Middle Age Can Be Hazardous to Your Health

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Despite the many flaws in our healthcare system, we could always point to data showing that over the last few decades we were living longer and healthier lives—even if not quite as long and healthy as our contemporaries in many European and some Asian countries.

It now appears that’s no longer true for one segment of the U.S. population.

I’m talking, of course, about the surprising findings released last week that the death rate among non-Hispanic white men and women ages 45 to 54 increased from 1999 to 2013 after decreasing steadily for 20 years, as it did for other age cohorts and ethnic groups.

The rise was small in absolute terms—half a percent a year—but it was a relatively sharpreversal in direction from the average 2% a year decline in death rate from 1978 to 1998.  Moreover, this population experienced an increase in non-fatal diseases and conditions, too (called morbidity).

For both death rates and morbidity, the reversal occurred in all income and education brackets in the 45-54 age cohort, but it was most pronounced among those with lower incomes and less than a college education.

The researchers found that no other developed country experienced a similar reversal.  And blacks, Hispanics, and those aged 65 and above in the U.S continued to see death rates fall in the period examined.

The bottom line in terms of overall impact: If the death rate for white 45−54 year olds had continued to decline at its previous (2%) rate, half a million deaths (and these are premature deaths) would have been avoided from 1999 to 2013. That’s comparable to lives lost so far to AIDS, the author’s say. It’s also on a par with the increased death rates and lower life expectancy in Russia in the 1980s and 90s.

What’s going on?! The researchers didn’t mince words in their published article or in media comments: this unwelcome turn of events is attributable almost entirely to “deaths from distress and despair…both economic and psychological,” as co-author Ann Case of Princeton University put it in an NPR radio interview.

Namely, the rise in death rate, they found, was triggered by drug and alcohol poisonings, suicide, chronic liver diseases and cirrhosis of the liver. Likewise, the increase in morbidity reflected a rise in alcohol and illicit drug use; abuse and misuse of prescription drugs; psychological distress; physical problems and pain (neck, facial, joint and back, and sciatica), and difficulties with the activities of daily living.

I’m sure the sophisticated THCB readership can pretty much deduce the confluence of factors that precipitated this reversal, though few of us might have predicted it would be so intense or so specific to the white middle-aged:

  • The erosion of the manufacturing base and loss of blue-collar jobs (down from 28% of jobs in 1970 to 17% in 2010, and still declining), and the loss of rural jobs
  • Wage and income stagnation in the low- and middle-income groups
  • Income inequality and economic insecurity
  • The great recession
  • The decline of the stable 2-parent family (the percent of single white mothers rose from 18% in 1980 to 30% in 2010 for those with no college degree)
  • People giving up on being in the work force
  • Shifts in social trends leading to more isolation andloss of community
  • The ready availability, overuse and abuse of both prescription and illegal drugs, especially narcotic painkillers and heroin (opioids)
  • Poor diet, physical activity and health and lifestyle habits (despite years of public health messaging)
  • Asuboptimal and dysfunctional mental health system and poor access to mental health care and substance abuse programs
  • Rising out-of-pocket healthcare costs for people with inadequate or no health insurance, leading them to postpone or forgo treatment

This new-found trend represents a public health failure and a failure of our healthcare safety net.  In particular, it’s yet another marker of dismal mental healthcare access and inadequate community-based substance abuse programs.  If not addressed, the trend bodes ill on many fronts.   For one, this cohort will age into Medicare in worse health than the current elderly.  That will cost money.  The reversal is already eroding productivity, the authors suggest.

They don’t pull punches in other conclusions: “Addictions are hard to treat….so those currently in midlife may be a ‘lost generation’ whose future is less bright than those who preceded them.”

That less prosperous future is, of course, also forecast for today’s urban black youth, new retirees, and even segments of the millennial generation—due to some of the same cultural, social and economic forces.  Healthcare professionals, administrators and policy wonks can’t solve all the above-mentioned underlying problems but it seems to me that they (we) have a responsibility to advocateharder for solutions.

Steven Findlay is an independent journalist and editor who covers medicine and healthcare policy and technology.

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18 replies »

  1. This is the largest demographic of the former backbone of American economic might. Not only is there less opportunity for them now,, but the very values that they hold dear have been rendered obsolete, rendering their lives as unfulfilling and without meaning for them.

    It is not a failure of the mental health system.

  2. You are confusing ‘facts’ with ‘motivations’.

    Peter, you seem to be getting positively tumescent with reactionary rage now, and I am in no mood to spoil your fun. Whatever helps you sleep better at night, old chum.

    Just remember: I said it is ‘a’ factor, not ‘the’ factor.

    and you are saying: It is not even ‘a’ factor.

    A little bit of epistemic humility will go a long way. Although I’m well aware of your difficulty in holding down two (seemingly) contradictory thoughts at once.

  3. I’m not making “assumptions”, I’m stating fact. No, religion is not the single cause, but it is the binder of multiple causes which people use to subjugate populations and cloud the real issues which are too painful to admit, especially by leaders.

    In the Middle East, poverty, unemployment, lack of opportunity, government oppression, supression of free thought, are a few of the causes, but religion enables the oppressors and distracts the populace.

    Saying the decline of religion is one of the causes of white middle age male health isn’t even close and is a tactic used by those who don’t want their money used to address these issues. It’s as shallow as Nancy Reagan’s, “Just say no” solution.

  4. You’re making two errors in your assumptions.

    a) A single factor leads to all good or all bad (linear thinking).

    b) A single factor solves anything (reductionist thinking).

    For solvers, these are common fallacies.

  5. “Religion is a remarkable institute for social cohesion…”

    I guess if everyone believes in the same one, but that’s never been the case as religion has been used to wage war and oppress people. How cohesive was the 600 year Catholic inquisition. Even in the Middle East where Islam is the dominate religion it’s factions wage social and real war on each other. In India Hindus and Muslims riot against each other. Here in the U.S. how many “cohesive” Christians visit each other’s churches, especially the black and white ones, or band together to affirm the protection of Muslims to build their mosques under the protection of the Constitution.

    “That aside, there is the Protestant work ethic in which work itself is glory.”

    Would that include the “glory” of the unsafe, polluting factories of the industrial revolution and the children used to keep them running?

    I’ve never seen religion solve a social problem, at least on the massive scale as is necessary to answer the needs of those described above, or anyone else.

    Slavery was not solved by religion nor segregation nor the Great Depression or even the need for access to health care, these were solved by secular government.

  6. I think it has actually. And Charles Murray chronicles it pretty well. I recommend reading his book.


    Religion is a remarkable institute for social cohesion (that was its purpose), although clearly not the only one institute that promotes cohesion. That aside, there is the Protestant work ethic in which work itself is glory.

    Many with the Pavlovian antipathy to religion (and I am one who hates organized religion viscerally) seem unable to process the cohesive nature of religion.

    The other thing which confounds people, including many social engineers who visit this forum, is that a variable (such as religion) which is neither necessary nor sufficient to explain a finding can still be an important variable.

    In complex social phenomena there are many variables, which explain the process but neither explain the process fully nor explain it all the time.

    No doubt some clever soul will tell me that the deep south is very religious yet suffers from the malaise of unemployment and alcohol addiction. That inequality is a factor, as are banker’s bonuses. That praying to god doesn’t get jobs.

    These are no doubt very clever points but miss the complex nature of social phenomena.

  7. I agree. The religion point is a sub plot. The key drivers here are likely to be economic and lifestyle. The long term impact of the wars in Iraq and Afghanistan is also a really big deal …

  8. Hmmm. I’m not sure there’s been any substantial decline in religious/faith activity or church affiliation among white middle-aged, lower income Americans. I’d guess that’s still quite strong, especially in rural areas and small towns. But I don’t know the data. I agree that involvement in church-based community activities is meaningful to millions of people and any erosion of that is likely to enhance social isolation and undermine mental health.

  9. I agree John, the social contact of being in an organization is important to mental well being. But it’s the socialization with others, not the religion that is important. Any social organization will do the job, even meeting with friends for coffee is a help.

    But sharing despair with others in the same circumstances will not “fix” those things listed above.

  10. That’s my point. Community support is one of many social determinants of health. Like it or not, Religious organizations are part of that – both for good and bad.

  11. Could it be there are other factors (economic, social, cultural ) involved as well?

  12. We are just diaphenous containers of watery saline and protein–like the jelly fish in the Monterray aquarium–and, if we could measure death rates on a micro-scale, probably any insult to our cells causing apoptosis, necrosis, or senescence (no cell division after certain age) would slightly increase mortality. Bad thoughts, improper food, trauma from xs and deficiency of thousands of components of life could do this.

  13. Sorry Peter, I forgot for a moment – complex social phenomena are down to a single cause. Thanks for reminding me.

    It must be inequality then.

  14. “this unwelcome turn of events is attributable almost entirely to “deaths from distress and despair…both economic and psychological,””

    “I’d add death of religion to the list.”

    You’re kidding – right?

    How come the south, which is more religious than the north, suffers as much or more in this study?

    Praying won’t provide jobs or economic justice, it does provide an opiate in the form of false hope – devoid of the truth.

    “The country’s most religious state is Mississippi, with 61% fitting the “very religious” description.”

    Yea, Mississippi, the poorest, dumbest, fattest state.

  15. Yes. Good list. I’d add death of religion to the list. Charles Murray described this phenomenon in “Coming Apart.”