‘Deaths of despair’: grim decline in life expectancy
The cover of a recent issue of The Economist magazine highlighted a heartening story: “Staying alive: Why the global suicide rate is falling.” Inside, we learn, “Globally the rate has fallen by 38 percent from its peak in 1994. As a result, over 4 million lives have been saved.”
One country, however, is a stark exception to this welcome improvement: the United States. The federal Centers for Disease Control and Prevention reports that since 1999, the suicide rate has risen by 33 percent, and the trend has accelerated since 2006. Some 45,000 people kill themselves each year, more than the number who die in auto accidents.
That is not the only grim news. More than 70,000 Americans died of drug overdoses last year — which is an average of 191 per day. That was up from 63,632 the previous year.
These two developments have produced a three-year decline in Americans’ life expectancy, the longest such reduction since a century ago, when World War I and a devastating worldwide flu epidemic cut short a vast number of lives.
The big difference this time is that people are dying of self-inflicted causes, not huge global events far beyond individual control. They suggest that many people find some conditions of modern American life, even during a period of economic prosperity, too painful to bear. “We are losing too many Americans, too early and too often, to conditions that are preventable,” said CDC Director Robert Redfield.
Why this is happening is hard to decipher. The highest suicide rates are among men over the age of 45. The most rural areas have been particularly affected, with the age-adjusted rate jumping 53 percent since 1999 — compared with 16 percent in the most urban places.
Overdose deaths occur disproportionately in one part of the country, with the highest rates in West Virginia, Ohio, New Hampshire, Pennsylvania and Kentucky. Unlike suicides, they are roughly as likely to occur among city dwellers as their country cousins.
What can be done? Locating the sources of misery that drive people to such options is important. Prince- ton economist Anne Case says the increase of “deaths of despair” is “consistent with the labor market collapsing for people with less than a college degree.
In turn, those people are being less able to form stable marriages, and in turn that has effects on the kind of economic and social supports that people need in order to thrive.” Reversing those maladies won’t be easy or quick.
On the overdose side, steps have been taken that should help. A bill signed by President Donald Trump in October makes some useful changes to expand access to drug treatment and promote wider use of naloxone, which is used to reverse opioid overdoses, by first responders, and to discourage over-prescribing of opioid painkillers.
The biggest factor in the epidemic lately is fentanyl, a synthetic opioid that is far more powerful than heroin — and is often mixed with other, less potent opioids unbeknown to the user. Since 2013, the number of deaths involving fentanyl have skyrocketed from about 3,000 to more than 28,000.
One safeguard is making it easy for users to get test strips that show whether drugs include fentanyl. A small study in North Carolina found that drug users who got these test strips generally used them and took measures to reduce the danger when fentanyl was detected.
Expanding treatment for mental health problems and substance abuse would also help to save people from suicide and drug overdose.
The expansion of Medicaid in most states under the Affordable Care Act has made mental health treatment easier to obtain. The Trump administration has offered waivers to states that want to provide more inpatient care for both substance abuse and mental health.
For the modern United States to suffer a three-year decline in life expectancy is a tragedy and a signal for urgent action. Faced with an epidemic of deaths from despair, Americans need to join together in the task of restoring hope.