The decline in U.S. life expectancy and rise in “deaths of despair” have been widely attributed to the growing opioid crisis, but new research says there are many more factors at play, including immigration and income inequality.
The psychological well-being of Americans has been dwindling for the last 40 years, affecting all groups and regions of the country, but opioids only tell part of that story, according to a report released Friday by the Columbia University Mailman School 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, professor of health and management at Columbia School of Public Health and a co-author of the paper.
So-called “deaths of despair” have typically been associated with drug-related causes, especially opioid overdoses. Drug overdose-deaths soared by 21% in 2016, mostly because of widespread distribution of synthetic opioids like fentanyl, according to the Centers for Disease Control and Prevention.
The life expectancy for Americans born in 2016 has fallen to 78.6 years, from 78.7 and 78.9 in the two previous years, the CDC reported. There’s been a notable increase in the mortality rate of white, middle-aged men and women with no high school education.
But the new Columbia report says drugs are only a part of the problem. “The increase in mortality and decline in health of Americans affects all people and started way before the opioid epidemic,” Muennig said. Earlier smoking among white women could also be producing “lagged mortality effects” that are surfacing in middle and older ages, he added.
Expensive health care is likely the most important factor, the study found. Medical costs have risen 34% in the last decade, outpacing income growth, which rose 20% during the same timeframe, according to an analysis from personal-finance site NerdWallet. People sometimes delay seeking treatment until they have the funds.
About 27 million adults pay for their health care on credit cards, the report found. Some Americans wait until they get their tax refunds to either pay off those bills or go to the doctor or pharmacy for check-ups and medicine.
The U.S. faces another health-related epidemic: obesity. The U.S. topped one list of the most obese nations in the world, just ahead of Mexico, according to the Organization for Economic Cooperation and Development.
Income inequality is growing in the U.S.
The U.S. has fallen behind other countries in several key areas, including education, income equality, environmental protection and private gun ownership regulation, the Columbia researchers said. American students rank somewhere in the middle for science, mathematics and reading, compared to other advanced industrial nations, behind Singapore, Taiwan and the Netherlands, a 2017 Pew Research Center analysis found.
As for income inequality, it’s worse. The top 1% of Americans earned 26.3 times as much as the bottom 99% in 2015, a jump from 2013 when they made 25.3 times the bottom. In fact, the top 1% hasn’t controlled that much wealth — 22% of total income in 2015 — since right before the Great Depression. “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,” Muennig said.
Income has stagnated for millions of Americans
Incomes aren’t growing to keep up with families’ spending needs, or their growing debt, according to economists Barry Cynamon of the Federal Reserve Bank of St. Louis and Steven Fazzari of Washington University in St. Louis.
The middle class has shrunk dramatically in the last few decades, and income for those households grew only slightly (6% from $74,015 in 2010 to $78,442 in 2016) compared to upper-income households (9% from $172,152 to $187,872 between the same time frame). Lower-income households’ income grew 5% from $24,448 to $25,624.
The good news: The U.S. economy is doing well, said Paul Ashworth, chief economist of Capital Economics, and should continue to do well this year and next because of a range of tax cuts introduced by the Trump administration. While interest rate hikes by the U.S. Federal Reserve may put pressure on economic growth in the next couple of years, he expects that to be a “modest downturn that’s quickly reversed.”
A slowdown in immigration affects the status of all Americans’ health, as studies suggest that immigrants are healthier than native-born U.S. citizens, at least when they first arrive in the U.S. “Almost all of our growth in health and life expectancy since the 1980s have been from immigration,” Muennig said. “Immigrants have been boosting life expectancy.”
The Trump administration, however, has had a strong stance on tightening immigration.
Immigration also raises average wages slightly for the country, partially because U.S.-born and immigrant workers are not competing for the same jobs, and when they’re in the same industries, they complement one another, according to the Hamilton Project, an economic research group within Washington, D.C.-based think tank Brookings Institution.
“Deaths of despair” is part of a problem that has recently received a good deal of attention because whites were identified as the primary victims, the latest report concludes, “but it is a problem that is more extensive and more enduring than the white despair narrative can fully explain.”
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