Life expectancy continues to fall. What is this distinctly american phenomenon that you found . Well, mortality rates are not supposed to be going up for the past century and most wealthy countries, the u. S. Included, weve seen our Life Expectancy in the u. S. , the mortality is supposed to be going down, but it is backwards. What we have seen is the death rates in the working age population increasing, and reversing years of progress that we have made in improving the health. What is behind the study . Why did you do it . Well, our center of society and health at vcu studies the Population Health trends as have other experts in the field. And we have been aware of something awry for many years, and recently many years of Life Expectancy decline for three years in a row, but the analysis is showing decades of the making and the u. S. Started to fall since the 1980s. How does it stack up against other countries in the same time span, and other economicallydeveloped countries. That is the concern that other high Income Countries have seen their Life Expectancy decline while this decrease is occurring in the u. S. Going back in time to the 1980s, the u. S. And the other countries were seeing the Life Expectancy improve in a healthy clip but in the 1980s we started to lose pace and the rate of increase fell off. By 1980, we had fallen behind the oced average and by 2011, we had plateau and now decreasing. So these other countries who spend less on health care than we do are continuing to see the Life Expectancy climb. And so in the journal of medicine they write that the major contributor that has been an increase of the mortality of specific causes drug overdoses, suicides, organ system diseases among all racial and adult groups since the 1990s and with the largest increases happening in the ohio valley and new england, and the increasing cases of midlife mortality are broad and thus working with the employers and the economy and the national security, and the trends affect parents whose children are more likely to die and their own health at risk when they reach that age and sooner. And the states with the biggest increases in the midlife mortality rates, New Hampshire with 23 , and maine with 21 , and vermont with 20 , and West Virginia 23 , and ohio with 22 and indiana 15 , and dr. Wolf, over what time period is this increase . Since 2010. So between 2010 and 2017. So seven years . Yes. And we read off a number of things in the comment, and if you had to tick off the top one, two, three, what would it be . Drug overdoses is the major contributor to the trend which is fueled by the Opioid Epidemic set in motion in the 1990s when oxycontin was license and led to the cascade of the problems with opioids and elicit opioids like heroin and fentanyl, and that is the major contributor to the trend, but hardly the only one. We have seen increased death rates from alcoholrelated diseases and suicide and that cluster of three conditions, drugs, alcohol and suicides have been sometimes been called the deaths of despair, but we found increases of death rates from dozens of organ diseases and diseases like diabetes and obesity and all totaled 35 causes of death that have increased the morbidity. And that contributes to the lifestyle, doesnt it . Yes, things like obesity is a major contributor to the problem, but the mechanisms for some of the other diseases, and some are related to Health Behaviors and some are related to the quality of the health care that people are able to obtain and some of them have a lot to do with the Living Conditions, including the social environment. And dr. Steven wolf is with us to talk about the increased mortality rates in the United States and the Virginia Commonwealth University study and he is one of the lead authors on that report. And we would like to hear from you. If you are under the age of 25, use 2027488000 and between 24 and 64 that is 8001 and for all others over 65 and over that is 2027848002. So 2027488002. We will get to the phone calls momentarily, and tell us how you went about collecting the data for this report. Well, we looked at two kinds of data, and looked at Life Expectancy and mortality rates that are recorded in all 50 states around the country. And the Life Expectancy data comes from the mortality rates, and the morbidity is from the disease prevention. And our study goes back to 1959, the year i was born, and we looked at it from the longterm perspective to get a sense of when all of this started and the other unique thing that we did is to look at the data from all of the census divisions and 50 states, which is intentional to help us to locate what parts of the country were most deeply affected. We think about the American Health or the u. S. Health statistic, and it is shaped by 50 states, and we wanted to try to understand which states were driving the trend. As we are talking about this morning, a reminder that you can read the report at societyhealth. Vcu. Edu, and does your report suggest any solutions . Well, it was hard enough to document the scope of the problem, and our research did not focus on proving the causes and what they were, but we did walk through a number of possibilities and frankly, our field needs more research to definitively prove the causes, but there are bread crumbs here in the data, and one has to do with the geography of where this is happening the most. The ohio valley seems to be ground zero of where this has happen and we have calculated how Many Americans have died the excess deaths because of the increase in 2010, and in four states out of the 50 state, and four states accounted for onethird of the excess death, ohio, pennsylvania, kentucky and indiana. And many other areas of the rust belt and central appalachian were deeply affected. So that makes us answer the question, why there . What is it about that part of the country that has been so deeply affected. And so we talk about some potential explanation, and obviously, we can blame a lot of it on the Opioid Epidemic, and these are the areas where the opioids are prevalent, and gaps in the Health Care System, and obesity are all potential factor, the but when you are realizing that there are 35 causes of deaths where the mortality has increased, it makes you wonder about the systemic cause of the problem. And interesting to be mentioning ohio, because the New York Times is publishing this morning and online interactive about the class of 2000 in minford, ohio and the School Yearbook as a staple of teenaged life, but for some it reflects the devastating toll of opioid crisis, and they go to the area for the photos in this yearbook, and think go through some of the people, and many of the people who have been affected by it first in their lead here is oxycontin just started to show up. Purdue pharma introduced the opioid painkiller when the class entered high school, and some of the students began to experiment, and combining opiates with the alcohol at parties and something best seen online at nytimes. Com. Yes, one of the more disturbing findings in the study is that younger adults, and that is including some of the people featured in the story aged 2534 is where we have seen the largest relative increase in mortality rate, and 29 since 2010. Some of the data just in the last year or two is beginning to show in late teens and early 20s, the numbers creeping up, and it is concerning. Lets hear from you, and by the way the line for those of you under 25, 7488000. We go to steven in milwaukee, and thank you. Go ahead with your question or comment. Caller i have a couple of things. First of all, i practice in the general internal medicine from 1976 to 2011, and on the north side of milwaukee. And the oxycontin thing was a governmentcreated disaster because we didnt have people, anything like a narcotic problem until the government let that stuff out. That is just absolutely criminal. I mean, there was no use for it, and people with pain could take vicodin or tylenol 3 or 4 or percocet, and if they had to take more than one pill a day, there isnt anybody who took percocet who needed to take it more than three times a day, and most of them took it once a day or twice a day. And so the longacting 24hourplus oxycontin created so many deaths. And the much bigger thing in terms of the death in the cardiovascular area was fructose. Corn syrup . Which is a what they call corn syrup, and a high fructose corn syrup. This is a poison. Fructose, and there sis a i thik a pediatric endocrinologist working out of california, i think, who they did metabolic studies and showing just how bad fructose is for you, even though fructose is a natural sugar and fivecarbon sugar unlike fructose with a sixcarbon sugar and the body doesnt know what to do with it. What about you, dr. Wolf . Yes, steven is making some point, and there is a parallel of the issues both of what happened with the opioids and high fructose corn syrup, and both cases we are seeing where the policies in terms of the private sector and promoting products and the Public Policy converged to create some the root causes of the issue. And so we had a drug manufacturers promoting a product which is currently under investigation as to how much knowledge they had of the potential dangers of the drug and whether regulatory governmental bodies were careful enough in scrutinizing how the products were promoted. A very gullible medical professi profession, and im a physician myselfb and fell victim to the advertising and felt it was important to prescribe the drugs. So there is the convergence of the industry incentive and lax government oversight, and with the case of the obesity, obviously, we are all personally responsible for what we put in our mouth, but we are in the environment where we are heavily influenced by the advertising and marketing and consumption of the food chain, but policies around the agricultural subsidies led to the production of fructose corn syrup which became the predominant sweetener in the food and may have fueled the obesity epidemic, and that is a big driver in the trends of obesity. And we go to the lines, and nicolas of lindenhurst, new jersey. You are on the air. Caller yes, a question for dr. Wolf. I am wondering specifically, if you see a correlation between the United States becoming officially the most overworked society compared to say japan, and what is referred to the blue zone, and you see the difference of the access to health care and Infectious Disease care, and how that affects the longevity. And explain to us what a blue zone is if you know. The caller is referring to areas that have disproportionately high Life Expectancy. Is that what you are referring to, caller . I let him go. And the point is to what extent is this due to an overworked society. I dont know if we can say for sure that the trends that we are seeing is due specifically for, that and it is true that in other countries there sis a les intense work culture and more vacation time, and more time for family, but it is hard to tease out how much we are seeing that is due to that and how much has a lot to do with the social policies and programs that exist in other countries to help families and communities that are falling on hard time buffer the impact of the conditions without it hurting the health. There is poverty in every country, and people lose their jobs in every country, and the support systems to fall back on may be stronger in other countries than the u. S. Where the culture tends to expect people to fend for themselves when they run into these problems. Does the issue of stress play into this . The u. S. As a country where people express or report more stress whether it is related to work, psychological stress . There is increasing concern that stress is a big factor here. When we think about, again, the geography of where this is happening, the rust belt, and areas where people have been struggling in the middleclass with hard economic deprivation for many year, that creates chronic stress, and we live in the social environment that is creating chronic stress, and we know that chronic stress is bad for the body and damages organs, and the stress itself could be harming our health, and unhealthy coping behaviors in dealing with stress could be harmful, and so for some people that means to turning to alcohol or drugs as a way of dealing with their pain, physical or psychic, and for other people, it might be turning to smoking, and maybe overeating, and in some people acting out. And we have seen increases in the homicide rates in this age group, and stress may be an important root cause for a lot of the problems that we are seeing. To johnstown, pennsylvania. Joh john . Caller good morning. How about death by gun, and those other countries that are doing better than we are dont have a nra or a Second Amendment. And the Second Amendment is not a commandment, it is an amendment and it can be amended. Recently in philadelphia, a girl stepped off of the bus, and 16yearold girl and shot to death. So this is what we have to deal with in this country, sadly. So lets bring up the gun issue, too. Thank you. Yeah, and without getting too much into the politic, because i hear there are some Politics Around the gun issue, but the data clearly show that this increase that we are seeing in the suicide rates in the age group, and as i mentioned a moment ago the homicide rates, most of the deaths involve firearms, and in fact, when we did the analysis looking at the state level mortality trends, one of the interesting findings that we found is that in general suicide rates by firearms have increased over this period of years that we are discussing, and four states where it decreased, and those were the outliers and coincidentally, those were states that had a stronger gun control protection, and those states did see their firearm suicide rates decrease. As the data came in, how surprised were you and your colleagues on this . Well, to some extent we were not surprised, because we have been studying it for a few years and already had it on the radar. We were surprised by the pervasiveness of this problem and how many different conditions were showing this increase in mortality rates. And then when we did the state level analysis, we were quite struck by this concentrated impact in very specific regions of the country. And yeah, you mentioned the ohio valuelevalley. And the pacific rates, there was impact of the folks faring well. And this is a visual, where we started with this visual representation of that as dr. Wolf was talking about, and so the increases are barely at zero. So obviously, california is here, and wyoming, and lighter shades here, and obviously in the northwest and the Mountain West states. I wanted to move this up and show, because we have a number of people waiting on the 25 to 64 line, and this is the look at the mortality rates, and age adjusted mortality rates, and of that age group, and going back to that year, 1999 and just over 360 per 100,000, correct . We are now atticing back up, and it had gone down for many, many years, and the rise that dr. Wolf and the colleagues are reporting on. We will go to sun city florida, and sun city center, and jason, good morning. Caller good morning. Thank you for taking my call. I have two questions. One about how many human beings or little babies are born each day in the United States, and how many people die each day in the United States. Thank you. I dont know those numbers off of the top of my head. Okay. Next up is alexandria, virginia. Welcome. Caller hi. Hi. Thank you for taking my call. Sure. Caller i am calling in as the granddaughter of italian immigrants and i grew up in the northeast ohio and i consider what is going on up there to be a spirituality loss, because i feel that i have had to move across the country, and it is the diaspora that continues for my grandparents who are looking for a better way of life. I am no longer in ohio, because i have had to move to maintain employment. But there is a story about the italians there who banded together, and the rate of Heart Disease was nonexistent, and the cdc went there and studied that group. The spirituality and the group that gathered together to make sure that each were taken care of is i think significant, because in being, having to move across the country so much, and instability for our group from the rest of us in ohio plays a significant role. And just to close, Mother Teresa said that many are dying for a piece of bread, but many are dying from lack of love. Thank you for covering this. Yes, i wanted to talk about something that the caller brought up the importance of the social environment and the social fabric, and we have increasing Research Showing that the social connectedness is good for the health, and social isolation and to some extent being cut off of the spiritual support that we have whether it is faithbased or otherwise is also important to our health, and one of the theories about why in the u. S. We are seeing this decline in health might have something to do with the lack of social support systems that may exist in other countries where there is a tighter community where there is more of a sense of people having your back, and what academics call the social capital, and in rural parts of the country, there is a big part of social isolation and loneliness, but it is not restricted to the rural area, because other people in the suburbs may have felt disconnected than they did a generation or so ago. And were you looking at the numbers or yes, we are looking in this study with the numbers and on the ground, we are dealing with communities and on the ground. What is a followon for this reporting . Well, it is going off in many directions. One particular question has to do with why the state Health Trajectory started die ver ed de way they did. We found a pattern where the states Life Expectancy started to part with each other. So for example in new york, they had a lower life expect pancy tn oklahoma, but then they diverged and oklahomas began to climb. Maybe you say that is very different region, but adjacent states like alabama and georgia, the Life Expectancy started to separate, and we want to understand what that is about. We had a conversation about the closure of rural hospitals and the access to care in rural areas, and is that a factor . The Health Care System could be a very important explanation of the trend, and why in the u. S. And not other countriecoun because one of the big zegest in the lack of health care, and i mention it, because both of the groups have Strong Health insurance protection, the Childrens Health Protection Plan and medicare. Yes. For seniors. Linda is on the line. Thank you for joining in. Caller i am turning 65 this year. I think that a lot of it is traumatic brain damage due to the car crashes or guns. You know, we are living longer, and we have such a lack of medical care in some states that leave you to fend for yourself. And you know, the food, and everything has those sweeteners and everything, and we dont know what chemicals have been sprayed on our vegetables, because hardly anything is grown in our country anymore, and stress. You hit that one on the head. Stress is a big one. I cant work anymore, because of a traumatic brain injury, but i didnt cause, and it is hard to get by. Okay. Linda. Dr. Wolf. I am sympathetic to that, and people with disabilities whether it is traumatic brain injuries or other forms of disabilities are more vulnerable to falling through the cracks in the Health System especially in this age group again. And you have stronger protections if you are older with medicare and so forth, but in the working age population, and people who are dependent on the employment skills to support themselves, they are more vulnerable to falling through the crack, and it is a Ripple Effect on their health and the health of the family. To that point, your report says that, does it not, the death rate of infants and older people are improving . Yes, they are heading in the direction that we want to see, and the direction that working age mortality used to be headed which is decreasing. We have made Good Progress of lowering the infant mortality rates and mortality rates for children have fallen and among the older adults, the mortality rates are headed in the right direction. But if it is in the 2465 rage, t range, it would be affecting life Life Expectancy, correct . It is already affecting Life Expectancy and that is the motivation of the study. We knew about the decrease of the Life Expectancy and we wanted to understand what is driving it, and it is the working age population. Michael in deerfield. Good morning. Caller good morning. I think it is wonderful that you are touching on this subject, because it is so important to each of us, and our lives literally, and it is a epidemic of selftreatment in a sense is how i look at it, because that is exactly what these people are doing. I wondered the question for you would be does Adverse Child Experiences tie in with your work, number one, and the other thing they wanted to ask you about is if you have an ability to look at former smokers. I came across some data in the longevity data that says if you are a former smoker, there is a gene set activated that can increase longevity, and others said that you cant live past 110 unless you have had some contact with tobacco, but you have to quit before you die of cancer of course, but that is separate from your focus. And so separately, doesnt that indicate some type of social epidemic in that it is behaviorally transmitted like a psychobiological trauma that is being conveyed socially in a much larger sense where it is affecting things across the board, and in the same vein, i wonder if you would consider coming down to looking at broward county, florida, where we had the school shooting, and it is unusual that we have a School District to cover the entire county and we are coordinating and implementing best practices, but the kids are being traumatized and every week the children are going through a planned or unplanned drill, and we are trying to combat that and your work is pivotal to that, and i am wondering if you could speak to that. Well, that is covering a number of interesting things, and we wont have time to cover them all, but i want to talk about the a. C. E. S, which is adverse childhood experiences. This is what happens in the early part of life that shape the Health Trajectory over time. So we talk about the life course perspective, because the early years of the Early Childhood have a huge impact on what happens later in terms of the teenaged Health Problems and struggles with school, but later on with the risk of the chronic diseases up into old age, and that is interesting in this particular mystery, because we dont know whether this increase that we are seeing in the working age adults has something to do with what happened to them when they were young. There is an area of research that is called cohort analysis to look at when they were born and what happened to them that might have precipitated their vulnerability to these Health Problems, and so that Early Childhood crucible becomes very important. Lets hear from stephanie from long beach, california. Caller hi. Happy thanksgiving to you all. I would like to think that this is an intersection of many, many factors in the society. For one, the lack of job security of people of middle age, especially in the midwest. As you said, the effects of stress on the body lowers your immune system, and leaves you susceptible to other disease, but worry and stress. And interestingly enough in men, i think that there is a sense of shame that is very, very deeply felt, because they do not have job security, and they cannot provide for their families. When you think that most people in this country cannot afford an emergency bill of 400, you know that those families have incredible anxiety. As a result of the anxiety they selfmedicate and opioids are a part. The government has a part of the Opioid Epidemic, because it is the Drug Enforcement agency that proves how much oxycontin can be produced. Okay. Stephanie, i will let you off there. And we touched on the opioid comments, and the other comments she made. Yes, we talked about the stress and the social factors and emotional reactions to those, but we also talk in practical terms. The area of the country that is feeling this is the area of the country that is hit hard by the economy, so if you are struggling to make ends meet, there is a practical consequence that struggles with the housing costs, and that may mean that you are going to go to the doctor less often. You are less likely to afford the copayments and the deductibles, and the prescription medicine, and you cant do as good as taking care of the diabetes and the Blood Pressure, and so it is not complicated. And so the question is what do we need to do to bring the support and ease the stress on the families to have not only greater economic mobility, but better health. The california caller talked about job security and said that it is worse among men, and did your study find vast differences of the morality rate between men and women . For generations, the men have had a higher death rate than the women, and that is a norm, but what is disturbing here is that for many of the causes of death, the relative causes of death was higher in women than men. Again, this speaks to a potential explanation, because in this new economy, women are more vulnerable than men, because there is less support systems in place to help. We also found larger increases in people with less education, and say, lack of a high school diploma, and this is a population that is more vulnerable in the new economy. And we go to phelps, kentucky. Irene. Caller thank you. Good morning, and thank you for taking my call. I would just say that stress is a big part of what is going on with Peoples Health as well as drug and alcohol and all that, but a lot of time what gives people a lot of stress is like in the area where i live, there is nothing but minimum paying jobs, and that is what i worked at. I become disabled at that job and now i get 771 a month, and it is hard to pick what you are going to do, which bill you got to pay, and you know, you just cant eat healthy like you should on that kind of money. I agree. The caller is calling from kentucky, and this is one of those four states that i mentioned, and what she is speaking to is what we struggle with the policy. The previous generation who did not have the increase of working age mortality knew if they put in an honest day work with the employer, they could have job stability, and put money down on a home, and have their children get through school, but now we are in an economy where that rug has been pulled underneath them. And so the psychic stress of not having that security, but the Financial Stress of that to protect your health and the health of the children again speaks to policy priorities about doing more to support the middleclass, and providing good jobs that provide a livable wage rather than the current kind of the economic stresses that the families are facing. How would you view the results of your vcu study align with the Health Care Dollars that we spend per capita. And at the top is 10,586, and switzerland is the closest at 3,617 and then austria and the netherlands and others. I am not sure of the data that is coming from. July 2019. Okay. So back before i had gray hair, there were charts with the same pattern. So years and years, we have been outspending the health care in aggregate and per capita spending. This is a good teaching point, because it emphasizes that health care is not the answer. We overspend on the health care here in the United States, but the people are living shorter lives and sicker than people in other countries who spend far less on health care, and that is because, i am stating this as a physician, health care only accounts for 10 to 20 of the health, and the health is shaped by Living Conditions and the environment. We are missing the point when we try to solve this problem by lavishing more money on health care. And the next call is phil in morganson, georgia. Caller good morning. A question for dr. Wolf. I am struck by the large size of the cohort and it is a 40year age group, and the very long, longevity of the time of the study. Could you tell me what the change was in the mean and median age of the cohort over time, because i am wondering if we just got older on average. Thank you. Right. It is a very good question. I dont know how much your audience wants to get into the weeds, but the caller is asking how the age distribution has changed. Obviously if the average age is getting higher and shifting to an older age. Older society. Then that could make us look less healthy, because the people who are older tend to be less healthy, but the way we account for that is something called the age adjustment, and adjust the statistics to account for the age distribution, and the increase we are seeing is already accounting for the age distribution, which is the concerning part of that and even after the adjustment, we are seeing the large increases. And chris is in highgate center, vermont. Chris . Caller good morning. I think that im a perfect example of what you are talking about. And the Drug Companies are really to blame for this for 13 years, and that has just been made for the Cancer Patients and the post surgery and being on that heavy drug for 13 years, the last few years i had no quality of life. Zilch. I didnt see friends, family, nobody. I was on oxycodone for 13 years and off of it right now, and i have more Life Experiences than i have had, and dont get me wrong, because it was a blessing of a drug because it took the pain away. Chris, tell us how old are you . Caller 17 years ago in 2002, so i was 47. At the end i was on the fentanyl and it was slowly killing me, and now i am getting off of the oxycodone, and i feel more healthy, and with the help of marijuana and that is what is getting me off of the oxycodone and i feel so much better, and that is what i wanted to say. Okay. I want to congratulate the caller for getting off, because it is not an easy accomplishment, but it is going to be huge in terms the of improving his health. This is so many heartbreaking stories like this that i have been hearing just since the release of the study and putting a human face on the way it is affecting people. When i was a young physician in training, the doctors were taught that you are not doing a good enough job in treating pain, and we were taught how the help patients with the pain, and it set in motion a real tragedy. He was calling from vermont. Looking at the chart of your study that vermont is the increase of the mortality rates in vermont are 20 and maine 21 , and New Hampshire 23 , and talking about the ohio valley, and the same sort of thing socially anyway going on in that new england area . Yeah. Upper new england, mainly. New hampshire, vermont, maine and a large relative increases of all mortality probably not unrelated to the Opioid Epidemic. And john is next, and excuse me, jim in texas. I am getting the names confused. Jim in tom bean, texas. Caller am i on . Yes, you are. Caller i wanted to talk about something that seemed to be missed. My company moved me down here in 1974. My kids were toddlers then, and now upper 40s and low 50s and very healthy. I view back to the people that we used to know, and most of them are all dead. And some of my relatives that are still up in indiana, they have all passed away. They were never really healthy that much when they were alive. My kids are all very healthy like i said, and their kids are very healthy and so i think that weather has a lot to do with it. I think back, and theres only been about two to three blizzards to come through texas in all of that time. Now, we have had the hot summers and i dont think that has as much effect on the human being, but i am trying to ask if weather is a big contributing factor to the fact that this midwest is hitting so hard with all of the deaths. I will hang up and listen to the answer. All right. Thank you, jim. I am not aware of any evidence that cold weather is a factor, but new york and new jersey are states that have done relatively well. I would not dispute the possibility though that something about the environment could be contributing to this. More research is going to be needed, and obviously, much more concerned about the effects of Climate Change and how it is going to intersect with this, but i dont believe that the exposure to cold weather is responsible. And dr. Steven wolf is with us until 10 00 eastern, and he is one of the authors of to report societyhealth. Vcu. Edu. And one more comment on the mortality rates that the u. S. Life expectancy stopped increasing in 2010 and has been decreasing since 2014. Despite excessive spending is on health care, vastly extending life beyond Life Expectancy because of disease and other factors. Jim. Caller yes. I think that we should put more emphasis in prevention and giving more access to the healthy food. When you are going into the grocery store, the products are loaded with sugar and sodium. Sodium has seemed to be a factor in high Blood Pressure, Heart Disease and giving more healthy access in restaurants. You go into the restaurants, and it is loaded with sodium. Sodium is a culprit for ill health and so i would like to know what your comment is on that. As a doctor, i could not agree with you more. Prevention is crucial, and the healthy diet is certainly important, and we saw among the trends in the data, the big increase in the hypertensive Heart Disease caused by high Blood Pressure and sodium is a culprit there. And again, we can promote the traditional Public Health advice like that, but actually making a meaningful change and moving the needle on the Health Trends requires a combination of not only the traditional Health Advice like you would hear from the doctor like myself, but the changes in the social and economic policies to make it possible for the people to have affordable heathy foods and not to go to the fast food restaurant, and to go to the neighborhoods where there are green parks to exercise. The problem with the Health Advice is that we know what to recommend to the families, but they are living under conditions that are making it difficult to follow the recommendations. What did your report find in the mortality rates among racial lines . I am glad that you asked that, because there was misconception of the Media Coverage of this trend to imply that it was basically a problem of white people. And that it was not occurring among people of color, and that is still the case in the case that the largest number of americans experiencing this are nonhispanic whites, and we are seeing this increase occur among africanamericans, and mexican americans, and it is a tradition now among africanamericans, and we have known for years that the africanamericans have had higher mortality rates and there is a black white mortality gap that Public Health people have tried to battle. We have made Good Progress. If you are looking at the charts in the study, you will see that the black mortality rate was falling nicely for a number of year, but now, all of the sudden, it has changed direction and climbing again, and we are starting to see the gap widen, and it is reversing years of progress, and narrowing the prosperities. Jim in tacoma, washington. Caller hello. Jim, you are on the air. Caller my name is jerry, and i was born in the 70s and raised in the 80s and the 90s and im ms with, amsw, and i rea child there was a pull yourself up by the bootstraps, and stop bleeding, and take responsibility. Then we have taken the Opioid Epidemic, and that people were saying that the doctors were forcing them to take medicine, but i clearly remember people doctor shopping and going to florida to buy tons of medicine when they had no medical problems, and i heard him saying that there is a rise in the black community, but there has always been a drug problem in the black community, and the problem is that if we abolish the Second Amendment, that is where our death rate comes from, but my question is how do we address the medical racism, because the solutions that you are asking for, those are solutions that black activists have been asking for since the 1960s, and 70s and 80s and 90s and more greener places and less deserts. And you said that you were an msw, a social worker . Caller yes. And so the change of this trend whether it is low income whites or the people of color is very much dependent on the access of the conditions that improve our health. And we are able to get a access to education, and affordable housing, and food and medicine, and so this crisis is not a discovery, but it is bringing the opportunities to the middleclass for economic social mobility that many middleclass americans are clamoring for the the families in need and the neglected communities that are economically marginalized and so with that we can improve their health and Life Expectancy. And you have used the terms excess deaths in this, and so in this chart, the excess deaths of 20102017, and the concentration of the most of them in the ohio valley, and the states that you mentioned in the fewest of california and the west coast, and define for us what you mean by excess death. Well, i mentioned that the mortality rates have increased just since 2010. If you add up how many lives that has cost us, that increase in mortality rate year by year from 2010 to 2017 above and beyond what it should have been if the trend continued . Yes. It is coming up to something of 33,000, which is the equivalent of a boeing 737 crashing every ten days for seven years. So that is a large number of people dying just because of the increase of mortality. And we go to dillon in south carolina, and lisa. Caller hello. You are on the air. Hi, lisa, you are on the air. Caller okay. Im a physician and i work as a hospit hospitalist, and admitting the patients from the e. R. And 10, 20 years ago i read a similar study which was written where you have more doctors and more medical care, you have higher mortality and i agree, because from my perspective, 50 of the parents i admit have a side effect of a medication, poly pharmacy and die yuretics or complications from surgeries. And the study she is referring to i did not write, but there is a lot of work done by the Dartmouth University researchers and many others who talked about this relationship between health care and Adverse Health outcomes which are called e y eatrigenic death, and we know that there are errors that are committed. And sometimes there is a chicken or the egg problem here. Because they are sicker and need more health care, but we need to improve the quality and the Safe Health Care that are provided to reduce these deaths. But we did not see direct in evidence this case that the mortality is a direct product of the Health Care System, and instead be lack of the access of health care, but other researchers are beginning to wonder if the vast sums of money going into the Health Care Expenses are sucking the resources out of education, out of social programs that, and by having that indirect effect, it could bem co compromised. A couple of comments on text and twitter. Anne talking about antianxiety and antidepressants and the effect they are having on suicides. And you have talked about that. This one says with Mental Health increasing, how does that affect this study . We talk about this epidemic, but it is important for people to remember that it is just the effects of the drug, and there are many others. If we were to wave a magic wand and eliminate opioids, there are concerns about methamphetamines and benzodiazapines and the ainge psy drugs that she is referring. To, and we can look at the classes of drug, but we are missing the point if we are not stepping back to wonder why so many people are turning to them. And that is the mantra of ne needing to look at the root causes. Judy in bradenton, florida. Caller good morning. I didnt think they would get on. But i wanted to say that i should add to the study the lack of oversight, and i know that for fructose, it was not taken off of the market, and i have to mention that my brother and sister both died of cancer at ages 26, because of a pristine area of the chemical dumped into the lake they lived on. And they were fined for it, but it didnt help them. And as far as the job security, i would say that i think it is a lot contributing to the union influence, because the unions have been okay. Judy, i will let you go there. And on cancer, dr. Wolf, there is progress made on the specific types of cancer. Yes, and im glad that you brought it up, because the ur the mortality causes going down and then back up, and in the late 1940s we were making progress of eliminating ischemic Heart Disease, and Car Accidents and others, but what was happening is the increases of the gains of the increases that we had been talking about. So for a while, the gains were offsetting the problem, but now they are e cliclipsing the rate death from the drug overdoses and these other causes so that the tide has been turning. And we will go to terry next in homestead, florida. Caller thank you, cspan and thank you dr. Wolf for your enlightening report. And i have one question real quick. What role does the degradation in the environment such as Climate Change and pollution and so forth play a role, if any, in the mortality . Thank you, terry. We touched on the weather earlier. Dr. Wolf, anything . We are not at a point where we have enough data to say it is the environment. But when i talked earlier about a systemic cause, that is a factor, and so in future years they may look back and understand how there were changes going on in the environment that were contributing to this, and the workplace environment, and talking about the working age adults and something that is happening with exposure occupationally that is contributing. And now, michelle in michigan. You are on with dr. Wolf. Caller yeah, i have something important to say about fentanyl. I took it for years for neuropathy, and what i did to stop taking it is that i left the patch off ten days and it eased me off of the fentanyl, and i had no reaction. It worked perfectly. So anybody out there who is considering it, they should. Thank you for phoning in. Dr. Wolf . I do want to touch on the previous callers look into the website of why this is happening in other countries that are capitalist countries, and makes us wonder if the lack of government oversight, and the freedoms that the companies have in the u. S. To market products without as much restrain like tobacco, firearms, opioids and fructose, and other products contributing to this, and to what extent could we do better to make sure that we market the products in a way that is more conscious of the health risks, and avoid the need to retroactively discover needless deaths that have occurred, because we have jumped the gun in letting the products out too soon. And dr. Steven wolf, Professor Emeritus at the Virginia Commonwealth University and read that report online, and thank you d, dr. Wolf for being with us. Thank you. Coming up at the top of the hour, senator Lindsey Graham is going to speak to us about the articles of impeachment, and we will have live coverage at 2 00 p. M. Eastern on cspan3, and online at cspan. Org and also free with the cspan radio app. Follow the house impeachment process and the administrations response on cspan, and watch live unfiltered coverage in the primetime reairs and stream any time on demand at cspan. Org impeachment, and listen wherever you are with the free cspan radio app. Our cspan campaign 2020 bus team is traveling across the country asking voters what issues they want the president ial candidates to address. I feel like whoever becomes the president should focus on the cabinet as a whole. And for example, the secretary of education, and whoever is in that position they should make sure that who is best for that position. By doing this, then, you know, they would make more progress as a whole. One of the questions that i would like to see all of the candidates answer this Campaign Season is based on the rights enumerated in this book right here and where they believe each of the rights come from. One of issues that i wanted the candidates to address primarily is Mental Health. The main time that we see Mental Health in the news is after a terrible gun violence, and most elements of Mental Health do not distribute to that. I suffer from anxiety and depression, and i am not getting the best care that i can, and i need candidates to do more to help people like me. The esh shoo thissue that i to have the candidates address is the involvement of the pharmaceutical companies and health care. And specifically with the problems that we are having with opioids. And probably every american is affected. Voices from the road. The International Monetary funds managing director spoke at the annual wall street journal ceo counsel meeting last week. Here is a portion of that conversation. So larry gave us a very good primer on the u. S. Economy, and began talking about the international economy, and lets take that up further. And so we will look at the economies outside
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