Some grim news has emerged revealing the sad decline in the health of the United States. America saw its most significant 2-year fall in life expectancy, 2.7 years, in almost 100 years. This has led to U.S. life expectancy being at its lowest since the mid-1990s. This unprecedented fall requires deep examination.

 While COVID is a major cause behind this decline, another disturbing cause of mortality also demands our urgent attention. The so-called “deaths of despair” – a term used for deaths attributed to suicide, drug overdoses, and alcohol-related disease coined by Princeton economists Anne Case and Angus Deaton – have also been rising during this time.

The rise of “deaths of despair”

Fentanyl overdoses, for example, are now the leading cause of death among people ages 25 to 45 exceeding the previous leading cause, motor-vehicle accidents. The CDC has also reported seeing an increase in drug misuse and alcohol-related deaths among the elderly. This rise in substance abuse should not be confused as afflicting only the young and old. Nearly two-thirds of the nation’s annual average of alcohol-related deaths is among working-age Americans who succumb to these deaths during their most economically productive years. These worrying trends mirror those of mental health, which show one in six U.S. adults using at least one drug for a psychiatric problem. 

While COVID has appropriately received large attention and action, the “deaths of despair” have not, even though they have been rising in parallel with those due to COVID. These deaths are, by many measures, an epidemic occurring alongside the COVID epidemic. The obvious questions emerge: Why have they risen, and what should be our response?

Loneliness and its discontents

To read deeper beneath the headlines of these “deaths of despair,” we can look to the work of famed sociologist Emile Durkheim who wrote about them more than a century ago. Durkheim argued that larger social phenomena resulting in the loss of dignity in people’s lives and the breakdown of communities around them provide the backdrop to these deaths or to what he referred to as anomic (alienated) suicide.”

While the extent of modern social phenomena behind “deaths of despair” today may be too voluminous to explain in one article, one disturbing trend deserves our close scrutiny: loneliness.

Research has long confirmed the sustained decline in essential relationships or “social capital” in the United States and Western democracies. Examples abound: Fewer families report consistently having dinners together, even less if we count those uninterrupted by technologies; Church attendance or even faith group affiliation, traditionally a source of meaning and connection for many, has also sharply fallen; few share any relationship with their neighbors other than living proximity. Though these trends began long before COVID, they likely accelerated during the pandemic as “social distancing” and “quarantine” necessarily became the norm.

 Johann Hari has masterfully written about loneliness in his book Lost Connections: Why You’re Depressed and How to Find Hope. Essential connections, he writes, take many forms: to meaningful work; to other people and community; to meaningful values or philosophies; to happy childhoods; to a sense of respect; to the natural world; to a sense of a hopeful future. To be severed of any of these “connections,” Hari warns, comes at a high cost to well-being.

An argument can be made that our lost connections, in any form that Hari has written, are the raw timber upon which the flames of “deaths of despair” have been ignited. This may be the modern variant of the individual alienation and social upheaval behind the “Anomic Suicides,” which Durkheim posited long ago. Hence, the “deaths of despair” may be the symptom of greater social pathologies, loneliness among them, that require our healing.

Our response as community

Understandably, medicine, its spaces, and practitioners can only do so much in the face of complex social phenomena. However, this alone cannot be a reason to renounce any responsibility. As overburdened as they are, clinics and providers can be instrumental in diagnosing and perhaps even rekindling “lost connections.” In a practice known as “social prescribing,” clinics can be bridges to the community by collecting and sharing resources on social gatherings, community spaces, and activities of mutual interest.

At the level of government, Surgeon General Vivek Murthy has already done an exemplary job of raising loneliness to the level of a public health crisis. Another step would be speaking more directly about the “deaths of despair.” The steep rise in these deaths requires a heightened public consciousness and a greater collective response, which only governments and elected officials can summon.

None of this can be in lieu of one’s thoughtfulness. The adage, “I am my sister’s and brother’s keeper,” must take on new meaning and urgency in our lives. Check-ins, even brief ones, on family and friends we have not heard from in a long time can work wonders for someone otherwise suffering silently and feeling adrift. To the extent possible during this era of viral pandemics, social gatherings should become more commonplace and include more of those outside our closest circles. No amount of medicine or scope of public policy can replace or replicate this essential brick-by-brick construction of the community.

This, however, is only possible when our real presence replaces virtual ones: our conversation and gatherings can no longer be mediated by social media nor be constantly intruded upon by the barrage of technological diversions so ubiquitous to modern life.

The rise of the “deaths of despair” concurrent to and partially responsible for the historic decline in life expectancy should raise the alarm for everyone concerned for the health of our country. The news of these deaths may be harrowing, their causes complex, and the solutions to them even more difficult to come by – but this should not lead us to throw up our hands in futility or hopelessness. By raising the call for spreading goodwill and strengthening the community, we can begin to mount the response to overcome these disturbing trends.

Mohammed Umer Waris is a family medicine resident.