Life expectancy for Americans is dropping. Not since the Spanish flu epidemic 100 years ago have we seen such a decline in American health as in recent years, driving down life expectancy. Sandro Galea is with Boston University's School of Public Health. He spoke with WGBH All Things Considered anchor Barbara Howard about that drop in life expectancy. This transcript has been edited for clarity.

Barbara Howard: So let's put this in historical perspective. Talk about the 1918 pandemic, the Spanish flu.

Sandro Galea: Well, it was one disease, and it killed millions of people worldwide. And it resulted in an extraordinary dip in life expectancy in the country, and a dip that we have not seen anything like it until recently.

Howard: Yeah, it was enough to contribute to a decline in life expectancy in the U.S. And for about a century, it marked the worst decline in American health until recent years. When did that start?

Galea: In 2015, we had a downturn in life expectancy, and then it continued in 2016 and 2017. So this three year dip has been the first time we've had a three year dip since 1918.

Howard: The year 2014, just before we saw that dip, had the highest life expectancy. What changed?

Galea: Well what would change is a number of things. The biggest reason really is the increase in overdoses and suicides. There are other things that are going on, including the gains that we were making in cardiac disease deaths have slowed down. We're still gaining, but those gains have slowed down. So it's really a combination of factors.

Howard: So drug overdoses and suicides, those are mostly younger Americans. So what, that's driving down the overall life expectancy numbers?

Galea: It is. And we're losing about one tenth of a year every year. So we're talking life expectancy at roughly 78 - 78 with some decimals. Now that might not sound like very much, but what really matters is the trend. What's really alarming here is the fact that we have been losing now consistently for the past three years, and obviously the worry is what happens if this continues.

Howard: What group of Americans is seeing the sharpest decline in life expectancy?

Galea: It's mostly men more than women, largely because younger men are dying from overdoses. But we're also seeing a steeper increase. for example, in suicides among middle aged women.

Howard: Why is that?

Galea: Well, it’s unclear. Suicides are twice as common in rural areas than they are in urban areas. Two-thirds of suicides are due to guns. Guns are much more available in rural areas. So it's probably a combination of factors.

Howard: How does the U.S. stack up against other countries now, compared to how we stacked up in years past?

Galea: The story of how the U.S. does compare to other countries is really fascinating, because we had a better life expectancy than most high-income countries until the late 80s, early 90s. Since then, our life expectancy, while it has still been going up, our slope of it going up has been decreasing. So we have lost almost five years compared to other high-income countries. You know, I said that our life expectancy is around 78. The countries with the highest life expectancy, they’re in the low 80s, so four to five years ahead of us. And we have lost that ground in the past 30 years, more or less. So we have been slowly falling behind, and now with this dip, we're falling further behind.

Howard: And you attribute that to what?

Galea: There are many reasons that contribute to that, but broadly, the single biggest reason probably is that we have not been keeping up with creating a healthy world around us. The reason we have gained so much in life expectancy in the past hundred years is not so much because of medicines. Medicines matter, but what matters much more is that we’ve been building healthy neighborhoods, healthy environments, better education, better incomes, better socioeconomic conditions. That's what's really driven it. And that's what we're losing ground on.

Howard: Which countries have the greatest life expectancy rates?

Galea: Typically Japan and South Korea, in the past couple of decades. Those two countries have been going back and forth.

Howard: What are they doing that we're not doing?

Galea: I think they're building healthier environments. I think they're making sure that older citizens have access to food. They have neighborhoods which are safe to exercise and play in, and they have education systems that creates a generation of citizens that knows what healthy behaviors are, and how to access healthy living.

Howard: Can you project out and say where the U.S. will be in the next 10 years, say by 2030?

Galea: Well this is the alarming part. Health in the U.S. has been surpassed by many countries, countries like Costa Rica. If we keep going along this path, our life expectancy will be surpassed by places like Mexico in the next 10 years.

Howard: Well thank you for coming in.

Galea: Thank you for having me.

Howard: That's Dr. Sandro Galea of Boston University's School of Public Health with that sobering update on how after a century of enjoying an increase in life expectancy, the U.S. is now seeing a drop in the average lifespan of Americans. Dr. Galea has written a book called, “Well: What We Need to Talk About When We Talk About Health.”