Oct. 03 2018

Deaths of Despair: 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

Although recent declines in life expectancy among white Americans, coined “deaths of despair” grabbed headlines, scientists at Columbia University Mailman School of Public Health have assembled evidence that these declines are neither a recent problem nor confined to whites. As early as 1980, researchers began to observe declines in life expectancy relative to other countries and in various measures of psychosocial well-being. According to the new study, increases in despair over time, up to and including a recent spike in deaths related to opioid use, stem from structural problems, including the failure of democratic institutions and the rising costs of medical care. 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 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 contributing to 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.”
 
Co-authors include David Fink and Zafar Zafari, Columbia Mailman School; Megan Reynolds, University of Utah; and Arline Geronimus, University of Michigan.
 
The research was supported by the U.S. National Institute on Drug Abuse (DA031099).