Suicides and Drug Overdose Deaths are up; Life Expectancy is Down

I recently blogged about the upward trend in suicide in the U.S., which bucks the global trend of declines in suicides. Yesterday, the U.S. Centers for Disease Control and Prevention put out three new reports on death in America (no, not death "to" America)--the news is all-bad, as the Associated Press reports:

Suicides and drug overdoses pushed up U.S. deaths last year, and drove a continuing decline in how long Americans are expected to live. 

Overall, there were more than 2.8 million U.S. deaths in 2017, or nearly 70,000 more than the previous year, the Centers for Disease Control and Prevention said Thursday. It was the most deaths in a single year since the government began counting more than a century ago. 

The increase partly reflects the nation’s growing and aging population. But it’s deaths in younger age groups — particularly middle-aged people — that have had the largest impact on calculations of life expectancy, experts said. 

It is very clear that the widespread availability of opioids is a key factor behind this increase--the means available to kill yourself either deliberately (suicide) or accidentally (drug overdose) are more numerous than ever. But what is the underlying motivating factor? In my earlier blog I mentioned the "sea of despair" that seems to have engulfed middle-aged Americans--especially non-Hispanic Whites. The AP story has a similar story line:

Dr. William Dietz, a disease prevention expert at George Washington University, sees a sense of hopelessness. Financial struggles, a widening income gap and divisive politics are all casting a pall over many Americans, he suggested. “I really do believe that people are increasingly hopeless, and that that leads to drug use, it leads potentially to suicide,” he said.

This gets us back to the increasingly important issue of wealth and income inequality. It was brought to center stage a a few years ago by Thomas Piketty, and it is almost certainly at the root of many of the social problems we are seeing in the richer nations. 

Two New Cool Tools for Demographers

I learned today about two new cool tools for demographers interested in what's going on in the world. First, thanks to Debbie Fugate for alerting me to the new POPGRID website hosted by CIESEN at Columbia University. As usual, Alex de Sherbinin has assembled a lot of good interactive data. Here's how he explains what's available:

The POPGRID Data Collaborative brings together the major producers of gridded population and human settlement data, as well as key users and stakeholders, to coordinate efforts and better respond to user needs. POPGRID is pleased to announce the launch of a Web site that guides users on the products available and their characteristics (including comparison tables), and a map tool (POPGRID Viewer) that enables visual and quantitative comparisons among data sets.

Then Steve Ruggles alerted us to the second great thing coming along today--a new tool from the IPUMS project at the Minnesota Population Center:

IPUMS is proud to announce the arrival of a bouncing baby cross-tabulator to the family! Grab your mobile devices and give IPUMS Abacus a try. Cross-tabulated IPUMS USA Census/ACS data are now at your fingertips! Get started: http://usa.abacus.ipums.org

As always, you need to get out there and try these tools and see what works for you.

Suicide Rates are Declining Globally, But Not in the U.S.

This week's Economist has a very nice summary of the global trends in suicide (or "intentional self-harm" as it is known in the International Classification of Diseases). In the world as a whole, the rates are declining, but the United States is bucking that trend.

Globally, the rate has fallen by 38% from its peak in 1994. As a result, over 4m lives have been saved—more than four times as many people as were killed in combat over the period. The decline has happened at different rates and different times in different parts of the world. In the West, it started long ago: in Britain, for instance, the male rate peaked at around 30 per 100,000 a year in 1905, and again at the same level in 1934, during the Great Depression; among women it peaked at 12 in 1964. In most of the West, it has been flat or falling for the past two decades.

America is the big exception. Until the turn of the century the rate there dropped along with those in other rich countries. But since then, it has risen by 18% to 12.8—well above China’s current rate of seven. The declines in those other big countries, however, far outweigh the rise in America.

There are a couple of important reasons for the global decline--urbanization and women's liberation. Although in most societies men (especially older men) tend to have the highest suicide rates, in China and India (the world's two most populous countries), the burden of suicide was often on women trapped in a relationship and family that was not of their choosing. Indeed, a few years ago I blogged about the fact that urbanization in China seemed to be lowering their suicide rate.

The graph below, based on data from the University of Washington's Institute for Health Metrics and Evaluation, compares the recent trends among several countries, and you can the U.S. pattern is different from the global pattern:

In the U.S., we have two important things that contribute to the rise, and I've blogged about both in the past: (1) the "sea of despair" that has taken root especially among white working class Americans; and (2) the availability of guns. Both of these are within the purview of public policy, and the lack of legislative initiatives on these underlying contributors to suicide almost certainly explains the rise in the rate of suicides in the U.S.

Is There a Looming White Minority in the U.S.?

A front page story in today's NYTimes by Sabrina Tavernise has the obviously provocative headline:
"Why the Announcement of a Looming White Minority Makes Demographers Nervous." At issue is the Census Bureau's classification of race and ethnicity, and how that factors into their population projections, and then how people interpret those data. Is the fear (stoked by Census Bureau projections) that Whites are on the verge of becoming a minority group in the country one of the things that has ramped up populist rhetoric?

In a nation preoccupied by race, the moment when white Americans will make up less than half the country’s population has become an object of fascination.

For white nationalists, it signifies a kind of doomsday clock counting down to the end of racial and cultural dominance. For progressives who seek an end to Republican power, the year points to inevitable political triumph, when they imagine voters of color will rise up and hand victories to the Democratic Party.

But many academics have grown increasingly uneasy with the public fixation. They point to recent research demonstrating the data’s power to shape perceptions. Some are questioning the assumptions the Census Bureau is making about race, and whether projecting the American population even makes sense at a time of rapid demographic change when the categories themselves seem to be shifting.

This is not a new topic of conversation. You may recall my blogging about it a few months ago. As Dowell Myers at the University of Southern California said back then, and again in today's story, the Census Bureau defines "white" in a very narrow way that does not take into account the kind of intermarriage that is going on and which, in essence, is continuing to have a "melting pot" effect. The way racial/ethnic categories are defined creates the image of a reality that doesn't reflect the real world. On that point, here is my favorite quote from the story:

Mary Waters, a sociologist at Harvard University [more about her at this blog post], remembered being stunned when she saw the research. “It was like, ‘Oh wow, these nerdy projections are scaring the hell out of people,” she said.

"The question really for us as a society is there are all these people who look white, act white, marry white and live white, so what does white even mean anymore?” Dr. Waters said. “We are in a really interesting time, an indeterminate time, when we are not policing the boundary very strongly."

Why does the Census Bureau even ask these questions? When Richard Nixon was President he wanted to get rid of them, but the argument then, as now, is that they help us track discrimination and other kinds of inequalities. But, are these data more dangerous than helpful? The country needs to have a big discussion about this.

A closely related problem is the extent to which the concern about race/ethnicity gets mixed in with the migration policy issue. Read the interview with Hilary Clinton about migration in today's NYTimes and see what you think...

Pregnancy Related Deaths Higher in US than any other Rich Country

The New York Times today published an article that fortunately has gotten a lot of attention. It details the tragedies of women and their babies dying because of pregnancy-related problems. To be sure, there is a reason why people have always said that "getting pregnant may be the most dangerous thing a woman can do," but maternal mortality rates have come down dramatically all over the world. Yet, here in the United States the rates are higher than in any other rich country, according to data compiled by the World Health Organization, and they have been going up, not down, according to the U.S. Centers for Disease Control and Prevention. Here's their graph of the trend:

The reason for the increase, and for the fact that the U.S. is higher than other rich countries seems to have a simple remedy--examine every such incident and figure out what went wrong and circulate that information so health practitioners won't keep making the same mistakes. You might think that everyone would want to do that, but sadly you would be wrong.

It wasn’t until 2003 that states started adding a pregnancy check box to death certificates, and some didn’t do so until the past two years. “Thiscreated a data mess where nobody could figure out what the national trends were,” she said. She described this as “a huge missed opportunity for intervention in conjunction with the Millennium Development Goal.” At the same time, “the National Center for Health Statistics, which is the government agency responsible for publishing maternal mortality data, completely stopped publishing it.” 

The only exception in the United States was California, where, in 2006, the Stanford University School of Medicine worked with the state to create the California Maternal Quality Care Collaborative. The initiative developed “quality improvement tool kits” that doctors and hospitals could download. They included detailed instructions about best practices for various preventable complications that can arise during or after pregnancy, like hemorrhaging and pre-eclampsia.

As a result of this initiative, between 2006 and 2013, California saw a 55 percent decrease in the maternal mortality rate, from 16.9 to 7.3 deaths for every 100,000 live births. During that same period, according to The Washington Post, the national rate increased — from an estimated 13.3 to 22 deaths in 100,000.

Next door, in Canada, the rate is 7 per 100,000, and in Switzerland it is 5, just to give you a sense of where the U.S. stands. 

People Are Waiting Longer to Get Married

One of the central points raised by the theory of the Second Demographic Transition is that young people in richer countries are growing up with ideas of what to do with their lives besides the time-honored tradition of marrying and having kids. Today the U.S. Census Bureau reminded us of this trend with data from the Current Population Survey. Here's the pattern over time in average age at marriage for males and females in the U.S.:

The graph starts back in 1890 when the rise in the age at marriage (relative to earlier years not shown in the graph) was associated with the beginning of the decline in fertility. This was prior to the advent of effective methods of contraception, so delaying marriage (which in those days also meant delaying the onset of sexual activity) was a way of limiting fertility. The post-WWII period changed all of that and set in motion a round of early marriage and childbearing that produced the baby boomers. But the younger generations have been consistently delaying marriage, although not necessarily delaying sexual activity. In the process, they are creating a very different set of family and household relationships than we've experienced before. This is, of course, why family demography is such a key element in modern social science.

The Demographics of the Far Right Movement in Germany

My thanks to a reader who pointed me to an article in the NYTimes that I had missed a few days ago, about the demographic factors in East Germany that are helping to drive the far right movement in that country. It seems to take us back to the "tearing down of the wall." From this distance that just seemed like a universally good thing (well, unless you were a big shot in East Germany's Communist Party). However, this article suggests that West German men came in to run businesses and governments in East Germany, and East German women were at the same time heading west, leaving behind a lot of spouseless and jobless East German men. The story starts out with an interview of one of these men...

...Frank Dehmel was on the streets of East Germany in 1989. Every Monday, he marched against the Communist regime, demanding freedom and democracy and chanting with the crowds: “We are the people!” Three decades later, Mr. Dehmel is on the streets again, older and angrier, and chanting the same slogan — this time for the far right.

He won freedom and democracy when the Berlin Wall came down 29 years ago on Nov. 9. But he lost everything else: His job, his status, his country — and his wife. Like so many eastern women, she went west to look for work and never came back. To understand why the far right is on the march again in Germany, it helps to understand the many grievances of its most loyal supporters: men in the former Communist East.

Although Angela Merkel--Germany's leader for the past 13 years--is from the East, there is the sense among these men that she betrayed them, and that was even before she encouraged a million asylum seekers (largely from the mess in the Middle East) to settle in Germany. 

“We have a crisis of masculinity in the East and it is feeding the far right,” said Petra Köpping, minister for integration in Saxony. When Ms. Köpping took office in 2014, she thought her job was to integrate immigrants. But as hundreds of thousands of asylum seekers began arriving in Germany a year later, a middle-aged white man heckled her at a town-hall-style meeting. “Why don’t you integrate us first?” the man had shouted. That question, which has since become the title of a book written by Ms. Köpping, prompted her to tour her eastern home state and interview dozens of angry men. The disappointed hopes and humiliations of 1989, she found, still fester.

And Ms. Köpping notes that when the wall came down, it was women who were most likely to jump at the new opportunities:

Long before the #MeToo movement, Communism succeeded in creating a broad class of women who were independent, emancipated, often better educated and working in more adaptable service jobs than eastern men.

After the wall came down, the East lost more than 10 percent of its population. Two-thirds of those who left and did not come back were young women.
It was the most extreme case of female flight in Europe, said Reiner Klingholz, director of the Berlin Institute for Population and Development, who has studied the phenomenon. Only the Arctic Circle and a few islands off the coast of Turkey suffer comparable male-female imbalances.

In large swaths of rural eastern Germany, men today still outnumber women, and the regions where the women disappeared map almost exactly onto the regions that vote for the Alternative for Germany today.

This is an important story for several reasons, including the fact that the rise of the Far Right in Germany seems to have a different set of underlying (albeit clearly still demographic) causes than those in the United States (and probably anywhere else). We need to keep that in mind as we digest the news. 

Demographics of Homelessness

Voters in San Francisco today will decide the fate of a local proposition aimed at coping with the growing number of homeless persons in that city. Indeed, homelessness is generally on the rise in California, and Los Angeles passed a proposition two years ago to deal with the issue. Although there are a variety of causes, a NYTimes story adds a new wrinkle:

Dennis Culhane, an expert on homelessness at the University of Pennsylvania, says there is also a much more unappreciated factor: demographics.

The current acute homelessness crisis in cities across California corresponds with the coming-of-age of the millennial generation, which at its peak in the mid-1990s had more births than at any time since the baby boomers of the 1950s and ’60s. A previous bout of severe homelessness came in the 1980s, when the second half of the baby boomers were in their 20s.

What does demography say about the future of homelessness in California?

Nationally, births declined for seven years from the millennial generation peak of 4.2 million. There may be some hope in that. Yet the millennial cohort will be with us for decades longer — and Dr. Culhane believes it will take a “massive infusion of resources” to assist the neediest among them. “At the scale of homelessness we are witnessing on the West Coast, little pilot efforts here and there are not going to make a dent,” he said.

There is also a state-wide initiative on the ballot--Proposition 10--that would allow widespread rent control in an attempt to keep rents from rising to the point that people are forced out of their homes--and thus into a state of homelessness. Rising rents and rising income inequality in California are also creating demographic pressures in the state. This is yet another good example of demography as "a drama in slow motion."  Stay tuned!

Immigrants Actually Subsidize US Health Care, Rather than Bringing Diseases

There has been a huge deal made about the demographic characteristics of the "caravan" of immigrants heading through Mexico on their way from Central America to the United States, where they apparently hope to seek asylum. Fox News and the Trump administration have repeatedly suggested that they are bringing small pox and leprosy. This is clearly nonsense. The World Health Organization declared back in 1980 that small pox had been eradicated from the world (thank you, vaccinations!!). Leprosy is still with us, but almost all cases are concentrated in Africa and South Asia, so it is unlikely that anyone in this group heading north has been exposed to the disease. We can put those negative ideas to bed with regard to this group of migrants, or any other group of people coming into the U.S. (all of whom are, of course, subjected to medical exams in all events).

What about the positive aspects of immigrants? In my last post, I mentioned that the Baby Boomers are really going to need some young immigrant workers to help pay for their retirement. It also turns out that immigrants are a net economic benefit to the health care system in this country. Many thanks to Professor Rubén Rumbaut for a link to a blog post in AcademyHealth by a physician who is Director of Research at the Institute for Community Health in Massachusetts.

Published in the October edition of Health Affairs, findings from our study using nationally representative data show that immigrants heavily subsidize private insurance of US-born enrollees and boost profits of private insurers.

For many immigrants, such as undocumented immigrants or those residing legally in the US for fewer than five years, private insurance is often the only coverage option. Because immigrants are mostly working-age adults with high rates of labor force participation, many enroll in job-based coverage.

Our study was the first to look at immigrants' role in financing private health insurance. We used data from the Medical Expenditure Panel Survey and the Census Bureau’s Current Population Survey to determine immigrants' premium contributions to private insurance, including premiums that employers paid on their behalf. Then we tabulated all payments that private insurers made to doctors, hospitals, and other providers for immigrants' care to determine whether immigrants paid more or less into private insurance than they used. Undocumented immigrants, who generally use little medical care, generated the largest surplus at $1,445 per enrollee. The surplus contributed by immigrants offset a per enrollee deficit among US born individuals of $163. Previous research shows that insurance outlays for immigrants are low because they are relatively young and healthy, and often face linguistic and other barriers to care.

This is the "real" side of immigration. The U.S. is a nation of immigrants, and the only people who can realistically complain about that are Native Americans.