More adults are dying before the age of 65 – The Week

Report on Premature Mortality and Systemic Inequities in the United States

Introduction: A Challenge to Sustainable Development Goals

A significant rise in premature mortality in the United States is highlighting deep-seated inequities within the nation’s healthcare system. A growing number of individuals, particularly from marginalized communities, are contributing to Medicare throughout their working lives but are not surviving to the eligibility age of 65 to receive its benefits. This trend represents a substantial challenge to achieving several key Sustainable Development Goals (SDGs), including SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities).

Analysis of Premature Mortality Trends and Disparities

Key Statistical Findings (2012-2022)

A study published in JAMA Health Forum reveals alarming trends in mortality among adults aged 18 to 64:

• Premature mortality increased by 27.2% over the decade.
• The increase was 10% higher among Black adults compared to white adults, underscoring a severe racial disparity.
• Significant geographic inequalities were observed, with states like West Virginia, New Mexico, and Mississippi recording the highest premature mortality rates, while Massachusetts and Minnesota had the lowest.
• These findings are compounded by previous research indicating that avoidable mortality has increased across all U.S. states while decreasing in comparable high-income nations.

Implications for SDG 3: Good Health and Well-being

The rising rates of premature and preventable death directly contravene the objectives of SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. The data indicates a failure to meet Target 3.4, which calls for a one-third reduction in premature mortality from non-communicable diseases. The disparity between the U.S. and other developed nations suggests systemic failures in providing the conditions necessary for a healthy populace.

Systemic Barriers and the Violation of SDG 10

The Medicare Inequity

The core issue identified is a structural inequity within the Medicare system. As eligibility is tied to age 65, the rising premature death rate means a growing segment of the population, disproportionately Black and low-income workers, is effectively subsidizing a system from which they will never benefit. This reality undermines the principle of universal coverage and creates a system where contributions do not guarantee access.

Impact on SDG 10: Reduced Inequalities

The current situation exacerbates inequalities, running counter to the mission of SDG 10. The system’s failures manifest in several ways:

• Disproportionate Impact: Black and low-wage workers are more likely to hold jobs without health insurance, limiting their access to preventative care and early treatment.
• Deepening Divides: Rather than shrinking, these health inequities are widening across nearly every state, indicating a systemic problem that requires institutional reform.
• Unequal Opportunity: The inability to access timely healthcare before age 65 denies individuals an equal opportunity to live a long and healthy life, a foundational aspect of reducing inequality of outcome as outlined in Target 10.3.

Socioeconomic Determinants and a Path Forward Through the SDGs

Contributing Societal Factors

The report identifies that premature mortality is not solely a result of individual behavior but is heavily influenced by broader societal and environmental factors. These determinants are directly linked to several SDGs:

• Environmental Health (SDG 11): Exposure to polluted air and other environmental hazards contributes to poor health outcomes.
• Economic Stability (SDG 1, SDG 8): Chronic stress related to financial insecurity and lack of decent work with benefits like health insurance is a major factor.
• Access to Services (SDG 16): The lack of affordable and accessible healthcare coverage before age 65 points to institutional failures in providing for public welfare.

Recommended Interventions for Sustainable Development

To address this crisis and align with the 2030 Agenda for Sustainable Development, the study proposes a multi-faceted approach focused on systemic change:

1. Policy Reform for Universal Access: Implement coordinated health and social policy reforms to ensure timely, equitable, and affordable healthcare coverage for all individuals before the age of 65. This directly supports SDG 3 (Good Health and Well-being) and SDG 16 (Peace, Justice and Strong Institutions).
2. Invest in Social Determinants of Health: Direct sustained investments toward factors that shape long-term health outcomes. This includes:
   • Housing (SDG 11): Ensuring access to safe and affordable housing.
   • Education (SDG 4): Improving educational opportunities to enhance health literacy and economic prospects.
   • Income Security (SDG 1, SDG 8): Promoting policies that ensure living wages and economic stability.

Addressing these root causes is essential to reverse the trend of premature death, mitigate the intergenerational loss of productivity, and make meaningful progress toward a more equitable and sustainable society.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article highlights issues directly connected to the following Sustainable Development Goals:

• SDG 3: Good Health and Well-being

  The core theme of the article is the rising premature mortality and disparities in life expectancy in the U.S. It discusses the failure of the healthcare system to ensure long and healthy lives for all citizens, particularly before they reach the age of 65.

• SDG 10: Reduced Inequalities

  The article repeatedly emphasizes the deep and growing inequalities in health outcomes. It points out significant disparities based on race (“10% higher in Black adults compared to white adults”), income (“wealthier people tend to live longer than poorer people”), and geography (“states such as West Virginia, New Mexico and Mississippi had the nation’s highest premature-mortality rates”). The text describes the system as having “structural inequity.”

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s discussion of premature death and systemic health disparities, the following specific SDG targets can be identified:

1. Target 3.4: Reduce premature mortality from non-communicable diseases

   This target aims to “reduce by one third premature mortality from non-communicable diseases through prevention and treatment.” The article directly addresses this by citing a study that found “Premature mortality increased in adults aged 18 to 64 by 27.2% between 2012 and 2022.” It also notes that “avoidable mortality increased in all U.S. states,” which is central to the concept of premature mortality.

2. Target 10.2: Promote universal social, economic, and political inclusion

   This target seeks to “empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.” The article shows how marginalized communities, specifically Black and low-wage workers, are excluded from the full benefits of the healthcare system. It states, “When you look through the lens of race, it’s clear that one group is increasingly dying before they ever see the benefits of the system they helped fund.”

3. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome

   This target focuses on ensuring “equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory… policies and practices.” The article describes the Medicare system as one that “effectively bakes structural inequity into a system that was meant to be universal.” The disparity in life expectancy and access to care for marginalized groups represents a clear inequality of outcome, which the article argues is “deepening across nearly every state.”

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions and implies several indicators that can be used to measure progress:

• Indicator for Target 3.4: Premature mortality rate

  The article explicitly provides data for this indicator. It states, “Premature mortality increased in adults aged 18 to 64 by 27.2% between 2012 and 2022.” This quantifiable metric directly measures progress (or lack thereof) toward reducing premature deaths.

• Indicator for Target 10.2 & 10.3: Disparity in health outcomes by race and income

  The article provides specific data points that serve as indicators of inequality. For race, it notes the increase in premature mortality was “10% higher in Black adults compared to white adults.” For income, it references a study finding that “wealthier people tend to live longer than poorer people in the U.S.” These comparative statistics measure the gap in outcomes between different population groups.

• Indicator for Target 10.2 & 10.3: Disparity in access to health insurance

  The article implies this indicator by stating that “Black and low-wage workers disproportionately have jobs that don’t provide health insurance.” Measuring the proportion of different demographic groups without adequate health coverage before the age of 65 would be a direct way to track progress on ensuring equitable access to healthcare, as recommended by the study’s authors.

4. Table of SDGs, Targets, and Indicators

Source: theweek.com