I turned 40 this year. But amidst parties to mark our arrival into middle age, my friends, siblings, and I have also grieved the loss of at least a dozen friends, classmates, and peers.
My two brothers and I each lost a friend to suicide. We stare at our phones, speechless, trying but failing to process the unimaginable loss. Bright, smiling faces appear in obituaries on my Facebook feed. I contribute to the GoFundMe pages established for the children left behind, knowing from experience — my own mother died suddenly at 43 — that no amount of money will ever replace a parent. A month after my fortieth birthday, my lifelong best friend was diagnosed with Stage 4 metastatic breast cancer. It begins to feel like the sky is falling. I pause in panic before checking my text messages: What if someone else died? Making it to 50 seems like a stretch.
Though the causes are varied — suicides, strokes, heart attacks, a freak accident, long battles with addiction — I begin to wonder: what is happening with people my age? Has something in our society failed us as a generation?
WWhen my mom died from a brain aneurysm in 1985, her early death was an anomaly. But what’s happening to my peers now is evidence of a larger public health crisis, one that’s received a lot of buzz since economists Ann Case and Angus Deaton of Princeton University published their shocking 2015 study. This report noted an alarming rise in the death rate since 1999 for non-Hispanic whites age 45 to 54 — a trend The Atlantic dubbed “despair deaths.” The mortality rate climbed so much that it affected this group’s overall life expectancy, which is unprecedented in the industrialized world in the last five decades.
(This is not to say that whites are suddenly worse off than other groups like Hispanics, African Americans, or Asian Americans. They’re not. But other racial groups have continued to see steady declines in their mortality rates.)
The problem is pervasive across all 50 states; every single state in our nation saw a gap between the expected and actual death rate. But the South has been hit particularly hard. According to a study by The Commonwealth Fund, in Alabama, Kentucky, Tennessee, Oklahoma, Mississippi, and West Virginia, the death rate among this group is currently a shocking 60–76% higher than expected.
Across the country, whites — particularly those in middle age — are dying younger. Women in their 40s living in rural areas have seen the most dramatic drop in mortality. The big question, of course, is why.
Case and Deaton’s study pointed to the rising rates of suicide, accidental poisoning (mostly from alcohol, drugs, and opioids), and chronic liver disease. We’re in the midst of a horrific prescription opioid epidemic — prescriptions for painkillers like Vicodin and Oxycontin have quadrupled in the last 14 years, and there are an absurd 250 million prescriptions doled out annually, enough for every American adult to have a bottle.
At the same time, we’ve seen a leveling off of the declines we’ve seen for years in heart disease, strokes, diabetes, respiratory illnesses and obesity. And since 1999, middle-aged whites have also reported declining health status, increased levels of pain, greater difficulty with daily activities, and a rise in mental health problems.
Economists originally reported that the economic crisis was to blame — and certainly, income inequality plays a role. According to an analysis by The Washington Post, white women in the top 1% of household income can expect to live an entire decade longer than their counterparts in the bottom 1%.
But as The Hamilton Project pointed out its June report, if the economy were the primary driver of these early deaths, we’d be more likely to see a more steep decline in deaths among men than women, while the opposite is true. And middle-aged people aren’t dying earlier in other countries like France, Germany, Australia, or the United Kingdom.
Dr. Ali Mokdad, Professor of Global Health at the Institute for Health Metrics and Evaluation, and many other experts instead blame the American healthcare system. Our medical community provides excellent care to people who can afford it, he said, but leaves behind those who cannot pay.
In fact, according to another Commonwealth Fund report, the U.S. health care system ranks last among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity, and healthy lives.
Many experts agree that there are societal influences at play: social isolation, fracturing of society, access to firearms (which is highly correlated with the rate of fatal suicide attempts), an increase in income inequality, and a lack of health insurance. As one example, in 2012, 60% of people admitted to substance abuse treatment facilities did not have the necessary insurance to cover it. How can you possibly recover from addiction if you can’t pay for the treatment you need?
Mokdad added that many U.S. health insurance programs don’t have a preventative component; if somebody gets into an accident they can find treatment, but insurance rarely pays for classes to quit smoking or lose weight.
Shanthi Mogali is the Director of Psychiatry at Mountainside Treatment Center, a nationally acclaimed alcohol and drug addiction treatment center in the Berkshire mountains of Connecticut. She has seen an unusual trend recently among her middle-aged patients. She describes people who have never even smoked marijuana before and are suddenly hit with a life crisis in middle age and don’t know how to cope. They engage in what she calls “self-treatment of emotional pain” with binge drinking or popping pain pills. “Eventually that becomes their way of coping; I’ve seen it so much.”
After watching several friends and peers die tragically this year, and my college roommate receive her dire cancer diagnosis at 39, I’ve grown more anxious myself. “Are you sleeping at night?” I ask my friends. They’re not. The answer given to us by many of our doctors? More pills. Though my doctor did briefly mention exercise and sleep hygiene, I walked out of my most recent check-up with another prescription for Klonopin. I was never asked any screening questions for a history of substance abuse.
It’s a vicious cycle: we are witnessing a strange slew of tragic deaths in our age group, and to cope, we are offered pills to manage our grief.
Between 1996 and 2013, the number of adults filling a benzodiazepine prescription (drugs like Xanax, Valium, Ativan, or Klonopin) increased 67 percent These same drugs were involved in 30% of prescription drug overdose deaths in 2013.
It’s no surprise that we’re comfortable with prescriptions. Americans are bombarded with ads that tell them a pill will solve their problems: pharmaceutical companies spend a staggering $4 billion a year on ads to consumers, and there are 13 prescriptions written per year per American.
Mogali also points out our failure to treat the whole patient. She sees patients who went in for back pain, were never asked about their divorce, job loss, or ill spouse, and are now addicted to painkillers. Most doctors, she said, aren’t trained in addiction medicine and instead are financially rewarded for writing prescriptions. Recent analysis by ProPublica revealed that the more money doctors receive from drug companies— on average — the more brand-name medications they prescribe.
TThere have been some legislative reforms and policy improvements. Last month, the FDA announced that it will require strong warnings for opioids and benzodiazepines. Prescription Drug Monitoring Programs (PDMPs) — state-run electronic databases that track controlled prescriptions — show promising results for reducing “doctor shopping” and the number of prescriptions written.
But according to Mokdad, we can’t just police away this problem; we need to help people learn how to cope with emotional pain. We must get to the root of why people are drinking and drugging in the first place.
We need to spend more money on preventative programs, such as the Jed Foundation which focuses on teens’ mental health, as studies show that one predictor of drug addiction in adulthood is the age when drug use began. We also need to develop programs to support adults in transition, such as a job loss or divorce, as the risk of drug abuse increases greatly during times of transition.
We also need to raise awareness that prescription drugs are dangerous. After the births of each of my two children, I received 30 Vicodin pills. I used two and threw away the rest; are 30 powerful painkillers necessary for a small vaginal tear? Once again, I wasn’t asked any substance abuse screening questions.
We need to fund and implement more programs to help people proactively manage their physical, mental, and emotional health. Only then will we squash our societal impulse to fix everything — from a troubled marriage to a twisted ankle to high cholesterol — with a pill.
