Midlife Public Health Crisis: Economists Discover What the Epidemiologists Missed

Amid the hustle of the APHA Annual Meeting this week some may have missed the striking new paper on the declining health status of middle-age white Americans by Princeton’s Anne Case and her colleague/spouse this year’s Nobel prize winning economist Angus Deaton. Making elegant use of some of our key national health datasets, the researchers show that a confluence of mental health problems, chronic pain, inability to work, and substance abuse track closely with an escalation in suicides, alcohol and drug deaths since the turn of the 21st century. Most shockingly, these trends have been sufficiently persistent and large to drive up all-cause mortality at midlife among white non-Hispanic Americans during the period 1999-2013. The dramatic rise in mortality and midlife distress among those age 45-54 was concentrated among those with fewer years of education.

The rise in mortality and decline in life expectancy among such a sizable demographic group over a relatively brief time frame is nearly unprecedented in the 21st Century American population. Case and Deaton note that only the HIV/AIDS epidemic has done this much damage to public health in modern times. The demographic timing of this health shock during prime working and earning years also means that the economic consequences are considerable and likely to contribute to a sluggish U.S. economy.

These new findings on the declining fate of white mid-life Americans, combined with our existing knowledge about the persistent health disparities faced by racial and ethnic minority groups in the U.S., should be a call to action for those of us who study public health delivery and financing systems. It is not clear who if anyone is being well served by our status quo approaches to protecting and improving population health. Surely we can find ways of retooling the U.S. public health system so that it becomes more responsive and more effective in detecting and addressing key population health dynamics.

Such retooling will require strengthening the public health system’s engagement with and influence on larger social, economic, and environmental systems that shape health and wellbeing, which are likely at the heart of America’s midlife crisis. Check out our new Systems for Action Research Agenda for ideas on how systems and services research can help us get there.

I invite you to comment on this blog, tweet at me, nudge me on linkedin, and follow my research archive.

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