … That’s not going to be solved by a vaccine.”
In a wide-ranging assessment published on Thursday, the commission said Trump “brought misfortune to the USA and the planet” during his four years in office. The stinging critique not only blamed Trump, but also tied his actions to the historical conditions which made his presidency possible.
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The commission condemned Trump’s response to Covid, but emphasized that the country entered the pandemic with a degraded public health infrastructure. Between 2002 and 2019, US public health spending fell from 3.21% to 2.45% – approximately half the share of spending in Canada and the UK.
To determine how many deaths from Covid the US could have avoided, the commission weighted the average death rate in the other G7 countries – Canada, France, Germany, Italy, Japan and the UK – and compared it to the US death rate.
In another comparison, the commission found if US life expectancy was equivalent to the average in the other G7 countries, 461,000 fewer Americans would have died in 2018.
Throughout history, stagnating longevity has signalled grave societal problems, as has occurred in England since 2010 and in the years leading to the collapse of the Union of Soviet Socialist Republics. For much of US history, income and wealth were distributed more equally than in most of Europe. However, since the 1980s, the disparity between social and economic classes has widened as high-paid manufacturing jobs disappeared after trade liberalisation, unions were stifled, and tax and social policies increasingly favoured the wealthy. Despite a booming stock market and low unemployment, many people living in the USA were forced into precarious jobs that offered low pay and insufficient benefits. This widening income inequality has, widened inequalities in health.
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The disturbing truth is that many of President Trump’s policies do not represent a radical break with the past but have merely accelerated the decades-long trend of lagging life expectancy that reflects deep and long-standing flaws in US economic, health, and social policy.
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Trump gained from the public dissatisfaction with the status quo, while his electoral opponents (in both the primary and general elections of 2016) offered little break from the failures of past administrations. Focusing narrowly on Trump’s policies and rhetoric, while ignoring the failings that precipitated his election, risks obscuring the causes and remedies for the long-term downward trajectory of health in the USA.
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Declining US longevity between 2014 and 2017, and the minimal uptick in longevity in 2018, attracted substantial media attention. However, a focus on these recent trends risks obscuring how far the USA lags behind other high-income nations (figure 1), and how long these cross-national gaps have been in the making. Life expectancy in the USA was average among high-income nations in 1980, by 1995, it was 2·2 years shorter than the average of other G7 countries, and by 2018, the gap had widened to 3·4 years.
The extent of difference can also be quantified as the number of missing Americans—ie, the number of US residents who would still be alive if age-specific mortality rates in the USA had remained equal to the average of the other six G7 nations. By this measure, in 2018 alone, 461 000 Americans went missing, an annual figure that has been increasing since 1980 (figure 2, appendix pp 2–3). Most of the US mortality excess is among people younger than 65 years. If US death rates were equivalent to those of other G7 nations, two of five deaths before age 65 years would have been averted. To put this number in context, the number of missing Americans each year is more than the total number of COVID-19 deaths in the USA in all of 2020.
