Why life expectancy in America is down again

Why life expectancy in America is down again

OVERALL life expectancy in America fell fractionally in 2017, from 78.7 to 78.6 years, according to data published recently by the US Centres for Disease Control. Underlying the drop was a bad year for influenza and a slight increase in the toll of Alzheimer’s disease. But more significant was an increase in suicides and overdoses, which added 2.4 more deaths per 100,000 Americans. The data suggest a continued rise in what Anne Case and Angus Deaton, economists, have dubbed “deaths of despair”, which they link to the economic and social decline of America’s white working class.

But longer-term trends, evident in the data, suggest some reasons for hope. Suicide used to end nearly twice as many lives as drug overdoses; overdoses now end far more. That is a grim reminder of the terrible burden of America’s opioid epidemic. But it also suggests that reversing the direction of the mortality rate could be achieved without waiting for the lives of the unskilled to radically improve.

The figures make dramatic reading. In 1999, suicide took the lives of 10.5 Americans out of every 100,000. That increased to 14 in 2017. In the intervening years, death rates from drug overdoses surged from 6.1 to 21.7 per 100,000. Overdose deaths climbed 256% over that period (from 58% of the suicide rate to 150% of it).

Over the longer term, suicide rates are now at a historical high, but only a little higher than they were in 1950. Chronic liver disease and cirrhosis deaths remain considerably below their levels in the 1970s and 1980s. But drug-overdose rates, which were well below five per 100,000 people between 1950 and 1990, climbed above that rate by the turn of the century, and then spiked dramatically, reaching above 20 deaths per 100,000 in 2017. Since 2013 there has been an explosion in deaths from synthetic opioids like fentanyl. Death rates from these drugs climbed from one person per 100,000 in that year to nine times that in 2017.

These patterns suggest that while changing social and economic conditions may be one contributing factor in alcohol abuse, drug addiction and suicide, other factors are at work. 

Christopher Ruhm, an economist at the University of Virginia reckons that, over the long term, economic conditions alone explain less than 10% of the increase in drug-mortality rates. He points to the importance of public health efforts to control the opioid epidemic. The recent experience of Dayton, Ohio backs him up: over the past year, opioid deaths have more than halved. Public health experts attribute that to a combination of Medicaid expansion (which widened access to treatment); declining street availability of some of the most addictive opioids; the widespread availability of naloxone, which reverses opioid overdoses if rapidly administered; and post-treatment support for recovering addicts. 

Sadly, both Dayton’s policy response and its success in reversing the mortality rate remain the exception rather than the rule. The National Survey on Drug Use and Health suggests a small decline in the number of new users of heroin and pain relievers over the past year. But the number continued to rise among those over the age of 26. In October, new legislation made it through Congress and was signed by President Donald Trump. It should help increase access to addiction treatment, and help rein in the over-prescription of opioids. But funding under the bill is a small fraction of what is needed to support an addiction treatment infrastructure that could rapidly reverse this awful epidemic.

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