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Why the U.S. leads other wealthy nations in deaths of despair

Deaths of despair are skyrocketing in the U.S., while at the same time, they are falling in other wealthy countries. What are we doing wrong?
deaths of despair
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Key Takeaways
  • The U.S. firmly leads other comparable wealthy nations in “deaths of despair,” that is, deaths from suicide, drugs, or alcohol.
  • Researchers from the University of Pennsylvania sought to find out why, so they compared the U.S. to a control group of 16 wealthy countries.
  • They place the blame squarely on the lack of communal assistance in the U.S. While other countries offer affordable healthcare, free education, and plentiful paid work leave, the U.S. does not.

Since the start of the 20th century, life expectancy in the U.S. has steadily ticked upward, perhaps the clearest sign of a healthy, progressing society. But since 1980, something changed. While life expectancy in comparable countries continued to vigorously rise, in the U.S., growth slowed. Life expectancy has now completely flat-lined over the past few years, even before the COVID-19 pandemic resulted in one million early deaths. Americans born today cannot expect to live as long as their older peers. Why?

Deaths of despair

Perhaps the greatest contributor to this sad state of affairs are deaths of despair — that is, deaths from suicide or poisoning by alcohol and drugs. More than 158,000 Americans died from these causes in 2017, the latest year for which solid estimates are available. That number has certainly risen in the past few years, the only question is by how much.

While deaths of despair skyrocket in America — most significantly among white, middle-aged men with low income and limited education living in rural areas — they are falling on average in comparable wealthy nations. In a report published earlier this year in the journal JAMA Psychiatry, Peter Sterling, a professor of neuroscience, and Michael L. Platt, a professor of psychology, both at the University of Pennsylvania, sought to uncover why and to distill any potential policy remedies.

U.S. vs. The World

The sixteen “control group” countries they examined were Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, and the United Kingdom. A few differences immediately jumped out to the researchers:

  • Single-parent homes are far less common in the control countries than in the U.S.
  • All provide pre-natal and maternal care.
  • Free schooling for children begins at age three and continues through high school.
  • College tuition is far more affordable.
  • Employers allow far more paid leave.
  • Healthcare is essentially free.

“All these countries provide support from cradle to grave to help families make it through each stage of the life cycle,” Sterling told Medical News Today. “The U.S. provides no such assistance.”

In their paper, Sterling and Platt argue that this is what Americans, and indeed all humans, need to live long, fulfilling, healthy lives. Humans are wired to seek food, comfort, companionship, and enjoyment, and the brain reinforces these behaviors through the release of the “reward” hormone dopamine, they write. For much of human existence, extending back to our origins as hunter-gatherers, these foundations were satisfied with the help of community. But that communitarian ethos has fallen off considerably, especially in the U.S., where people have grown increasingly isolated. Americans say they are more lonely than ever. The dopamine doses that were once provided via community have dissipated, and hundreds of thousands are replacing them with dopamine hits from harmful drugs.

Can policy prevent deaths of despair?

To reduce deaths of despair in the U.S., policy solutions like greater regulation of prescription drugs, increased availability of pharmaceutical remedies, and an expansion of recovery and mental health services have been proposed. These are all worthwhile, Sterling and Platt say, but at the same time, they will not solve the underlying problems that drive Americans to despair in the first place.

“The sixteen wealthy nations provide communal assistance at every stage, thus facilitating diverse paths forward and protecting individuals and families from despair. The U.S. could solve its health crisis by adopting the best practices of the 16-nation control group,” they write.

It’s commonly said that it takes a village to raise a child. Here in the U.S., it seems that we have increasingly turned away from this cooperative refrain over the years, opting instead for cold individualism. According to this convincing paper, runaway deaths of despair are a brutal side effect.


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