The US is experiencing a public-health crisis involving epidemics of obesity, opioid addiction and depressive disorder leading to a fall in overall life expectancy. This is an unprecedented event for a high-income country in peacetime.
The major causes of rising death rates are drug overdoses, suicides and alcohol-related diseases. US life expectancy is 4.3 years behind leading developed countries. Add to this America’s obesity prevalence, mental health disorder and opioid misuse are among the highest in the world.
Mental illness is one of the main causes of unhappiness in the world and it produces nearly as much of the misery as poverty, and more than is caused by physical illness. Treating it should be a top priority for every government and would save billions. It is the main illness among people of working age and it reduces national income per head by around five per cent.
Why has the US performed more poorly than other high-income countries on public health? Firstly, the US system produces higher levels of income inequality than other high-income countries. The evidence is clear that low socioeconomic status is a major risk factor for poor mental and physical health.
The least well-off suffer a disproportionate share of the burden of disease, including depression, obesity and diabetes. Obesity causes depression and depression can lead to obesity. Depression and substance abuse are also directly linked. The US healthcare system is woefully inadequate to face these epidemics.
US healthcare is the most expensive in the world and coverage rates for the poor are the lowest among the high-income countries. The emphasis is on treatment rather than prevention and healthcare for depression is notably deficient.
The obesity epidemic is directly linked to the fast-food industry who aggressively market products full of sugar and processed foods and the opioid epidemic can be traced to the lobbying and direct marketing of major pharmaceutical companies.
Obesity can be reduced through regulations limiting sugar use, new taxes on soft drinks, the elimination of subsidies on corn, limits on food advertising targeting children and the promotion of public awareness regarding the causes of obesity and the benefits of healthy diets.
The opioid epidemic could be radically reduced by ending the direct marketing of addictive drugs to patients as well as banning the implicit and explicit kickbacks to doctors who overprescribe these dangerous products.
Mental health can be improved through preventative medicine and measures to strengthen social support systems for vulnerable groups. Depressive tendencies also result from excessive use of new technologies and excessive screen time is linked to increased loneliness. Steps to combat addictions to the new social media and technologies, will greatly improve mental health.
The introduction of programes of positive psychology and wellness at schools, workplaces and in the community can help individuals to change their own behaviours to overcome addictions.
The evidence is large and growing that such life-changing strategies can be highly effective. The main issue is corporate lobbying that keeps dangerous corporate practices in place and imposes untold burdens on the poor and vulnerable. There is much work to be done.