Deaths of Despair in the Era of Donald Trump: the Opioid Epidemic Is Just Part of the Problem

Rising medical costs may be the biggest contributor to declines in life-expectancy that began as early as the 1980s

Opioid-related deaths contributed to more than 60 000 U.S. lives lost in 2016 but absolute declines in life expectancy relative to other countries and in various measures of psychosocial well-being have been observed starting as early as 1980. Increases in despair over time have had a broad effect among all groups and regions of the country in the United States, not just less-educated Whites, who have been identified as the primary victims. Researchers at Columbia University Mailman School of Public Health provide an overview of trends toward both increasing despair and declining health observed among many groups of people in the United States. The paper is published in the American Journal of Public Health.

“The opioid epidemic is sitting on top of a much longer, and more poorly understood, decline in the health and well-being in the United States,” said Peter Muennig, MD, professor of Health Policy and Management at Columbia School of Public Health. “Virtually any social trend that might correlate over time with changes in health curves is a candidate.”

There are several plausible contributors to the term coined as “true deaths of despair” — defined broadly as a decline in measures of psychosocial well-being over time. “If there is anything to which one can point that makes the U.S. an outlier in global rankings of health measures it is rising medical costs which may be compromising Americans ability to satisfy basic needs,” noted Muennig. “These costs are eating into middle-class American’s disposable income.”

Muennig and colleagues describe some of the other more popular and plausible explanations.

  • Failure of democratic institutions and regulations. The United States is falling behind other nations with respect to educational performance, income equality, environmental protection, transportation, waste management, the rule of law, and private gun ownership regulations.
  • Economic stagnation since the 1980s for moderate income households of all races and ethnicities.
  • A slowdown in immigration. Immigrants are much healthier than native born people on average.
  • Earlier smoking among White women could be producing lagged mortality effects that are surfacing in middle and older ages.

“The answer rests in a combination of factors,” noted Muennig. “But the attention that has been given to Whites as the primary victims of declining health is distracting researchers and policymakers from much more serious, longer-term structural problems that affect all Americans.”

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