Newsletter | There's Something Going Wrong Around Here

We’re seeing a troubling increase in deaths of young people. In a new study, sociologist Elizabeth Wrigley-Field and her colleagues analyzed mortality data for US adults aged 25-44 and found a 70% increase in mortality in 2023 as compared with what would have been expected had 2011 rates continued. That translates to more than 71,000 excess deaths in this age group in 2023 alone.

Drug poisoning accounted for the largest share of both overall deaths (28%) and excess deaths (31%), but the second largest contributor was the catch-all "other natural causes” category, which also had the highest rate of increase – 225% – since 2011. Other significant causes include transport-related, alcohol-related, homicide, and a variety of cardiometabolic conditions. COVID-19 has been a huge event during this time, but the research shows that there was a steady increase in the overall death rate up through 2019, a greater increase during the peak of COVID and now a level that is higher than the pre-pandemic levels, suggesting possible lingering effects.

Atul Grover and Megan Ranney, in their opinion piece in STAT, “How to close America’s life expectancy gap,” focus on these early deaths as key to increasing life expectancy in the US. Grover and Ranney state that “if we could eliminate deaths from just three external causes of injury and death—alcohol, drugs, and firearms (including firearm suicides)—we would increase the average U.S. life expectancy at birth by about 1.6 years.” They point out that the US’s drug and firearm death rates are among the highest of all developed countries and that our per capita rate of alcohol-related deaths is comparable to others but rising rapidly. Their diagnosis is simple and eloquent: “These three external causes of death all represent underlying social dysfunction as well as ease of access to these means of harm.” Fixing them is, of course, easier said than done, but limiting access to each would be a start. 

Another rising cause of early death is—distressingly—cancer. In an excellent report in Time magazine, Jamie Ducharme explores the phenomenon of increasing incidence of cancers in people under 50. Diagnoses of all types of early-onset cancers rose 79% in that age group from 1990 to 2019—which might be explained in part by more widespread, more effective screening, except for the fact deaths from these early cancers have climbed by 28%. This number is rising even while overall cancer mortality rates in the US have dropped by a third over the same period.

So what’s happening? 

Honestly, it’s not clear. One clue is that the increases of cancers in digestive-related organs are particularly dramatic. As Ducharme puts it, “the data suggest that some element—or perhaps combination of elements—of modern life is sickening progressively younger adults.” But what is it? Some of the theories point to the western diet, based on a lot of red meat and ultraprocessed food; others suggest roles for microplastics and exposures to antibiotics; and still others focus on the interactions of our diets, microplastics and the gut microbiome. There’s even a suggestion that our constant exposure to artificial light might be altering our rhythms in problematic ways and that that could have an impact.

We hate to do it, but: enter Robert F. Kennedy Jr., who will lead a newly formed “Make America Healthy Again” commission, which is tasked with “investigating and addressing the root causes of America’s escalating health crisis, with an initial focus on childhood chronic diseases.” The executive order establishing the commission outlines several policies that might help, including emphasizing “transparent and open-source data,” making sure that US food is “is the healthiest, most abundant, and most affordable in the world,” and supporting health insurance benefits for lifestyle changes and disease prevention. It offers a laundry list of causes to be explored, including “the American diet, absorption of toxic material, medical treatments, lifestyle, environmental factors, Government policies, food production techniques, electromagnetic radiation, and corporate influence or cronyism.” This list is a great illustration of the tensions embedded in the MAHA movement—it includes both areas that are well established but still very much in need of more research with a sprinkling of familiar conspiracy theories.

The goals of the commission stand in stark contrast to many of the actions taken by the Trump Administration thus far—shuttering health information websites and removing scientific expertise from health agencies, to name two. These contradictions, starting with the odd political marriage that MAHA represents, are what intrigue the food journalist Helena Bottemiller Evich, who posted about the commission in her Food Fix newsletter. Writes Bottemiller Evich: “[MAHA] represented a significant political realignment—a scrambling of left and right, where all of the sudden, some progressive food policy ideas were being adopted by parts of Trump’s base alongside health freedom activism driven by the pandemic.”

There are real and troubling trends in the health of younger Americans. And there are unanswered questions about what’s driving them, let alone how to reverse them. A serious inquiry into how modern life might contribute would be most welcome. In a mere 100 days, when the Commission’s assessment report is due, we’ll know if it’s anything like serious.

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