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Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning again, everyone. Now we continue our WNYC Centennial series, 100 Years of 100 Things. This year-long series began in July on the day that WNYC turned 100 years old. The show committed to passing forward the station's history of trying to be interesting and educational and relevant to today in every year. We will try to keep it up for the rest of this series as we are entering the new year with things number 54 and 55, 100 years of birth rates and 100 years of life expectancy, and causes of death in the United States.

We did birth rates on Thursday. Today it's 100 years of life expectancy and causes of death. This is both a remarkable and very relevant-to-today history. Remarkable because if we go back to the year 1860 as a starting point, the average life expectancy in the United States was, think about it, what would you guess? It was less than 40 years old. According to the statistics website Statista, people in 1860 in this country only lived on average to 39.4 years old. 20 years later in 1880, that was unchanged. But then a remarkable increase began. In 1905, life expectancy had increased to 50 years old.

By 1935, it was up to 60 years old. In 1970, 70 years old. Just before the pandemic in the mid-2010s, average US life expectancy came close to 80 years old. 78.9 in 2015 is the exact number I have from Statista. Of course, there have been differences by race and gender and income, and other measures. We'll get into those. Interestingly, the race and gender life expectancies have both been narrowing. The disparities have been narrowing over time. We'll talk about how and why and the causes of death, the diseases and things that are not diseases that take people's lives have changed over time as a function of modern medicine and other things.

Today we're at a point of possible transformation in public health policy with the possibility of people like RFK Jr., Dr. Oz being in charge of it. Will they add to life expectancy and equity within it, or will their alternative approaches wind up decreasing how long Americans live? spoiler alert, the increasing life expectancy and decreasing birth rates that we talked about last week could and in my opinion, should change the conversation the country is having about immigration in the national interest and about health care reform.

Other wealthy countries are having these conversations too. Some are doing much better than us. Some countries are talking about how can we have more immigrants so we have a better worker-to-senior citizen ratio. There's a lot we'll try to get to in this 100 Years of 100 Things segment thing. Number 55, 100 years of life expectancy and causes of death in the United States. This is part of a pair with last week's birth rate segment, and so we welcome back the same demographer who studies both.

It's Mark Mather, Associate Vice President for U.S. Programs at the Population Reference Bureau, a nonprofit that specializes in US and global population data to help inform policymakers. He has written very interestingly, for example, about why American women still live longer than American men on average but the men are catching up. Mark, thanks for doing this two-parter with us and welcome back to WNYC.

Mark Mather: Hi, Brian, thanks for having me back.

Brian Lehrer: Can we start with just the remarkable arc of life expectancy growth over the last 150 years to go from 40 years old on average to 80 years old, as almost a steady march upward over the decades, like I laid out, is unprecedented in human history. Like so many other changes in this 100-year series, it seems to track with the rise of the industrial era. Are there some basic realities of the last 150 years that you identify as causing in general, life expectancy to double in this period of time?

Mark Mather: Yes, we have had some setbacks for sure, like the 1918 influenza pandemic, World War II, and most recently COVID-19, but overall, the reduction in death rates has been a major public health success story in the United States and in other industrialized countries. I think you alluded to this in your introduction, that it's better public health measures that have contributed to a lot of this improvement. So basic things like clean water, better nutrition, we had refrigeration in homes, so we had better food preservation starting in 1920s, 1930s.

Then things like the development of antibiotics in the mid-1930s that helped really reduce those deaths from infectious diseases that were so prevalent early on.

Brian Lehrer: I have another chart from Statista that compares the leading causes of death, the causes of death in 1900 to the leading causes of death in 2022. In 1900, the leading three causes of death were listed as pneumonia or influenza, followed by tuberculosis, followed by gastrointestinal infections. None of those are even in the top 10 anymore. Diphtheria was also in the top 10. That's gone from the list, too. Now it's heart disease and cancer, numbers one and two, and the number three cause of death these days is accidents.

There were plenty of accidental deaths in 1900 as well but the diseases that stopped being so fatal allowed accidents to climb to third place. Again, those ones that were 1, 2 and 3 in causes of death in 1900, but fell completely out of the top 10 were pneumonia or influenza, followed by tuberculosis, followed by gastrointestinal infections. That's advances in medical science, right?

Mark Mather: Yes, it's absolutely true that the things that are killing us today are very different than they were 100 years ago. It was infectious diseases back then accounting for nearly a third of all deaths. We had this epidemiological transition where it shifted sometime, soon after the 1918 influenza pandemic, starting in the 1920s, we started to see this shift towards what we call deaths from non-communicable diseases, these chronic diseases. Instead of infectious disease, it became things like cancer and heart disease and diabetes and the things that people often live with for many years and affect people in particular as they get older.

Brian Lehrer: I have a timeline chart from the think tank, the Hamilton Project, which shows certain milestone medical advances over time. For example, first, continuous water chlorination around 1910, then the diphtheria vaccine, the introduction of penicillin and pasteurization of milk laws, all in the 1920s. In this 100-year timeline, exactly 100 years ago, the 1920s, there was a revolution in medical science, vastly diminishing several leading causes of death. Should we also be talking about a marked decrease in infant mortality?

Like if more babies are just making it to start growing after they're born, is that a main reason that we've seen life expectancy go from 40 years old to 80 years old? We tend to look at what kills people along the way but what about people who really never got out of the gate?

Mark Mather: Yes, exactly. You mentioned that life expectancy was 40 or 50 years 100 years ago, but if you made it to 60, you had a good chance of living another 15 years. The main reason that life expectancy was so low is because there were so many infants and infant and child deaths. Around the time of World War I, about 1 in 10 U.S. babies died during their first year of life, whereas today it's like 1 in 175 babies who die before their first birthday. What that means is that over 99% of children are surviving infancy. That's been the real driver in that increase in life expectancy.

Brian Lehrer: There you go. Were babies dying, if you know, of those leading causes of death in the old days? Pneumonia, influenza, tuberculosis, gastrointestinal infections?

Mark Mather: Exactly. Germs were infecting people because they didn't have clean water, because they were feeding kids water that-- instead of breastfeeding, they might have been bottle feeding their babies with water that was not sanitized. That was a major issue.

Brian Lehrer: Today's leading killers, including cancer and heart disease, at the top of the list, it's really heart disease followed by cancer, but they're both pretty close and so prevalent. Also, diabetes increasing in prevalence as a killer into the top 10. Is it just that the other causes mostly are disappearing and so it makes it look like these are more prevalent? Or if you look at, let's say, the percentage of 60-year-olds 100 years ago who had cancer or heart disease compared to the percentage of 60-year-olds today who have cancer or heart disease or diabetes, has it actually gone up?

Mark Mather: Yes, that's a good question. I think the research shows that it is both. People are living longer, and if you're surviving to adulthood and older ages, it does mean you're more likely to die from other things like cancer and heart disease but if you think about patterns of smoking, that has had a major effect on patterns of mortality in the 20th century. It was a major driver of increases in cancer during the 20th century. If you think about cigarette smoking, we had less than 5% of Americans who were smokers around 1900, and then by 1965, it was 42%.

Things like lung cancer increased dramatically because of some of the behaviors that people had in the 20th century.

Brian Lehrer: Right. Continuing on that timeline of medical advances, this one's really just a medical study. We have the Surgeon General's landmark report on smoking and health around 1960. We also have the MMR vaccine around 1970. We also have the first antiretroviral to fight HIV in the '80s. That, of course, was taking a lot of lives for a time and not so much anymore. The Surgeon General's report on smoking, though 1960-ish, leads us to your article about the gender gap in life expectancy narrowing. Your chart seems to show that back in 1900, there were actually more older men than older women.

102 men versus every 100 women age 65 or older before women started living longer than men. Do I have that right?

Mark Mather: I think women were probably living longer but yes, at age 65, we could have seen that kind of agenda difference, partly because at birth we have more males being born than female, and it takes a while for women to catch up, in effect. Once you get to those very old ages, Yes, women, women were still living longer than men.

Brian Lehrer: In your data, by 1990, the peak year for the disparity, there were only 67 men for every 100 women over the age of 65. So different. How much of that was smoking rate differences? Like almost all of it?

Mark Mather: Yes. This was a kind of a mystery until some researchers at the University of Pennsylvania linked it to historical smoking patterns. If you look at the peak years for when men were smoking in the 20th century, it was in the early part of the 1900s, whereas for women, smoking prevalence didn't peak until 1965. What that basically meant is it took longer for the effects of smoking to catch up to those women. Once it did, their mortality rates started to look much more similar to the previous generation of men. That's why those gender differences in mortality have narrowed over time.

Brian Lehrer: Related, listener asks in a text, what about maternal mortality? We talked about infant mortality.

Mark Mather: Maternal mortality rates, there's been a lot of research on this lately showing that there's been a pretty steep increase in maternal mortality in the US. I think a lot of that is due to better measurement of maternal mortality. Maternal mortality rates are highest in the United States compared to any other wealthy countries, so they're much too high. There are really significant racial ethnic disparities, with Black women having rates that are about three and a half times higher than white women. It's a major issue and one that we have not solved yet.

Brian Lehrer: We're going to get more into racial discrepancies in a minute, but on the gender discrepancies, by 2020, let's say just before the pandemic, you have the disparity shrinking to 81 senior men per 100 senior women. That's, I guess, from men quitting or not starting smoking anymore and women having started smoking a little more over the course of the 20th century. That's a big improvement in the ratio if it was 67 men per every 100 women, and now it's 81 men per every 100 women over the age of 65. Something significantly changed in the last 30 years.

Mark Mather: Yes, I'm not sure what's causing differences in more recent years, but it's going to have some important social potential consequences for caregiving and things like that there. There may be more spouses who are available to take care of their husbands, husbands taking care of their wives in old age. The more balanced that those gender gaps in mortality are, I think the better off we'll be.

Brian Lehrer: We're going to get into the immigration policy implications of what you just said before we ran out of time. Listeners, we can take just a couple of phone calls for our guest demographer Mark Mather from the Population Reference Bureau as we talk about 100 years of life expectancy and causes of death in the United States. 212-433-WNYC. I did want to get to some international comparisons which will probably surprise a lot of people. Laura in Warren, New Jersey, a physician is going to lead us into that, I think. Laura, you're on WNYC. Hi there.

Laura: Hi. Thank you. Can you hear me?

Brian Lehrer: Yes.

Laura: Okay, great. One of the things that I think it was actually The Economist had an article about sometime in the last few months was comparing mortality in the US versus other rich countries like Japan and Europe. All of our mortalities improved over most of the 20th century but then the US mortality has plateaued since the 1980s, whereas mortality in say, Germany and the Nordic countries has continued to improve over the last 30, 40 years. You were talking about racial disparities, that the gap in mortality between Black Americans and white Americans has narrowed.

Part of that is that lower-class white mortality has actually worsened over the last several years due to things like increased drug and alcohol use, increased suicide and so due to worsening social conditions, presumably. Part of the reason for the improvement is not a good reason.

Brian Lehrer: Those are all great points and consistent with what I've been reading prepping for this segment, Mark. Right? There's an increase in mortality and it would affect lower-income white people among others, in probably mostly lower-income categories. Causes of death on the rise in this country while others decline, include suicide and alcohol and opioid abuse. Right?

Mark Mather: Yes. those are the so-called deaths of despair. They have disproportionately affected white Americans who are in lower income groups and probably living in more rural areas, especially in the South. The caller's right, that that's one of the reasons why we've probably seen some convergence in Black white mortality rates. It's because of that decline and that increase in mortality among those lower-income white Americans.

Brian Lehrer: Some of the stats on that, according to the Federal Reserve, which tracks this, in 1900, the average life expectancy for whites was more than 45 years old and for Blacks less than 35. Just before the pandemic, the difference was about 75 years of age for Black Americans, on average around 79 years old for whites. Still a meaningful disparity, but not nearly what it was in the earlier years in percentage terms. We see that life expectancy also tracks with income and we know there are ongoing wealth and income disparities by race.

Do you have anything you study population, maybe not poverty policy as much, but do you have anything on what has caused the narrowing of the gap? In addition to more deaths of despair among lower-income whites, has it been largely the advent of, say, Medicaid in the 1960s and other healthcare cost buffers for people of lower incomes who disproportionately tend to be people of color?

Mark Mather: Yes, I think it is. Certainly healthcare is a big part of it, that we've got better healthcare, especially for Black Americans living in the South. I think research has shown that it's, it's not just a single factor, but a combination of things because we've seen reductions in cancer, HIV. We've seen a decline in Black deaths due to homicide, lower infant mortality rates. It's really been a combination of things, I think that has contributed to that improvement.

Brian Lehrer: The caller mentioned international comparisons. In general, we have lower life expectancies now than all of the following countries. This comes from a chart from healthsystemtracker.org but for people who think about American exceptionalism, and we're so advanced and we have the best health care, which we don't, the United States has lower life expectancies than Germany, Austria, Britain, Canada, France, Belgium, the Netherlands, Japan, Australia, Sweden, and Switzerland. All of them have longer life expectancies than the United States.

These are 2022 numbers. The average for all those other countries I've listed, according to this chart, is 80 years old for men, 84.4 years old for women in all those countries. On average in the United States, it's 75 years old for men, full 5 years less, 80.2 years old for women, 4 years less. That's something you've looked at, Mark, right? The United States trailing other wealthy industrial countries.

Mark Mather: Yes, absolutely. If you look at those data, I think what you'll find is that people with college degrees in the United States are doing as well or better than the folks in those other countries in terms of life expectancy. It's the people who don't have college degrees that are really falling behind. That's been an accelerating trend so that people with a college degree today can expect to live about a decade longer than those who don't even have a high school degree. That's where we're really failing.

It has to do with lots of factors related to health-related behavior, access to health care, and good social policy is good health policy. I think you mentioned poverty and we've got pretty significant income inequality in the United States and a lot of that is contributing to these disparities.

Brian Lehrer: Dale in Chelsea has a history question. Dale, you're on WNYC. Hello.

Dale: Hello. During COVID I was watching a lot of old movies and there's a movie in 1950 called The Killer that Stalked New York and it basically highlighted in reality there was a smallpox epidemic in New York and they even had some anti-vaxxers in the movie but the mayor got all of these pharmaceutical companies together and asked about vaccines and said, "We need to triple those." He had, I don't know, thousands of people vaccinated and got rid of the smallpox pandemic in New York. Do you know about this?

Brian Lehrer: Mark?

Mark Mather: I don't know what happened with smallpox. I know with like polio vaccine, we had a very successful campaign that effectively eliminated polio in industrialized countries. I would think that the same type of thing happened with smallpox. We were able to largely eradicate a lot of these nasty diseases through educating people about vaccines. They were successful.

Brian Lehrer: We didn't mention them at the beginning. Some of those causes of death that vaccines have prevented, except diphtheria, which was in the top 10 and has fallen way out of that because of the diphtheria vaccine. I guess it's because polio and smallpox may have been big killers and polio, of course, a big cause of disability, but maybe not in the top 5 or top 10 causes of death, but still significant causes of death, and vaccines have so effectively wiped those out. I certainly don't see anything about vaccines themselves as significant causes of death.

It happens rarely but I guess we're about to enter into a new era of policy conversation, at least over that. Right?

Mark Mather: Yes, that's certainly a possibility. I think you're right about the polio and smallpox vaccines. You would often have outbreaks and maybe they didn't have the same kind of effect that some of these other infectious diseases have. Polio can have lifelong debilitating effects even if you survive it. I hope we don't go there but it's been part of the conversation, so we'll see.

Brian Lehrer: We're going to be covering part of that on tomorrow's show, folks, with New Jersey Congressman Frank Pallone, who's the ranking Democrat now on what's called the Energy and Commerce Committee but they deal with all the health policy. We're going to talk about that tomorrow. Before you go, I said we'd touch on immigration. One thing you've written about several times is the need for more immigrants to keep our workers to Social Security and Medicare recipients ratio healthy.

Not just the government financing of those programs, but also having enough health care workers to go around for all these 90 and 100-year-olds who the population didn't used to have. Do you think the immigration debate in the US is missing that component as we focus on legal status and mass deportation, beyond those who've committed serious crimes?

Mark Mather: I do. I think it's something we're going to have to really look at closely, even if it's just within a particular sector like health care. We've got such a rapidly growing population of older adults, all these baby boomers who are going to need a lot of health care. With the fertility rate as it is and a relatively old population, we may need to turn to immigration as a solution to really balance those needs. There's other sectors as well, I think, where we should really start talking about immigration as a potential benefit and not just look at the potential detriment to the economy because we're going to definitely have a deficit in the coming decades.

Brian Lehrer: Other countries are having these conversations too, right? Age ratio. Like I've read that Japan is about to start encouraging more immigration, which is not generally a Japan thing. Do you know about that at all in global terms?

Mark Mather: Japan is the oldest country in the world and they've been managing pretty well for a few decades now. They've got policies in place to encourage people to continue to work well into old age. They've got a pretty government-run healthcare system for older adults that meets most of their needs but I think they're now at the point where they see that immigration is the only solution to some of their challenges with the age distribution. We're going to get there as well at some point. I think it's better to start planning for that now rather than waiting until really we start to feel the consequences of population aging.

Brian Lehrer: Mark Mather, Associate Vice President for U.S. Programs at the Population Reference Bureau, thank you for doing two segments in a week with us on the birth rates and now the causes of death and life expectancy. We really appreciate all your knowledge and you sharing so much time.

Mark Mather: Thanks for having me.

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