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.