And yet it's so much more

Demographers and health researchers are noticing a dramatic drop in women's life expectancy is some areas of the United States:

The downward trend is evident in places in the Deep South, Appalachia, the lower Midwest and in one county in Maine. It is not limited to one race or ethnicity but it is more common in rural and low-income areas. The most dramatic change occurred in two areas in southwestern Virginia (Radford City and Pulaski County), where women's life expectancy has decreased by more than five years since 1983.

The trend appears to be driven by increases in death from diabetes, lung cancer, emphysema and kidney failure. It reflects the long-term consequences of smoking, a habit that women took up in large numbers decades after men did, and the slowing of the historic decline in heart disease deaths.

It may also represent the leading edge of the obesity epidemic. If so, women's life expectancy could decline broadly across the United States in coming years, ending a nearly unbroken rise that dates to the mid-1800s.

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"This is a story about smoking, blood pressure and obesity," said Majid Ezzati, of the Harvard Initiative for Global Health, a co-author of the paper.

The drop in life expectancy is about those things, but it's about a helluva lot more too.

It's the story of a nation that has a dangerously broken for-profit insurance to provide health coverage for most of its citizens, while leaving some 47 million uninsured. The coverage that people do have isn't necessarily even adequate to actually obtain decent health care.

It's the story of a nation that doesn't have - has never had - any sort of cohesive public health policies.

It's a story about cheap, processed foods of marginal nutritional value and mass advertising.

It's a story about poverty, and the conditions which cause poverty.

Limiting the story to just smoking, blood pressure, and obesity limits the solutions to the problems which vex us when it comes to public health in this country. By focusing on these three items, the solutions come in the form of individual interventions, in a manner of speaking. Educate people to make good choices, the logic goes. It, of course, elides over the much more complicated, and in the long-run, more damaging, structural problems that underlie the proximate causes of the decline in life expectancy.

There needs to be a much more expansive conversation about public health in this country, and it's a conversation that should make some people feel very, very uncomfortable.