Policy Implications from the Lancet’s “…Systematic Analysis of Life Expectancy Disparities in the USA

Why the “Ten Americas” Demand a Community-Governed Model Like Nepenthe

POLICY BRIEF

Title: Policy Implications from the Lancet’s “…Systematic Analysis of Life Expectancy Disparities in the USA: Why the “Ten Americas” Demand a Community-Governed Model Like Nepenthe

Date: June 2025

Prepared by:

Prof. Stephen B. Thomas, PhD, Co-Founder Nepenthe Health and Wealth Cooperative
Dr. Carol E. Ritter, MD, Co-Founder Nepenthe Health and Wealth Cooperative
Mr. Leon Rock, Co-Founder Nepenthe Health and Wealth Cooperative

🧠 Background

The Lancet’s 2024 “Ten Americas” study exposes a deep and widening crisis: life expectancy in the U.S. now varies by over 20 years depending on race, geography, income, and segregation. Rather than one health system, we are living in ten Americas, each shaped by structural inequality and racialized disinvestment.

The COVID-19 pandemic didn’t cause this fracture—it revealed and accelerated it.

This study is a clarion call for structural transformation—not just in health care delivery, but in how research, policy, and infrastructure engage with the people and places most affected by disparity.

🔍 KEY FINDINGS FROM “TEN AMERICAS”

1. Life expectancy gaps increased from 12.6 years in 2000 to 20.4 years by 2021.

2. Black, Latino, and AIAN communities bore the steepest declines during COVID (2020-2023).

3. Systemic racism, residential segregation, and regional disinvestment are leading drivers—not just income or education.

4. Trust, culture, and place are critical to health—but often ignored in traditional clinical research and public health frameworks.

✂️ THE CASE FOR NEPENTHE

Nepenthe Health and Wealth Cooperative offers a direct, community-rooted response to the inequities described in the Ten Americas report. It is a democratically governed Clinical Research Organization (CRO)—not managed by institutions but by the communities most often studied and least often served.

Nepenthe Core Innovations:

1. Barbershops and Salons as Health Hubs in historically excluded neighborhoods

2. Workforce training for barbers and stylists as health educators and clinical trial liaisons

3. Retooling the existing biomedical workforce preparing them to rebuild the trust needed to create a new infrastructure that places “Value In Prevention”

4. Shared governance and cooperative economics for sustainable community benefit

5. The African American Diabetes Association Benevolent Fund to directly support frontline cultural health workers

Why Nepenthe Aligns with the “Ten Americas”:

1. Moves from extractive to reciprocal research

2. Brings research infrastructure into high-disparity geographies

3. Centers trust, culture, and lived experience

4. Reinvests in communities that data shows are systematically shortchanged

⚖️ ETHICAL IMPERATIVE: OPERATIONALIZING JUSTICE

The Ten Americas study provides data. Nepenthe provides the ethical response.

"Those who bear the burden of research must also share in its benefits." – Belmont Report

Nepenthe is a living expression of that mandate. It brings the Belmont Principle of Justice into community-owned infrastructure—rooted in care, backed by data, and built to last.

🏛️ POLICY RECOMMENDATIONS

To respond meaningfully to the “Ten Americas”:

1. Fund Cooperative Clinical Research Models
   Direct federal and philanthropic funding toward models like Nepenthe that address the health equity gap by centering governance in high-disparity communities.

2. Prioritize Ethical Infrastructure
   Make health equity a deliverable, not a slogan. Require CROs and academic medical centers to demonstrate community investment, benefit-sharing, and workforce impact.

3. Support Reparative Public Health
   Expand funding for programs like the AADA Benevolent Fund and Shots@Shop that treat barbers and stylists as essential public health workers.

📩 CONTACT

Dr. Stephen B. Thomas
Professor, University of Maryland
Nepenthe Co-Founder and Health Equity Leadership Program (HELP) Director
📧 sbt@umd.edu | 📞 (412) 996-6555

Carol E. Ritter, MD
MD-VIP Affiliate
Nepenthe Co-Founder and Clinical Site Director
📧 carol.ritter@carolrittergyn.com

Leon Nathaniel Rock
Founder, African American Diabetes Association
Nepenthe Co-Founder and Citizen Science Director
📧 info@AfricanAmericanDiabetes.org | 📞 (240) 564-9040