生病的美国无法与中国竞争
2023-03-02 08:20阅读：
如果像谚语所说的那样，健康意味着财富，那么美国的经济前景看起来很严峻。传统上，美国享有健康溢价。殖民时代，美国男子平均比欧洲人高两到三英寸。这一事实令历史人口学家着迷，因为身高与寿命、认知发展和工作能力相关。而今天，优势正变成劣势。美国男人平均比北欧男人矮，且差距越来越大。3/5的美国人至少患有一种慢性病，2/5患有两种。无怪乎，《华尔街日报》文章说：“可以说，美国是一个生病的社会。”
美国的健康赤字是个日益严重的经济问题。劳动参与率只有可怜的62.4%，空缺职位多达1100万个，而找工作的人只有570万。雇主们抱怨缺勤和工作流动，以及岗位无法填补。医疗保健成本不断上升。在与俄罗斯以及中国的关系日益紧张的当前，健康赤字也是个国家安全问题。五角大楼2020年调查发现，超过3/4美国年轻人因健康问题不适合服兵役，其中以肥胖症最为突出。
健康危机最明显迹象是平均预期寿命的下降。2021年，美国人的预期寿命下降到76.1岁——1996年以来的最低数字。美国还是发达国家里肥胖率最高的国家之一，比例从1980年的15%上升到2020年的41.9%。这是日本肥胖率的10倍，也大大高于中国。药物泛滥加剧美国的毒品和酒精滥用问题。美国的新冠死亡率仍远高于大多数发达国家。这场大流行病导致美国（本来就低）的劳动参与率急剧下降，至今尚未完全恢复。布鲁金斯学会认为，约300万人的平民劳动力可能因“长新冠”失去工作，相当于1680亿美元的年收入损失。
山姆大叔的心理健康问题似乎和身体健康问题一样紧迫。美国疾控中心的报告显示，2021年，近1/3美国高中女生认真考虑过自杀。辍学率上升，大学入学率下降。这些都不是好兆头。
如果这一切对美国工作场所产生不利影响，工作场所也会对劳动力的健康产生不利影响，对蓝
领工人来说尤其如此。美国人需拿出反烟草斗争的决心来反对垃圾食品。他们还需要开始考虑人口状况，将其作为国家效率问题。良好的健康不仅是值得拥有的东西，也是国家竞争力的重要组成部分。健康状况不佳不仅是受到影响的个人的悲剧，它还制约了国家的生产力和自卫能力。
A Sick America Can't Compete With China
ADRIAN WOOLDRIDGE
If health means wealth, as the adage has it, then America’s
economic future looks grim. Traditionally, the U.S. has enjoyed a
health premium. In the Colonial era, American men were on average
two to three inches taller than Europeans, according to military
records, a fact that fascinates historical demographers because
height is correlated with longevity, cognitive development and work
capacity. Today, a premium is turning into a deficit. American men
are shorter on average than Northern European men, and the gap is
getting bigger. Six in ten Americans suffer from at least one
chronic condition and four in ten suffer from two. “America is a
sick society,” says William Galston in the Wall Street Journal.
“Literally.”
America’s health deficit is a growing economic problem. The labor
force participation rate is a dismal 62.4%: 11 million jobs are
vacant, compared with just 5.7 million people who are looking for
work, according to the U.S. Chamber of Commerce, and 2.8 million
people have disappeared from the workforce since February 2020.
Employers complain about absenteeism and job-churn as well as their
inability to fill jobs. Health-care costs head ever upward. At a
time of growing tensions with both Russia and China, the health
deficit is also a national security problem. A 2020 survey for the
Pentagon found that more than three-quarters of young Americans
(18-24) were unfit for military service due to health problems,
with obesity the most prominent among them.
The most vivid sign of the health crisis is falling life
expectancy. We have long assumed that modernity brings longer
life—indeed, that longer life is proof that all that creative
destruction is worth it after all. That has not been the case in
the U.S. since 2014. In 2021, life expectancy fell to 76.1
years—the lowest figure since 1996, erasing a quarter century of
progress. Other advanced countries are pulling further
ahead—Germans could expect to live 4.3 years longer than Americans
in 2021 compared with 2.5 years in 2018 and the French six more
years compared with four years in 2018. West Virginia’s life
expectancy is lower than Mexico’s.
The U.S. has one of the highest rates of obesity in the advanced
world, a rate that has increased from 15% in 1980 to 30.5% in 2000
to 41.9% in 2020. This is ten times the rate in Japan and
significantly higher than China. Obesity is linked to multiple
health problems, including heart disease, depression, hypertension,
lifestyle related cancer and diabetes, which afflicts 13% of the
population and costs U.S. employers an estimated $90 billion a
year.
The obesity problem is significantly worse in a cluster of southern
and southeastern states (Alabama, Arkansas, Florida, Georgia,
Louisiana, Mississippi, North Carolina, South Carolina, Tennessee
and Texas) that have strong military traditions. It is also worse
in the working class and in Black and Hispanic populations (the
figures for Asians are more complicated because there is such a
difference between Southeast Asia and the Indian subcontinent). A
2020 study put the economic cost of obesity at almost $1.4 trillion
for 2018—almost 7% of the gross domestic product.
The opioid epidemic turbocharged America’s problems with drug- and
alcohol-abuse. Deaths from drug overdoses rose from 17,000 (62 per
million) in 2000 to 92,000 (277 per million) in 2020, largely
driven by the mass production and distribution of opioids by big
pharmaceutical companies. Unsurprisingly, opioid abusers are more
likely to take unscheduled leaves or drop out of the workforce
entirely as well as to die prematurely.
The opioid epidemic may have taken root in populations that already
had health problems: The vast majority of opioids were originally
prescribed to people who want relief from pain caused by either
disability or illness. The epidemic is certainly more concentrated
in certain classes and areas where repetitive physical work is a
way of life: Death rates from overdoses are five to seven times
higher for those without a college degree than for those with one
and much higher in ex-coal mining communities, particularly in
Appalachia, than elsewhere.
The Covid-19 pandemic acted as the third horseman of the health
apocalypse. America’s Covid death rate is still much higher than in
most other advanced countries, with 339 deaths per 100,000
population compared with 254 in France, 201 in Germany and 134 in
Canada, thanks to the country’s poor primary healthcare
system.
The pandemic led to a sharp decline in America’s (already low)
labor force participation rate, a decline from which the country
has still not recovered. It also seems to have left a longer-term
legacy in terms of “long Covid,” a problem that doctors are still
trying to understand but which leaves people with problems such as
fatigue, shortness of breath, and brain fog. The Brookings
Institution suggests that some three million people—or 1.8% of the
civilian labor force—may be out of work due to long Covid,
representing $168 billion in lost annual earnings.
Covid has also exacerbated obesity and addiction-related problems.
Overweight people are more likely to die from Covid or suffer
enduring consequences than thin ones. The Covid epidemic acted as a
national pusher for addictive substances, with the number of
overdose deaths for opioids, methamphetamine and even alcohol
surging during the pandemic. One 2022 study suggests that increased
substance abuse during the pandemic accounts for between 9% and 26%
of the decline in prime-age labor force participation between
February 2020 and June 2021.
Uncle Sam’s mental health problems seem to be as pressing as his
physical health problems, though they are clearly harder to measure
and diagnose. A Centers for Disease Control and Prevention report
shows that in 2021 nearly a third of high school girls seriously
considered taking their own lives. Young men suffer from an
epidemic of alienation with increased dropout rates from school and
falling rates of attendance for university. None of this bodes well
for the future.
If all this is having an adverse effect on the U.S. workplace, the
U.S. workplace may also be having an adverse effect on the health
of the workforce. This is particularly true of blue-collar and
frontline workers—that is, the people who operate in the physical
world rather than the virtual one, making things or delivering
packages. At best, American managers are guilty of ignoring the
needs of frontline workers while living in a bubble of fellow
managers. At worst, they have been squeezing them to work ever
harder in what are already monotonous jobs. The epidemic of
quitting such jobs is partly because people find them so
unforgiving but partly because they suffer from health problems
themselves, or else must look after family members who suffer from
health problems.
What can be done about all this? Addressing America’s health-care
crisis is even more difficult than addressing declining educational
standards. The fast-food industry is a powerful lobby determined to
stuff the population (particularly the poor) with saturated fat and
salt while whispering sweet nothings about ESG. The health-care
industry is a mass of malign vested interests and skewed
incentives. The left’s reluctance to blame the victim has left
people (including doctors) unwilling to say the obvious—that
obesity is generally caused by eating too much and moving too
little. The right’s instinctive loathing of government busy-bodying
makes it difficult to deliver even the most basic advice on the
foolishness of drinking a gallon of sugar-laden soda.
Still, hard does not mean impossible. America took on the once
mighty tobacco industry and won: The U.S. has lower rates of
cigarette smoking than other advanced countries, particularly in
southern Europe, where people still puff away over their meals. In
the early 20th century, the British realized that they could not
preserve their position as Europe’s leading economic and military
power against a rising Germany unless they did something about the
poor health of the population—as Lloyd George put it, “you cannot
conduct an A1 Empire with a C3 population.” A reforming Liberal
government waged war against adulterated food, established a school
health service and splashed out on free school milk (“there is no
finer community than putting milk into babies,” said Winston
Churchill, who was then a Liberal).
Americans need to apply the same determination to the fight against
junk food that they brought to the fight against tobacco. They also
need to start thinking about the condition of the population in the
same hard-headed way that Britain’s early 20th-century liberals
did, as a matter of national efficiency as well as national
compassion. Good health is not just something that is nice to have.
It is a vital component of national competitiveness. And poor
health is not just a tragedy for the individual who suffers from
it. It is, in aggregate, a constraint on the country’s productivity
and ability to defend itself.
