20 Nov 500,000 Preventable Deaths
Written by: Bart Magee, Ph.D.
The recent publication of a shocking study by Anne Case and Angus Deaton on the rising mortality among white, middle-aged, working-class Americans has social scientists and policy makers alarmed, and rightfully so. The rise in death rates means that in the span of a little more than a decade about a half million American lives have been tragically lost. In itself a terrible discovery, but a key part of the story really got my attention: most of the increased deaths were due to suicide, deaths from drug overdose and complications from alcohol abuse. Among other difficulties, the individuals affected are reporting more problems with chronic pain leading to greater use of opioids leaving them vulnerable to addiction and overdose. Clearly, a massive mental health crisis among a large cohort of Americans. What’s going on here? Why are these people suffering so badly and how can we ensure they get the help they need?
Digging deeper into the findings the picture does get more complicated and nuanced. There may be cohort effects due to the baby boom group’s larger size and when the group data was segmented the rise in death rates appeared to flatten out. But after all the post-analysis, the main point remains unchanged: When compared to similar groups in other countries and as compared to other racial groups here at home, white Americans in this age group who have a high-school education or less are dying at a much higher rate than they should be and for reasons that can be prevented.
Much of the thinking about causes has focused on the social and economic changes that have hit this group hard. Deindustrialization has affected people with the least education most traumatically. However, blacks and Hispanics have endured greater hardships with higher unemployment rates and lower incomes than whites, and the working classes in other countries have suffered the same or worse without becoming more self-destructive. What may set this group apart is an increase in social dislocation and disarray. Studies have documented a decrease in connection to religious communities among working class whites compared to others. Others have looked at the experience of dashed hopes of the (white) baby boom generation, the one raised on the imagination of ever-expanding possibilities. This was the generation that participated in enormous cultural change and put a man on the moon. Not surprisingly, this youth-oriented cohort has had well-documented problems in aging showing higher rates of obesity, diabetes, and disability than the previous generation in spite of the vastly improved medical treatments available to them.
What emerges begins to look like a collective psychological problem: a losing battle to cope with disappointment and loss now exacerbated by the aging process. The expectation that the future was supposed to be bright with rising incomes, secure jobs, and expanding opportunity collided with the stark, turn-of-the-millennium reality of stagnant wages, economic disruption, and loss of social status in America’s new diverse demographic landscape. When you add profound disappointment to disconnection from social and religious institutions you have a recipe for serious depression. We know that untreated depression leads to all the major problems cited in the study- chronic pain, substance abuse and suicide.
Given the severity of this crisis, can we continue to stand for the astounding deficit in available options for treatment? A report earlier this year found that 55% of the nation’s 3,100 counties have no practicing psychiatrists, psychologists or social workers- none, zero. Most are poorer rural counties, but we know that even in places like San Francisco where the seems to be an abundance of providers, places like Access Institute that offer affordable care are still a rarity.
Changing this will require changing minds and hearts. Something to think about and discuss at the Thanksgiving table this week. How can we grow our collective ability to recognize and respond to the suffering of others, to bring them in from the cold and offer them a place at the table? I think the recent violent events in Paris only serve to highlight the need to reaffirm our commitment to our common human bonds, ones that are strengthened by both a recognition of our shared vulnerability and our capacity to provide healing.