New Report Recommends Urgent National Response
Lerner Chair of Public Health Promotion and an associate professor of sociology at Syracuse University. (Syracuse University)
SYRACUSE, N.Y., March 05, 2021 (GLOBE NEWSWIRE) -- Young and middle-aged adults ages 25-64 in the United States have been dying at higher rates since 2010, according to a new report from the National Academies of Sciences, Engineering, and Medicine.
The report, “High and Rising Mortality Rates Among Working-Age Adults,” says that rising death rates are striking working-age Americans whose risk of dying from certain conditions – such as drug overdoses, suicides, and hypertensive heart disease — has been climbing since the 1990s. According to the report, Americans are more likely to die before age 65 than peers in other rich nations.
Based on data from 1990-2017, the 454-page report documents a public health crisis sweeping the American workforce that has profound implications for families, communities, employers, and the U.S. economy.
“Even before the COVID-19 pandemic, life expectancy had been declining in the U.S. for several years,” said Shannon Monnat, Lerner Chair of Public Health Promotion and an associate professor of sociology at Syracuse University who was a member of the committee that wrote the report. “Working-age Americans have been dying at an alarming rate over the past several years, but not just from drug overdoses.”
The rising death rate is due to drug overdoses, alcohol, suicides and cardiometabolic conditions — a category that includes diabetes and heart diseases caused by high blood pressure and other conditions. The report recommends urgent policy actions, including addressing the overdose epidemic and the underlying causes of substance use disorders more broadly, stronger efforts to tackle obesity, and policies to reduce inequities.
Death rates are higher and are increasing faster among working-age adults with less education and income and among those living in nonmetro areas. The report says that death rates among Black working-age adults have been disproportionately high for many years due to economic inequalities and inequities in health care, housing, education, and other factors, reflecting the legacy of structural racism. Although progress occurred at the turn of the century in reducing the mortality gap between Black and white Americans, death rates in working-age Black people are now increasing, effectively erasing that progress.
According to the report, the increase in working-age mortality is mainly driven by these causes:
Drugs, Alcohol and Suicide
Drugs and alcohol are major contributors to the rise in working-age mortality. From 1990 to 2017, fatal drug overdoses in working-age Americans increased in every state, but increases were especially large in Appalachia, New England, and the industrial Midwest.
The report describes the overdose epidemic as a “perfect storm” created by a market flooded with highly addictive and deadly prescription and illicit drugs, and mounting demand for substances to bring relief from physical, mental, and psychological pain.
“Drug poisoning deaths, including those caused by opioids, have been the single largest contributor to the rise in death rates among U.S. working-age adults,” Monnat said. “The U.S. overdose crisis represents a perfect storm of underlying vulnerabilities combined with exposure to highly addictive and lethal substances.”
The report also explores the rise in suicides, which was most dramatic for white men and those living in nonmetro areas.
The report also focuses on rising deaths from cardiometabolic diseases, much of it caused by the health consequences (diabetes, hypertension, heart disease) of the obesity epidemic. Some of the most notable increases have been in the South and outside of large metropolitan areas. Young adults ages 25-44 have been especially affected because most were born after 1980 when the obesity epidemic began.
Younger adults have been more exposed to “obesogenic” environments — unhealthy diets and lack of safe, open space for exercise — for their entire lives. Compared to older adults, they became overweight at a younger age and are more likely to remain overweight or obese today.
To address working-age mortality and advance research and data collection, the report recommends these actions:
States that have not done so already should expand Medicaid coverage under the Affordable Care Act.
Economic policies are needed to address the long-term economic and social strains and dislocations that made communities that experienced economic decline over the past four decades vulnerable to opioids and other drugs.
Obesity prevention programs should start early in life and target children and teens most at risk for obesity, including racial and ethnic minorities, people living in poverty, and women.
Government and private organizations should fund research on more effective ways to prevent substance use disorders, reduce obesity, improve heart health, enhance behavioral health services for mental illness, and help those who are struggling to stop smoking or obtain effective treatments for chronic diseases.
To reduce and ultimately eliminate racial/ethnic and other socio-economic inequalities that continue to drive racial/ethnic disparities in U.S. working-age mortality, policymakers and decision-makers at all levels of society will need to dismantle structural racism and discriminatory policies of exclusion in areas such as education, employment and pay, housing, lending, civic participation, criminal justice, and health care.
“Too many Americans are dying too young,” Monnat said. “Understanding the mess we are in requires us to come to terms with long-term economic and social decline and the policy failures that drove that decline.”
The study — undertaken by the Committee on Rising Midlife Mortality Rates and Socio-economic Disparities — was sponsored by the U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation. The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.
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