GEven with the ongoing socio-economic impact of the Covid-19 pandemic, it is surprising that the Centers for Disease Control and Prevention recently reported more than 100,000 drug overdose deaths in the 12 months to April 2021. It wasn’t. Compared to the previous year. Most of these deaths were due to the use of synthetic opioids by middle-aged Caucasian men. The questions that are immediately asked are: What is the US Department of Health and Human Services (HHS) doing about these so-called deaths of despair?
The answer is calm.
The term death of despair comes from Princeton economists Anne Case and Angus Deaton. They sought to understand the cause of the decline in life expectancy in the United States. They learned that the fastest-increasing mortality rate among Americans was due to drug overdose, suicide, and alcoholic liver disease. Deaths from these causes have increased by 56% to 387%, depending on the age cohort, to an average of 70,000 per year over the last 20 years.
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Case and Deaton learned that these deaths occurred disproportionately in white men who did not have a college degree. In their 2020 book, Death of Despair and the Future of Capitalism, they argued that the main driving force for these deaths was economic misery.
This phenomenon was first investigated over a century ago. In 1897, French sociologist Emile Durkheim defined these deaths as “anomie suicides” (the meaning of anomies was alienated) in his book “Le Suicide”. He said that these deaths occur when social equilibrium or the collapse of social norms, or when individuals believe that there is a lack of community spirit, or when the government concludes that they are indifferent to their needs. Insisted.
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This psychological state is primarily the result of financial difficulties or loss of work or wages, and today approximately 66 million white workers, or people of working age, who do not have a college degree between the ages of 25 and 64. 38% experience disproportionately. .. As Case and Deaton showed, this population has seen a 13% decline in wage purchasing power since 1979 and an 85% increase in per capita income over the same period.
The resulting health effects are completely predictable. Anxiety, deprivation, loss of potential, lack of attribution, despair, and social maladaptation lead to negative emotions such as loneliness, misery, anxiety, and stress, resulting in, in part, more individuals. Psychological as you become physically experienced with pain and susceptibility to pain. According to survey data over the past 30 years, Americans, especially middle-aged whites, report more pain than respondents from the other 30 wealthy countries. Pain, especially chronic pain, can be a gateway to opioid use and addiction.
Taking into account the Covid-19 pandemic, it’s no wonder that 911 calls for opioid-related use increased by 250% from 2019 to early 2020.
In response to Durkheim, Case and Deaton conclude: They are the basis of working class life rituals, customs, and routines. It destroys work and, after all, the working class life cannot survive. Despair is brought about by the loss of meaning, dignity, price, and self-esteem that accompanies marriage and the loss of community. “
Brian Alexander’s recent report on a hospital in Brian, a small town on the northeastern corner of Ohio, gives a glimpse of how devastating anomies can be. Of particular note is Alexander’s discussion of Keith Swihart, who is experiencing the worst consequences of uncontrolled diabetes, such as blindness and disconnection. His wife Stephanie died of cervical cancer at the age of 46. Some of his friends commit suicide by overdose of pistols, rifles, ropes, or fentanyl and amphetamines. One friend, Zack Linard, wore a baseball cap with the words “ich bin innerlichtot” before shooting his head to death. Translation: “I’m dead inside.”
The reality of death in despair is far more insidious, as Alexander’s explanation is calm.
Stephen Woolf, physician and lead author of the 2013 groundbreaking medical research institute report “Shorter Lives, Poorer Health,” said that life expectancy in the United States has not kept pace with life expectancy in nearly the same country since the 1980s. I have been recording that for several years. Wages have begun to stagnate. Life expectancy stopped increasing in 2010 and has been declining since 2014. This decline is not solely due to substance and alcohol abuse and suicide epidemics. Woolf and his colleague Heidi Schoomaker also found that over-deaths in middle-aged white men and women were significantly increased from 35 other causes of death. These include infectious diseases, neurological disorders, and organ system disorders, psychiatric and behavioral disorders, obesity, and injuries. In summary, mortality from all causes, which should never increase significantly in a large population, has increased by about 25% over the last two decades in working-age white men without a college degree.
There are subtle differences in the relationship between economic conditions and mortality, but the fact remains that 38% of working-age Americans are significantly impaired in decades of financial hardship. I am. The reaction of HHS to this fact is difficult to understand due to the well-documented correlation between income and health. This means that medical and economic policies are inseparable.
As Woolf frankly stated when he opened his testimony before Congress on the 2013 “Shorter Life, Poor Health” report, “The less people earn, the sooner they die, they die. It makes me more sick. ”As Atour Gawande inferred, pretending to be another is like treating a gunshot wound with a pressure bandage.
In late October 2021, in anticipation of the CDC’s latest information on deaths from overdose, HHS Secretary Xavier Besera announced a “new overdose prevention strategy.” The department’s new reactive strategy reflects the old reactive strategy, ignoring context. In his honor, Besera sought to express support for harm reduction through safe consumption areas. However, the department immediately endorsed the comment.
With the exception that 38% of the workforce has terrifying health markers in relation to immigration politics and the ability to secure national defense, the HHS is about the impact of the workforce on health care funding, spending, and staffing. You may think you are concerned. Not only the contribution effect of health care itself.
Even before the pandemic, about 20% of men in their early twenties and early sixties, or about 20 million, were out of the workforce. This is three times the rate of 1960, worse than the depth of the recent Great Recession in the late 2000s. In addition to excessive illness and mortality, working-age men also have a high disability rate, stating that about 20% of men between the ages of 25 and 54 are disabled.
In addition to this, mass layoffs, including the medical labor market. Over the last two years, 18% of healthcare professionals have quit their jobs and 31% are considering resigning. The cost of this economical time bomb is currently estimated at approximately $ 1 trillion in gross domestic product. The rapid aging of the workforce exacerbates this economic impact. This means that demand for Medicare and Medicaid, which are already in a volatile financial situation, will increase further.
The undefendable excess of medical costs is largely absorbed by employer-based plans to insure approximately 160 million Americans. Case and Deaton claim that these health insurances are covered by the wages lost by employees (this money is “lost” because they are paid to workers), unemployment and low for decades. It effectively explains the particularly difficult wage stagnation among wage workers. Beyond the negative effects of excessive costs on care, the burden on low-wage workers already constitutes a reverse Robin Hood effect that exacerbates considerable economic inequality. As Case and Deaton conclude, “the industry that is supposed to improve our health is undermining it,” and “our government is colluding.”
It would be encouraging if HHS leaders, along with the White House and Congress, publicly acknowledge the death of despair, but they want to define them. However, federal health policy makers do not seem to be able to use this phrase or investigate the problem. Searching for a phrase on the HHS website does not give any results. Searching the Centers for Medicare and Medicaid Services website does not give similar results. The Biden White House has not yet used this phrase in speeches, remarks, statements, or releases. Woolf has not been invited to testify in Congress since 2013. Nobel Prize economist Deaton testified in 2020, but discussed Covid-19 at the House Budget Committee. None of the four parliamentary health committees are working on the death of despair.
Federal official recognition of the existence and impact of death in despair would be good. Nevertheless, HHS leaders should be aware of the link between socio-economic stratification and health or socio-medical status. Besera borrows a page from the founder of social medicine, Rudolf Wilhyo, to recognize that “disease is an expression of an individual’s life under adverse circumstances” and here the epidemic of death in despair. It’s even better to do. It must indicate a great deal of turbulence in a great deal of life. “
Besera and the rest of HHS need to bring society back to medicine and use both medical and social policies to combat the widely defined death of despair. The lives of 38% of Americans of working age are balanced.
David Introcaso is Vice President of Regulatory Policy at Strategic Health Care in Washington, DC and hosts the Healthcare Policy Podcast.
