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.