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The Epidemic of Despair

Will America’s Mortality Crisis Spread to the Rest of the World?

Drown your sorrows: in a bar in Janesville, Wisconsin, June 2009 Danny Wilcox Frazier / VII / Redux

Since the mid-1990s, the United States has been suffering from an epidemic of “deaths of despair”—a term we coined in 2015 to describe fatalities caused by drug overdose, alcoholic liver disease, or suicide. The inexorable increase in these deaths, together with a slowdown and reversal in the long-standing reduction in deaths from heart disease, led to an astonishing development: life expectancy at birth for Americans declined for three consecutive years, from 2015 through 2017, something that had not happened since the influenza pandemic at the end of World War I.

In the twentieth century, the United States led the way in reducing mortality rates and raising life expectancy. Many important health improvements—such as the decline in mortality from heart disease as a result of reductions in smoking and the increased use of antihypertensives and the decrease in infant mortality rates because of the development of neonatal intensive care units—originated

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