Feb. 17, 2017

'Deaths of despair' are cutting life short for some white Americans

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Despite decades of advancements in health care, diet and safety, middle-aged white Americans are now living shorter, not longer, lives.

Our economics correspondent reports in the latest installment of Making Sense.

PAUL SOLMAN: Maysville, Kentucky, in the northeast corner of the state, just a short bridge away from Ohio, despite some merchants’ best efforts at cosmopolitan outreach, the downtown is struggling. But at one local establishment, business is brisk and growing.

DAVID LAWRENCE, Mason County Coroner: This is the Batesville 20-gauge steel protector.

PAUL SOLMAN: This one is Churchill blue.

DAVID LAWRENCE: Churchill blue. We can get this in a misty rose for the ladies.

PAUL SOLMAN: David Lawrence manages the Knox & Brothers Funeral Home, is also the county coroner. He’s been seeing a lot of dead white males of late, especially ages 45 to 54.

DAVID LAWRENCE: A lot of it due to alcohol or drug abuse.

DR. WILLIAM CRAIG DENHAM, Family Physician: There has been a Denham practicing medicine.

PAUL SOLMAN: Craig Denham wears multiple hats too.

DR. WILLIAM CRAIG DENHAM: This small bag is my grandfather’s medical kit.

PAUL SOLMAN: A fifth-generation Kentucky family physician.

DR. WILLIAM CRAIG DENHAM: My great-great-grandfather’s.

PAUL SOLMAN: He’s also medical director for the fire department’s emergency service.

DR. WILLIAM CRAIG DENHAM: In the past two, two-and-a-half years, we have had about a 300 percent increase in the drug-related overdose ambulance runs. And the prevalence of opiate addiction in this area continues to increase.

BECKY MANNING, Widow: He’s like, mom, it’s nothing that you did. It’s me.

PAUL SOLMAN: Becky Manning’s son got hooked on drugs. Fortunately, he’s still alive.

BECKY MANNING: Almost 40 now.

PAUL SOLMAN: But she blames the drugs in part for her husband’s suicide.

BECKY MANNING: He just carried this tremendous guilt for everything, for our son doing drugs. Then he started getting depressed, and then my husband took his own life.

PAUL SOLMAN: How did he do it?

BECKY MANNING: He blew his head off. I came home to that.

PAUL SOLMAN: Best friend Marcy Conner’s husband also killed himself.

MARCY CONNER, Widow: He developed alcoholism very young in life.

PAUL SOLMAN: An addiction he shared with lifelong friends.

MARCY CONNER: One died with a heart attack, but drug use and alcohol use played all the way through his life. Another one died of cancer, drank up to the very end. And my husband actually had a G-tube in, a feeding tube in, and poured alcohol down his feeding tube until he died.

BECKY MANNING: Alcohol poisoning.

PAUL SOLMAN: These cases fit a disturbing national pattern. Though U.S. life expectancy has been going up steadily over the last century, there’s now been a sudden and dramatic reversal, for just one demographic.

ANNE CASE, Economist: White non-Hispanics in America, middle-age, are dying in large numbers.

ANGUS DEATON, Economist: It was certainly a huge surprise to me.

PAUL SOLMAN: Economists Angus Deaton and Anne Case, who are married, published their finding just after Deaton won the 2015 Nobel Prize in economics.

The paper showed that, starting in 1999, the death rate of middle-aged white Americans has been going up, instead of down.

ANGUS DEATON: We thought we must have made an error. I mean, the whole world is getting better. This middle-aged group is the one that’s benefited most, at least since 1970, from advances in the treatment of heart disease, from people quitting smoking, all of those things. And then suddenly for this trend that’s going down just to reverse out seemed like it had to be wrong. But it wasn’t wrong.

PAUL SOLMAN: The big increase was in what Case calls deaths of despair, alcohol-related liver disease, suicide, drug overdose.

ANNE CASE: People kill themselves slowly with alcohol or drugs, or quickly with a gun. For people aged 50-55, for example, those rates went from 40 per 100,000 to 80 per 100,000 since the turn of the century.

And it’s people with a high school degree or less who are killing themselves in these ways in large numbers. That’s the group that’s getting hammered.

DR. ELLEN KUMLER, Mason County Health Department: And now the CDC is paying more attention to that age group and demographic.

PAUL SOLMAN: Ellen Kumler, a public health doctor for Mason County, Kentucky, says the latest data from the Centers for Disease Control pick up where the Case-Deaton study leaves off.

DR. ELLEN KUMLER: When we look at the suicide rate, when we look at unintentional injuries, a lot possibly related to substance abuse, as well as liver disease, the rates of those issues have actually increased.

PAUL SOLMAN: Marcy Conner is a nurse specializing in substance abuse who has experienced deaths of despair time and again in her own family.

MARCY CONNER: I had a brother that committed suicide, also.

PAUL SOLMAN: And two cousins, one of them a nurse.

MARCY CONNER: And he started telling me that his depression medication wasn’t working as well, and pain medication wasn’t working as well. And he lost his temper at work one night and got fired.

PAUL SOLMAN: Got fired.

MARCY CONNER: They found him hanging in his garage.

PAUL SOLMAN: And the other cousin?

MARCY CONNER: She overdosed.

PAUL SOLMAN: And why so much drug use and abuse? Anne Case and Angus Deaton found something else in their study.

ANNE CASE: Since at least the mid-1990s, people’s reports of pain, of sciatic pain, of neck pain, of lower back pain year on year have increased.

MAN: Our best, strongest pain medicines are the opioids.

PAUL SOLMAN: The mid-’90s was also when the opioid painkiller OxyContin was approved by the FDA, and began to be marketed aggressively to doctors.

MAN: They do not have serious medical side effects, and so these drugs, which I repeat, are our best, strongest pain medications, should be used much more than they are for patients in pain.

PAUL SOLMAN: Within five years, the drug’s maker, Purdue Pharma, was earning a billion-dollars-a-year profit on OxyContin, which soon rose to $3 billion. As for the lack of serious side effects? Well, it did have one.

ANGUS DEATON: It’s basically heroin in a pill with an FDA label on the front. So, people get addicted to this.

ELIZABETH EASTON, Recovering Painkiller Addict: I started on oxycodone, or OxyContin, in high school.

PAUL SOLMAN: Elizabeth Easton is now in recovery.

ELIZABETH EASTON: I unleashed something horrid in me many years ago from doing one — one pill. I went from taking them to snorting them to, yes, injecting, which is really, really horrid.

PAUL SOLMAN: Because you have got to have it.

ELIZABETH EASTON: You have to. It’s the only thing that makes you feel normal. And it’s the farthest thing from normal.

BECKY MANNING: It controls your life. You’re a different person.

PAUL SOLMAN: That’s what Becky Manning saw in her son.

BECKY MANNING: Seeking and finding the next high was his priority, no matter who he took down with him.

MARCY CONNER: The brain is telling you, I have got to have it again. I need more. So that’s where you end up with that craving. The craving ends up with, you know, seeking supply.

PAUL SOLMAN: And though lawsuits and a government crackdown have helped curb the supply of OxyContin, cheap heroin is more than filling the void.

DR. WILLIAM CRAIG DENHAM: If you can’t get your pain pills that you’re abusing, you’re going to find the source somewhere. And so people are turning to the street drug heroin, which is more dangerous, in the sense that you’re taking something made in somebody’s garage vs. something made in a factory.

CHRISTOPHER RUHM, Economist: In many areas, it’s cheaper to get high on heroin than it would be to get drunk.

PAUL SOLMAN: Economist Chris Ruhm.

CHRISTOPHER RUHM: This is a major health crisis. I mean, drug poisonings have become the biggest source of preventable premature death. So, for example, there are more drug poisoning deaths than car crash deaths. And that’s quite recent.

PAUL SOLMAN: And says Dr. Denham:

DR. WILLIAM CRAIG DENHAM: I’m seeing just as many middle-aged women as I am middle-aged men.

PAUL SOLMAN: Bucking a century-long improvement in white longevity.

DAVID LAWRENCE: People without jobs and people kind of just keeping themselves secluded from others.

PAUL SOLMAN: For the PBS NewsHour, economics correspondent Paul Solman, reporting grimly from Maysville, Kentucky.

JUDY WOODRUFF: And, next week, Paul returns to Maysville to ask the obvious question: Why the startling increase in deaths in white America?

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