Financial despair, addiction and the rise of suicide in white America

http://www.theguardian.com/us-news/2016/feb/07/suicide-rates-rise-butte-montana-princeton-study

Chris McGreal
Sunday 7 February 2016

Kevin Lowney lies awake some nights wondering if he should kill himself.

“I am in such pain every night, suicide has on a regular basis crossed my mind just simply to ease the pain. If I did not have responsibilities, especially for my youngest daughter who has problems,” he said.

The 56-year-old former salesman’s struggle with chronic pain is bound up with an array of other issues – medical debts, impoverishment and the prospect of a bleak retirement – contributing to growing numbers of suicides in the US and helping drive a sharp and unusual increase in the mortality rate for middle-aged white Americans in recent years alongside premature deaths from alcohol and drugs.

A study released late last year by two Princeton academics, Anne Case and Angus Deaton, who won the 2014 Nobel prize for economics, revealed that the death rate for white Americans aged 45 to 54 has risen sharply since 1999 after declining for decades. The increase, by 20% over the 14 years to 2013, represents about half a million lives cut short.

The uptick in the mortality rate is unique to that age and racial group. Death rates for African Americans of a similar age remain notably higher but continue to fall.

Neither was the increase seen in other developed countries. In the UK, the mortality rate for middle-aged people dropped by one third over the same period.

“This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround,” the study said.

Deaths from poisonings by drugs or alcohol have risen dramatically to push lung cancer into second place as the major killer with a sharp increase in suicides now a close third.

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Other officials see a number of interconnected forces at work and the rising rate of middle-aged deaths as indicative of crisis wider than those who kill themselves.

Growing economic inequality and increasing financial struggles are intertwined with other issues such as health and addiction. Some people living on low incomes hesitate to go to the doctor even if they have medical insurance because of the cost of out-of-pocket expenses. Chronic conditions can go untreated and become debilitating.

Pain is a driver of alcohol abuse and addiction to opioid painkillers, which in turn is feeding a growing heroin epidemic in the US. Stress and mental health issues are sometimes driven by constant worries about money and fear for the future as growing numbers of Americans look into a financial abyss at retirement.

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So what’s changed to drive up the rate of people taking their own lives in recent years?

“Probably the biggest reason is socio-economic. We have about 150,000 people in our state that don’t have access to any type of healthcare, which is a major issue. We have a lot of people living in poverty. Wages are not going up at the same pace as rising health costs, rising cost of living and inflation,” Rosston said.

“Definitely you see a lot of people that all of a sudden they hit 45 or 50 and they don’t see retirement as a bonus. They see something that they’re going to have struggle with and they’re not going to be able to retire.”

Sullivan sees that as tied up with “the expectation that as a middle-aged white person you would outdo your parents economically and socially, and that didn’t occur”.

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In searching for explanations for why the US is alone among developing countries in grappling with a rising death rate among its middle-aged white population, Lowney contrasts his situation with a cousin, a fisherman in Ireland who was injured in a work accident at sea and spent a year in hospital.

“He told me it cost him 39 euros. That’s all because of the health system they have in Ireland,” he said.

Lowney ran up most of his debts before Barack Obama’s healthcare reforms. They have been a big leap forward for many Americans by, among other things, preventing insurance companies from cutting people off mid-treatment or capping payments for expensive medications, such as for cancer. But even with subsidized rates for low-income families, a trip to the doctor can still prove expensive because most insurance policies require holders to pay the first few thousand dollars each year before coverage kicks in.

That has put many people in the position of paying for insurance but being unable to afford to go to the doctor.

According to the Butte-Silver Bow Community Health Needs Assessment for 2014 23% of people in Montana have no health insurance.

But the report said that even among those with insurance, nearly 40% faced obstacles to receiving needed healthcare. About one-third said they could not afford the cost of the doctor or prescription. Nearly 8% said they lacked transport to get to a clinic. More than 11% said they skipped or reduced prescription doses in order to save money.

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“I’ve heard that the majority of Americans are afraid of even a $500 emergency. They’re one broken refrigerator away from not being able to make it. That’s us.”

That may go some way to explain the differing middle aged death rate with other developed countries that have extensive welfare systems, free or cheap health care and greater support for pensioners. The proportion of US pensioners living in poverty is more than double that in Germany and nearly six times that of France. Few western Europeans are fearful of losing their homes to pay medical bills.

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