Life expectancy fell in 2015 for the first time in more than 20 years, by itself a shocking and sad statistic that separates the U.S. from all other high-income nations.

A closer look behind the numbers, however, suggests an even more grim situation. The lives of the people at the lower end of the economic spectrum are getting decidedly worse, at a time when the gap between the wealthiest and poorest Americans is growing at a historic pace.

In short, in far too many ways, America is becoming less of a place of shared prosperity and opportunity, and it is literally killing Americans.

The decrease in life expectancy, reported by the National Center for Health Statistics, was the first since 1993, when the AIDS epidemic, a high homicide rate and a particularly bad flu combined to make that year an outlier.

More work is needed to clarify the results from last year, but all indications are that this is not a statistical blip. It follows five years in which improvements in death rates were among the smallest in the last 40 years, and it shines more light on a report from last year that showed a jump in the mortality rate of white middle-aged Americans, one blamed on increases in drug overdoses, alcoholism and suicide, the so-called “diseases of despair.”

The latest report shows those increases also occurring across racial lines, and in heart disease, respiratory disease and strokes. In fact, rates rose for eight of the top 10 leading causes of death.

What’s more, in perhaps the most striking aspect of the report, life expectancy at age 65 did not change. Instead, middle-aged Americans are getting diseases that used to be reserved for the elderly, then not getting any better.

It’s impossible to not see the connection between the increase in mortality among middle-aged Americans and the rise in inequality that has marked their generation.

In the last 40 years, the country’s economic pie has grown slowly, yet the piece going to the richest Americans continues to expand at a rate as fast as any in this country’s history.

As a result, the prospects for middle-aged Americans have shrunk. In 1970, 90 percent of 30-year-old Americans could expect to earn more than their parents; by 2014, only 50 percent could, the direct result of the ill distribution of the country’s economic gains.

Too many middle-aged Americans are working in jobs with low and stagnant incomes, with little chance of meaningful advancement and not enough in their savings to pay for retirement, or even an emergency. Increasingly, life in and around the middle class does not mean a solid job with predictable hours, workplace protections and a paycheck that leaves something left over after bills, but precarious employment with few benefits, and the chance that an illness, broken-down car, or a lost job will lead to bankruptcy, a lost home, or addiction and other chronic health struggles.

We’ve known for years now that the U.S. economy has been hijacked by inequality. However, it’s not enough to think of it as just a problem of economics — it’s a public health issue, too, and one that needs attention before it grabs the next generation.

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