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April 7, 2021 - 11:23am
Before Covid, there was another epidemic — the opioid epidemic.
In fact, as Anne Case and Angus Deaton of Princeton University have shown, the problem isn’t only the fatalities caused by opioid misuse, but also other forms of drug overdose, suicide and alcohol-related liver disease.
Described by Case and Deaton as “deaths of despair”, these scourges have had a measurable impact on mortality trends in America. Indeed, the problem was serious enough to send a century-long trend of ever-increasing lifespans into reverse.
It is not an equally distributed phenomenon. The rise in deaths of despair is overwhelmingly concentrated among poorer Americans. The size of this effect is shown in new research from Case and Deaton published in the Proceedings of the National Academy of Sciences.
The authors analyse figures for “expected years of life from 25 to 75”. In a population where everyone died aged 25, the expected years of life would be zero. If, on the other hand, everyone reached their 75th birthday then the figure would be 50.
In the following chart, we see a long-term increase in expected years of life that peaks in the early 2010s and then, disturbingly, starts to decline. That’s bad enough, but the authors then present separate figures for people who have a four year degree (shown on the chart as “BA or more”) and for those who don’t (“No BA”):
As you can see, the whole of the decline is concentrated among the less educated part of the population. Among graduates, expected years of life continues on an upward trend. In other words, class-based inequalities are widening.
But what about racial inequalities? In another chart, the authors show separate trends for black and white Americans (also broken-down by education and sex):
This shows that racial inequalities certainly exist — with black Americans at a disadvantage to their white counterparts. However, the racial gap has narrowed considerably for both men and women over the last three decades — in clear contrast the widening class gap. That’s an irony given just how intensely focused US politics is on race right now.
Of course, lifespan isn’t the only measure of inequality. Nor does any recent improvement in racial justice erase centuries of slavery, segregation and racism.
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SubscribeWe have known about all this for some years and there have been countless articles about it in all the US magazines etc. It is one of the reasons why Trump won in 2016, and why he would have won last year had it not been for Covid and the way in which Big Tech, the media and the various authorities ‘fortified’ the election.
The war against needed, and legally prescribed, pain meds is criminal. Many people live a life we could not understand, chronic pain, that means pain which never goes away, and the right pain drug relieves that – but because some degenerate culture in some Hilly-Billy town are addicted to them illegally we criminalize the ones who need those pills. We deny them.
We all can learn to live with pain, and those of us who take such meds, we mostly live with it fine, but here is the thing – SLEEP. If it keeps you awake you never get relief, it will drive you mad. I take a narcotic at night to sleep because background pain stops me falling asleep. If I could not sleep I would shoot my self as you cannot believe how horrible it is to be exhausted and in pain and cannot sleep, it will drive you mad, the exhaustion – but mostly because sleep is the chance you get to mentally re-charge, and you need that one, long, time where you can just sleep and get your brain some recuperation.
Society lets the people in pain suffer now days, because of these yahoos who take it illegally. I do not care about them as they chose it, and would just be on heroin or fental or meth or crack or alcohol instead. We do not reduce the addiction overall by making pain meds hyper restricted, we just let addicts select one drug over another, and sentence those who did not chose to be in pain, to suffer,
Well as another chronic. I can agree about pain. But the article doesn’t relate to us, it relates to the sense of hopelessness in some who will turn to anything to change their condition. Rewarding work, even volunteer work, would allow some return of personal dignity. That seems ignored by politicos intent on ‘helping’ people. Looking at the labor participant rate tells the story – too many without contributing to society is a social disease.
Yes completely agree. Sadly the educated middle class, who have the positions to change things, don’t seem to care about the desparate lower class. They have no stake in the lower class and as in the UK they do not act when the problems are all around them. Virtually all positions of power are held by degree educated rather than people who have an understanding of those struggling communities.
Before Covid, there was another epidemic — the opioid epidemic.
Yes, there was and before Biden, we had a president who noticed this problem and tried to address it. But because it was him noticing it, the media and assorted others were required to ignore it.
It is a very unknown fact that opioid deaths did decrease under T. for the first time in 20 years. And this was not by accident. The administration did address the issue.
He seems to have, yes:
https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
Thanks for the link. It is quite revealing.
“Before Covid, there was another epidemic — the opioid epidemic.”
Pure and utter hyperbole. There is a drug and alcohol epidemic, yes, but that is just how it is. I know drugs, and marijuana is as bad as any of them really, yet we are all legalizing it, wile making legal pain meds illegal for those who need them.
I hope UNHERD does some on legal marijuana as I have lots to say on it. It is not a good drug, maybe fine as a teen rebellion and experimenting thing, but used commonly, it is a bad drug.
Looking at the data by race, the most interesting point is that hispanics have a life expectancy higher than whites by about the same margin of whites over blacks. So if America is institutionally racist, have we all gotten it wrong and it’s actually designed to favour hispanics rather than white or black people?
That’s the danger of stats as social data – there are always factors that cannot be added in due to shortage of time/resources/will. Perhaps hispanics (including amerindians) have better diets or are more active? Maybe they have better support networks so ODs get rapid EMT response, or are more willing to get stuck in with naloxone or coke/speed to reverse respiratory stress from opiate OD? Maybe they prefer BTH to nasty synthetics so are less likely to OD in the first place? If i were a gambler i’d go with the last option as the best guess…
They needed to add Chinese, Japanese, Korean, Indian Americans, they would need a higher scale as they would be so far above all the other races! And people think genetics do not play a role in how we turn out.
Not so much genetics but culture. I suspect numbers for natives would be well below Blacks. And that wouldn’t be because of opiates but alcohol. There are genetics that strongly relate to alcohol abuse.
One of the things I hate in medicine (I am a doctor) is this constant background hum about “the social determinants of health”. Those on the left-hand side of the political spectrum (ie: 90% of younger medical doctors) have a very simplistic understanding of the issue of how wealth relates to mortality. They think that if you give poor people more money, they would be healthier. This is “obvious” because richer people live longer.
But for anyone with even a modicum of intelligence and objectivity, they realize that you need to correct for factors like smoking rates, substance abuse, eating habits, etc etc before you can tell if wealth is an INDEPENDENT predictor of mortality. And the answer seems to be – from what is available, as most of the research is biased towards “proving” that poor folk are victims – that wealth is a very minimal predictor.
And even if one accepts that it is a minimal predictor, the question remains: What is the mechanism? How are one’s coronary arteries directly affected by the number of zeroes in one’s bank account? How is this possible? To me, the likelihood of this being the case is small. The most reasonable explanation I have ever heard is the chronic stress theory (poor people suffer more chronic day-to-day stress, which leads to higher baseline cortisol levels, which negatively impacts cardiovascular health amongst other systems). But even that is tenuous, as I meet a lot of very stressed and depressed rich folk, and many happy poor ones, and suicide rates don’t predict that well by social class.
To me, the mortality gap between classes is much like the gender wage gap. It looks impressively large until one opens one’s brain to the obvious causes of this disparity, causes that are verboten to discuss as they destroy the “Victim” theory.
“But for anyone with even a modicum of intelligence and objectivity, they realize that you need to correct for factors like smoking rates, substance abuse, eating habits, etc etc before you can tell if wealth is an INDEPENDENT predictor of mortality.”
Interesting perspective from a doctor. I wonder why young doctors are so quick to sign on to the poor = bad health theory? Medical school is highly competitive and typically only people who are academically gifted are admitted. I would think they could easily grasp elementary concepts in statistics.
Perhaps their political sensibilities override their intellect and they simply accept the prevailing narrative about the effect of poverty on health without even bothering to think about it.
Bear in mind all new doctors have been indoctrinated with left wing ideology in university prior to entering medical school
Take people of India Indian descent, they do not seem to have a problem with alcoholism, yet take Native Americans, they have a huge propensity to alcoholism. I am sure it is a good part genetic, I have seen too much of this in real life to think alcohol is merely cultural, there is a strong genetic component..
I think I noted that earlier. Apparently those of Polynesian or Oriental descent may have alcohol issues countered by cultural norms. I have been informed of my error, but my beliefs remain.
Like native Americans aboriginals too I read.
The most reasonable explanation I have ever heard is the chronic stress theory (poor people suffer more chronic day-to-day stress, which leads to higher baseline cortisol levels, which negatively impacts cardiovascular health amongst other systems).
I suppose chronic stress could also have an impact on smoking, substance abuse, depression and eating habits. So there is possibly an indirect link there.
Would you not also need to look at housing conditions, working conditions, access to healthcare and the quality of the healthcare people have access to? All those factors would be directly impacted by wealth and have an impact on health.
It’s not the number of zeroes in the bank account that matter but the things that the zeroes give you access to.
Of course, there are other impacts on how people live their lives, trust in doctors, belief in science, etc that could impact health that aren’t necessarily related to wealth that also have an impact.
I’d have thought going to work would be more stressful than sitting in front of the TV all day.
Mechanism is the neglected factor in most of ths kind of analysis now, be it health, social attainments, education, etc. The data tells us there are disparities by sex, class, race, ethnicity. OK, but that’s not useful without a mechanism.
But so many words to describe these disparities – racism, sexism, privilege – actually obscure that question
The poorer people are the more likely they seem able to spend a small fortune each week on cigarettes
I think that the above graphs are just trying to make an impact where there is no impact – playing with figures.
The BA graph looks interesting but the whole of the difference between the categories is only about 2.5 years. Why is it surprising that people with BAs live 2.5 years longer? They are likely to have a better job, they think more, they maybe read a little, they talk about health. It is amazing, in fact, that the spread is only 2.5 years.
For the hispanic/black/white, the education level needs to be factored in for it to be meaningful.
The Hispanic result is interesting and is worthy of further study. For me, the annoying thing is the men vs women. All discussion we see is that women have a terrible life compared to men. What a con !!!!
Yes totally agree – meaningless stats – unless of course the stats show that having part or whole Spanish* blood makes you superior, fine with me – viva la raza etc. (*so Moor x Frank x Gaul x Arab x Jew x Carthaginian etc etc)
Mestizo, indigena, or which ever word is best, is likely part of what is meant by Hispanic, rather than just Spanish (or Moor x Frank x Gaul x Arab x Jew x Carthaginian etc etc).
Many Hispanics simply still want to live an adequate life where men remain macho as do women, comfortable in family traditions. Anglos seem to fret about such things.
Agreed, the graph is weirdly scaled which makes the recent spread look a lot more dramatic than it is. This is year 9 statistics lesson stuff on how to manipulate your graphs to exaggerate a point.
That these sort graphs are used to restrict pain medications is disgusting. USA has a war on the chronic Pain sufferers! And UK does as well!
I use a controlled medication, it is very important to my quality of life, I have used it daily for 12 years so I may fall asleep. This is becoming exceedingly harder to get, I have no problem as I have been on it so long with no problems so a doctor can give it to me, but a new patient needing it would likely be told to do some meditation and take an aspirin. This is twisted. Quality of life is more important than length of life.
I have to use my old doctor, although he requires cash as he does not take Medicare, so pay I $125 four times a year to get my prescriptions as new doctors are watched so closely on how much they prescribe THEY WILL NOT TAKE NEW PATIENTS WHO NEED ON GOING CONTROLLED MEDS, because it would make it harder to give the rationed amounts to their regulars.. You cannot believe the new regs on allowing a person in chronic pain to get pain meds! It is terrible. Those pain meds really work, and to sentence someone to pain is evil. I am a hard man, as all in my work are, we do not mind pain, but when it is chronic, when it never goes away, it is too much even for us with tolerance.
If the hillbillies and rough elements of society are addicted to pain killers should have ZERO effect on me getting my meds, but instead it does. They chose to be addicted (and I have been addicted to other drugs so know the scene) but us pain sufferers did not chose it. I got my condition from work, years of injury, I do construction, self employed, and as most of my kind have, have been hurt a great deal, it just is part of my work, broken bones, stitches, and repetitive stress injuries. My work just uses you up, and so the controlled meds can make it all livable, where without them I would likely just shoot myself as endless pain wears you down.,
Us old timers mostly can show each other our backs and the long zipper like scar from a spinal fusion from some injury – I am amazed how many have this! You need people to be working high up, on bad footing, and hanging off ladders and walking scaffold and roofs, and using tools, and we get hurt, it is not if we get hurt, but when and how often. Pain meds are our right as injury is a fact of what we do. (I put on a roof last week, I am mid 60s, over 20 foot off the ground, it is what I do, it is hard work and one slip and down you go, smash!)
Then the terrible illnesses and medical conditions all may suffer, those can lead to a life of endless pain – they deserve their pain meds! It was not their choice. F*** the addicts, let them OD, it is not my problem, but to stop pain meds for those who need them? That is evil.
NICE is unfortunately recommending something similar here just because some people abuse the system.Its like if one child is naughty all the class must suffer.
I think you would find something similar in our islands….
Sorry I meant to say Isles as in British Isles.
What i dont get is the American obsession to classify by “race”. What about people who ancestrally are 1/4 hispanic. Or maybe 1/8 “black”. Does the proportionality of their “race” have an equally proportional affect on their longevity?
I imagine it does. The more mixed the genome the more likely survival, or so we might imagine. In Northern latitudes, sans supplementary Vitamin D, skin colour matters.
Colour me shocked.
lol!
“A new study shows that class, not race, is a bigger predictor of an early death”
When was this ever in doubt? You have only to look at the differences in lifestyle to see clearly why lower income people die earlier than middle and upper income people (class is a Britishism that doesn’t translate well to the US. Unless you want to tell me what class you think Barack Obama and Oprah Winfrey are)
Lower income people smoke at higher rates and they eat far more fast food. Head to any wealthy enclave and you’ll find lots of thin people in good physical shape because they don’t smoke and over eat. Obesity, a true scourge among lower income people, is a major cause of death in the US. It isn’t racial. Middle income black people as well as rich black people live like middle and upper income people of other races. College diplomas are not “class” based in the US but lower income people, of all races, are more likely not to have one. And yes, it matters when it comes to health. Lifespan isn’t a measure of inequality, it is largely a matter within the individuals control. If you smoke and eat too much, you won’t live as long.
I would be interested to see similar statistics on longevity in non Western countries. What would the controlling factor be in African nations ( taking out the likelihood of dying by violence, civil or national conflict, I suppose)? I think one might find that those large glossy men and the occasional woman one sees on the news and in Bond Street tend to live longer than the starving weeping children who punctuate daytime tv. Do the untouchables die younger than the Brahmin? Paddy Power wouldn’t give you odds against that.
BTW , my classification would be: Obama started out as middle class (typical silly white student has baby with foreign student who buggers off) then rose into the stratosphere in politics. Oprah is just a celebrity, that’s a class all of its own, though one whose membership is precarious.
when I lived in the States, I found the old money families were more patrician than The English aristocracy I knew at University.
Lifestyle deaths, not class, except for the relationship between the two.
There are some great documentaries on this. It hits urban centers and rural areas alike. Drugs have been created to be highly addictive. Politicians in Los Angeles ignore this and blame those living on the streets doing drugs on cost of living. They ignore that once someone goes down that path it is almost impossible to come out unscathed. I went to a funeral of a young man in December. Despite multiple rehab efforts and a good soul, he couldn’t get out of the addiction.
The rich are better off than the poor is hardly a journalistic revelation. More on the deluded campaign for equal outcomes from Franklin. Good so see how racial inequality has greatly improved which seems to mirror the finding of the recent UK race report.
Given global over-population, isn’t this actually a good thing?