It doesn’t come as shock that, compared to peer countries, the United States is a less healthy, more dangerous place to live. But it’s still sobering to see the cold, hard numbers that prove it.

Earlier this week, the National Center for Health Statistics revealed in a study that the average life expectancy in the United States suffered a noticeable decline in 2021, from 77 to 76.1 years. It marks the second year in a row US life expectancy has fallen, according to the New York Times: in 2020, the average lifespan dipped from 78.8 to 77.

In other words, Americans have experienced a drop in life expectancy of almost three years since 2019 — a “historic” falloff, one of the study’s coauthors told the Times. The last time the United States saw such a sharp decline was about a hundred years ago, in 1923.

The current nosedive also makes the US an outlier among rich nations. While most other similar countries also registered lower life expectancies in 2021 because of the COVID-19 pandemic, they suffered smaller drops in 2020 and enjoyed slight increases in life expectancy in 2021, on average. According to the report — authored by Steven Woolf, Ryan K. Masters, and Laudan Y. Aron — this divergence meant that people in the already lagging United States now have a life expectancy five years lower than those in comparably wealthy countries.

What makes the United States so, um, special?

A big part of the story is the precipitous fall in life expectancy among Native Americans and Alaskan Natives: from 71.8 in 2019 to 65.2 in 2021, a staggering seven-year drop. Former federal Indian Health Service official and Minnesota Chippewa Tribe member Dr Ann Bullock told the Times that “longstanding health problems — rooted in poverty, discrimination and poor access to health care — left Native Americans and Alaska Natives particularly vulnerable” to COVID.

Those problems are in large part the result of the United States’ brutal (and unrepaired) legacy of dispossessing indigenous people. But they’re exacerbated by issues that afflict the broader US population, which has also been hit with significant (though smaller) drops in life expectancy.

Times reporter Roni Caryn Rabin writes:

Although the U.S. health care system is among the best in the world, Americans suffer from what experts have called “the U.S. health disadvantage,” an amalgam of influences that erode well-being, Dr. Woolf said.

These include a fragmented, profit-driven health care system; poor diet and a lack of physical activity; and pervasive risk factors such as smoking, widespread access to guns, poverty and pollution. The problems are compounded for marginalized groups by racism and segregation, he added.

The claim that US health care is “among the best in the world” is certainly open to dispute. According to a 2021 Commonwealth Fund report, the United States does worse on most health care performance measures than eleven other high-income countries, largely due to failures to “provide for universal coverage and remove cost barriers” and “invest in social services.” Other sources have come to similar conclusions.

Yet even the Gray Lady has to acknowledge that the United States’ “fragmented, profit-driven health care system” holds some of the blame for our poor health outcomes. In fact, a study earlier this year found that a Medicare for All system would have saved hundreds of thousands of lives during the pandemic.

In other words, the United States’ extremely meager welfare state — in particular, its lack of universal health care — is responsible for people dying younger, especially (and predictably) amid a pandemic.

Poverty in the US, mentioned by Woolf as another contributor to poor health outcomes, is also uniquely bad compared to other developed countries. By contrast, countries with strong social democratic traditions and generous welfare states, like the Scandinavian countries, have among the lowest levels of poverty.

Not all the United States’ “health disadvantage” can be directly chalked up to its hyper-neoliberalism. Widespread pollution and easy availability of guns are not functions of the United States’ underwhelming social provisions. But they are arguably symptoms of another morbid strain of American exceptionalism: our remarkably antidemocratic Constitution, which systematically prevents popular majorities from enacting progressive reforms.

Thanks to institutions like the Senate, the Electoral College, and the Supreme Court, the Right is able to advance its goals despite failing to win popular majorities. Right now, that looks like a Supreme Court with a supermajority of conservative judges, appointed by two Republican presidents who lost the popular vote, blocking states from enacting gun control and tying the hands of the federal government on pollution regulation. Increasingly plutocratic concentrations of wealth, coupled with anything-goes campaign finance rules, allow corporations and the very rich to wield these antidemocratic structures for their reactionary, anti-worker ends.

It doesn’t have to be this way. We can remake our political institutions, and we can build a freer, more democratic society where everyone has the basic means to flourish.

But even if you don’t believe that, you should at least accept that we can prevent countless lives from being cut needlessly short in one of the richest countries on earth.