Profound impact of smoking, alcohol and obesity on improvements in life expectancy

Fanny Janssen, Sergi Trias-Llimós and Anton Kunst

Smoking, alcohol misuse and behaviours that result in obesity (such as an unhealthy diet and insufficient physical activity) have strong negative effects on individual health. Because these health behaviours are very common among people in Europe, smoking, alcohol and obesity also largely influence mortality rates and life expectancy in Europe.

However, the impact of these three lifestyle factors on life expectancy is likely changing over time. Smoking, obesity and alcohol misuse, like true epidemics, tend to first become more common in a population, followed (eventually) by a decline in their prevalence and associated mortality.

This raises the question of how changes in smoking, obesity and alcohol use have influenced improvements in life expectancy over time. Answering this question is particularly relevant because of the recently observed stagnation in life expectancy improvements in some European countries.

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Punishing the poor, killing the poor: punitive political responses to economic decline deepen health inequalities in the United States

Elias Nosrati, Michael Ash, Michael Marmot, Martin McKee and Lawrence P King

Nosrati authors

Health inequalities are on the rise in the United States: the gap in life expectancy between those at the top and the bottom of the income spectrum has increased rapidly since the dawn of the century, to the point where the lives of the poor are cut short by up to a decade and a half compared with those of the wealthy. Moreover, while the rich tend to live longer everywhere, life expectancy among the poor varies significantly by geographical region.

In our article recently published in the IJE, we show that these patterns of health are the product of powerful political and economic forces. Over the past few decades, neoliberal politics, the decline of unions and economic globalisation have resulted in rapid industrial restructuring and economic dislocation in the US. Organised labour has been eroded in the industrial heartland, and manufacturing operations have been shifted to the non-unionised south and to foreign countries.

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Deaths of despair? Recent trends present a more complicated picture of mortality among White Americans

Daniel H Simon, Andrea M Tilstra and Ryan K Masters

Simon authors

Rising mortality among young and middle-aged White Americans has alarmed researchers, public health professionals and the broader public. These concerns were amplified by a 2015 study in which the authors attributed rising mortality rates among White Americans to increases in deaths from chronic liver disease, suicide and drug overdoses. The authors argued that increased mortality from these causes of death is likely a result of the “same underlying epidemic” that is affecting a “lost generation” of Americans. The underlying epidemic was said to be “deaths of despair”, originating from rising distress, economic insecurity and chronic pain.

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