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Trevor Hancock: Misery and health: The diseases of despair

Last week, I wrote about happiness and health. Interestingly, we live next door to a nation that has put the pursuit of happiness into its founding document as a central purpose — and is spectacularly failing to achieve its aim.

Last week, I wrote about happiness and health. Interestingly, we live next door to a nation that has put the pursuit of happiness into its founding document as a central purpose — and is spectacularly failing to achieve its aim.

The 2012 World Happiness Report noted that: “The U.S. has experienced no rise of life satisfaction for half a century,” while the 2017 version of the report found happiness in the U.S. has been declining for most of the past decade. The opposite of happiness is misery, which seems to be where the U.S. is headed, and that shows up, in health terms, in what have become known as the “diseases of despair”: alcohol, drugs and suicide.

A November 2017 report called Pain in the Nation, released by the Trust for America’s Health and the Well Being Trust, notes that: “Drug-related deaths have tripled since 2000. … Alcohol-induced deaths grew by 37 per cent from 2000 to 2014 [and]. … Suicides increased by 28 per cent from 2000 to 2015.” The combined effect has been to lower life expectancy in the U.S. in the past two years — the first time in 60 years that has happened.

As I noted in a March 2016 column, and as this report confirms, these diseases of despair are found particularly among white, middle-aged Americans with less than college education. Among this group, life expectancy has declined 20 per cent, while deaths from drug overdoses, alcohol poisoning, liver disease and suicide all tripled.

“These trends are a wakeup call that there is a serious crisis in this country,” states Pain in the Nation. “They are signals of grave underlying concerns facing too many Americans — about pain, despair, disconnection and lack of opportunity — and the urgent need to address them.”

Not coincidentally, in December 2016, the Washington Post reported a study by Penn State University professor Shannon Monnat that found then-presidential candidate Donald Trump performed better “in the counties with the highest drug, alcohol and suicide mortality rates” than had the Republican nominee in 2012. This was particularly so in the Rust Belt states of the de-industrializing Midwest, as well as in New England.

The authors of Pain in the Nation propose to address these issues through a “national resilience strategy” that focuses largely upon individual and, to some extent, collective interventions intended to enhance resilience among people and communities and to identify problems early and intervene. While these are useful and important strategies, in my view they do not go far enough, because they do not address the upstream causes that lie behind the dramatic increase in the “diseases of despair” they document.

The 2012 World Happiness Report noted that in the five decades during which there has been no increase in happiness, “inequality has soared, social trust has declined and the public has lost faith in its government.” Moreover, this occurred while at the same time “income per person has increased roughly three times”; clearly, money is not buying happiness.

Indeed, the noted economist Jeffrey Sachs points out in the 2017 World Happiness Report, in a chapter on restoring American happiness, that: “The situation has gotten worse in recent years: per capita GDP is still rising, but happiness is now actually falling.”

Sachs writes that about half the decline in happiness can be related to four social factors: “less social support, less sense of personal freedom, lower donations, and more perceived corruption of government and business.”

Here in Canada, we cannot afford to be smug. We, too, have an opioid-addiction crisis and a lot of alcohol-related deaths; a 2015 OECD report shows that U.S. and Canadian alcohol consumption per person and the proportion of deaths attributable to alcohol are similar, while our rates of suicide are not that dissimilar from the U.S. (13.5 in the U.S. vs. 12 in Canada per 100,000 in 2014).

Nationally, the latest life-expectancy data only go to 2014, but here in B.C., life expectancy peaked at 82.9 years in 2014 and declined by about two months to 82.74 years in 2015 and 2016.

We need to learn from the U.S. that the pursuit of happiness is more than just the pursuit of money.

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

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