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The rising death toll stemming from the opioid crisis has claimed national headlines, but it’s only part of the story of misery that’s affecting the health of Americans.
Life-expectancy rates have dropped two years in a row in the United States, fueled by deaths from alcohol and drug abuse and suicides among middle-class whites, mostly in rural areas. in the 1980s, the United States began to lag behind other developed nations in life expectancy gains, even though Americans spend the most on health care. Now, America is the only wealthy nation in which life expectancy is in decline.
A National Research Council and Institute of Medicine joint panel in 2013 reported that overall health in America suffered across a range of concerns. Opioids accounted for more than 42,000 deaths in 2016, according to the Centers for Disease Control and Prevention, and there was a 137 percent spike in overall drug overdose deaths from 2000-14. Alcohol is a factor in the deaths of about 88,000 Americans each year, according to the National Institute on Alcohol Abuse and Alcoholism. There’s been a 24 percent surge in suicides in the nation from 1999-2014.
“It was already a pretty bleak picture,” says Steven Woolf, a physician and director of Virginia Commonwealth University’s Center on Society and Health.
Reasons behind the decline are complex and systemic. Woolf is part of a team that’s researching the extent of the problems and is seeking to raise awareness of the issues among the public and educate politicians, too. He co-authored an editorial, “Failing Health of the United States,” which was released on Wednesday in the British Medical Journal. The editorial’s co-author is Laudan Aron, a senior fellow with the Urban Institute in Washington, D.C., who also worked with Woolf in leading the 2013 National Research Council study.
The problem is prevalent in rural areas that have struggled for years and where the social fabric has frayed, according to Woolf. There is no one illness or cause of death that is fueling this surge. “It became clear to us that there is something systemic going on,” Woolf said Thursday.
Woolf and Aron note that it is likely some combination of factors that have led to the spike in deaths, factors such as economic insecurity, social isolation or the loss of a business that drove a local economy. They also note that the spike has not been seen in African-Americans, and speculate that that community shows more resilience after long years of dealing with discrimination and structural disadvantages.
Steven Woolf, director of VCU’s Center on Society and Health (Photo courtesy VCU)
The editorial says that there are limited resources available to stem the tide of misery; many lack universal access to health care and social services, and they feel they are facing a bleak future. “The 'American dream' is increasingly out of reach, as social mobility declines and fewer children face a better future than their parents,” they write.
They note that it will take money invested in support of families and communities to correct the situation, but that leaders have rarely found consensus for remedies. “The consequences of these choices are dire: not only more deaths and illness but also escalating healthcare costs, a sicker workforce, and a less competitive economy,” they write. “Future generations may pay the greatest price.”
Woolf and his team at VCU were commissioned to conduct studies in states including California, Missouri, Minnesota, Kansas and Virginia to look at what was driving the troubling statistics and where problems were occurring. They drilled down to the county level.
What they found was that the spikes in drug and alcohol deaths and suicides were not showing up in populations of whites living in metro areas, but were instead occurring in rural areas with long histories of economic distress, such as the boot heel and Ozarks in Missouri, and the northern forests and Central Valley in California, according to Woolf.
Reports are complete for California and Missouri. Their report on Virginia is set for release in March. Since they’re based in Virginia, the report on the commonwealth will be more detailed, looking at overall and regional trends. Woolf notes that while areas of Missouri and California were spared, all areas of Virginia have shown spikes in deaths from suicide, alcohol and drugs.
“The ultimate takeaway is we aren’t going to reverse this trend in death rates if we don’t help the families,” he says.
While many Americans are aware of the opioid epidemic, most believe that the nation has the world’s best heath care and that we are among the world’s healthiest people. The first step in addressing the problem is to communicate what’s actually going on and to raise awareness of the extent of the problems and the underlying causes beyond opioids.
“It’s just the tip of the iceberg,” says Woolf.
