A paramedic loads a cleaned stretcher onto the back of an ambulance before heading out for another call. The pandemic has only exacerbated decades-long trends in American death rates described in a new report.
CNN  — 

Younger and middle-age Americans have been dying at higher rates over the past three decades, marking what is becoming a public health crisis across the US workforce.

Among the causes of death increasingly striking working-age Americans between 1990 and 2017 are drug overdose, alcohol use and suicides, according to a new report published Tuesday by the National Academies of Sciences, Engineering, and Medicine.

Cardiometabolic conditions, which include diabetes and heart diseases, are another major driver toward the trend that Americans are more likely to die before age 65 than those who live in other rich nations.

Young adults between ages 25 and 44 have grown up amid an obesity epidemic, often with unhealthy diets and a lack of safe, open space for exercise, the authors of the report point out.

“We’re losing more and more Americans in the prime of their lives, in their most productive years and in their parenting years,” said Kathleen Mullan Harris, a professor of sociology at the University of North Carolina. She chairs the Committee on Rising Midlife Mortality Rates and Socio-Economic Disparities, which authored the report.

Declines in life expectancy over decades

The committee, which included researchers from universities around the country, was convened to help explain why US life expectancy had plateaued, and then declined in recent years.

“Beginning in 2010, progress in life expectancy stalled in the United States. Then between 2014 and 2017, life expectancy fell for three years in a row,” Harris said in a news conference on Tuesday.

The three-year slide was the largest sustained decline in life expectancy since the 1918 flu pandemic.

The commitee did not examine data from the past year, but its final report comes after the US Centers for Disease Control and Prevention reported that overall US life expectancy had dropped a full year in the first half of 2020, during the Covid-19 pandemic.

The current pandemic has only exacerbated the underlying trends driving down life expectancy in working age Americans, particularly in how disparities in health affect working class communities avnd people of color.

Higher death rates since 1990 among Black Americans can be traced to inequalities in socioeconomic status, health care, housing and education – all driven by historic systemic racism, the report noted.

During the 27-year period highlighted in the report, fatal drug overdoses rose sharply particularly in Appalachia, New England and the industrial Midwest, as the market was flooded with highly addictive prescription drugs. And the rise in suicides was most pronounced among white men.

“The period during which this mortality rate occurred was a period in which many parts of the country and many communities suffered significantly in terms of their economic circumstance,” said Dr. Steven Woolf, a committee member, and a professor in the department of family medicine and population health at Virginia Commonwealth University School of Medicine.

A prescription for change

The authors offered a number of recommendations to address the increased death rates, including strengthening regulatory control of prescription drugs and improving access to substance abuse and mental health services.

They argue that obesity prevention programs ought to begin early in life. And they should target those most at risk, including racial and ethnic minorities, as well as women and those living in poverty.

But beyond direct public health interventions, the researchers pointed to ways in which our social fabric can be adjusted to increase life expectancy.

“We also have to look upstream to what you might call the causes of the causes,” Woolf said during the news conference. “What are the living conditions, what is it about life in America that is increasing the vulnerability of our communities, families, and individuals?”

The report recommends using the Affordable Care Act to expand Medicaid coverage in states that haven’t done so yet.

“Our committee reviewed the literature, showing that Medicaid expansion is associated with significantly better health outcomes,” Woolf said.

While those economic trends manifest differently in different regions, they span the racial divide.

“We really need to think about the economy and how it’s left certain communities that very vulnerable – for example, to the collapse of manufacturing jobs and mining jobs – how to adapt our social and economic policies in a way that not only rescue their economic circumstances but also improve their health,” Woolf said.

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The report’s final conclusions call for engaging policymakers to dismantle structural racism and discriminatory policies in areas such as education, housing, lending, civic participation and criminal justice.

“It remains a priority for us to confront this as a nation and to pursue policies that will help us dismantle those historic policies and practices that have excluded so many from achieving their best possible health outcomes,” Woolf said.