Ko brezup prevlada: Morbidna slika ameriške bele srednje generacije

Anne Case in lanski nobelovec Angus Deaton sta v zadnji raziskavi opozorila na zanimiv fenomen povečane morbidnosti med ameriško belo nešpansko populacijo v srednji življenjski dobi (45-54 let). Kot lahko vidite na spodnji sliki, povsod v razvitih državah smrtnost v srednji generaciji močno upada, upada tudi med špansko (USH) in črnsko populacijo v ZDA, močno pa se je povečala med belo nešpansko populacijo (USW) po letu 1998.

Kaj se dogaja?

Slika 1: Število smrti na 100,000 prebivalcev, 1988-2013

Fig. 1.

 

Vir: Case & Deaton, PNAS 2015

Najprej je treba pogledati vzroke povečane umrljivosti. Kot vidite na spodnji sliki, se umrljivost zaradi tradicionalno najbolj pogostih vzrokov (rak na pljučih, diabetes) zmanjšuje ali stagnira, hitro pa se povečuje umrljivost zaradi ciroze jeter, samomorov in predvsem zastrupitve (z alkoholom ali drogami). Bela nešpanska srednja generacija se torej pospešeno predaja fatalnemu brezupu, alkoholu in drogam.

Slika 2: Število smrti na 100,000 prebivalcev po vzrokih, 1998-2013

Fig. 2.

Vir: Case & Deaton, PNAS 2015

Case & Deaton ugotavljata (glejte tabelo 1), da umrljivost med špansko in črnsko populacijo v srednji starostni skupini močno upada, drastično pa se je povečala le med nešpansko belo populacijo. Ugotavljata, da se je umrljivost (zaradi zastrupitve in samomorov) povečala predvsem med tistimi z najnižjo izobrazbo (srednja šola ali manj) in da se je najbolj povečala v starosti nad 45 let (najbolj drastično v starostni skupini 45-60 let). Case & Deaton to imenujeta “midlife morbidity” in pravita, da gre najbrž za posledice povečanega stresa v tej starostni skupini.

Slika 3: Število smrti na 100,000 prebivalcev po starostnih skupinah, 1998-2013

Fig. 4.

Vir: Case & Deaton, PNAS 2015

Case & Deaton pravita, da če bi se nadaljeval trend padanja umrljivosti pred letom 1999, bi v obdobju 1999-2013 bilo v ZDA “privarčevanih” pol milijona življenj. To je primerljivo z obsegom smrti zaradi virusa HIV. Drugače rečeno, povečana umrljivost zaradi alkohola, drog in samomorov je v 15 letih vzela toliko dodatnih življenj kot AIDS.

Vzroke za to nenadno povečano umrljivost med ameriško belo nešpansko populacijo je seveda težko natančno identificirati. Case & Deaton se nagibata k razlagi, da gre najbrž za posledice povečanega stresa in povečane negotovosti v tej starostni skupini. Pravita, da je v ozadju najbrž povečana ekonomska negotovost, ker je ta generacija spoznala, da ji bo šlo slabše kot njihovim staršem. Boji se, da nima prihodnosti. Eden izmed vzrokov bi naj bil v ameriškem pokojninskem sistemu, ki temelji na prispevkih in za razliko od evropskega ne zagotavlja finančne varnosti na stara leta, tudi zaradi tega, ker so prihranki naloženi v vrednostnih papirjih, katerih vrednost pa je zelo volatilna. Ta povečana morbidnost v srednji starosti med nizko izobražeo belo populacijo naj bi se izražala tudi v zmanjšani sposobnosti za delo zaradi fizične ali mentalne zmanjšane sposobnosti in naj bi bila v ozadju trenda padajoče stopnje participacije v delovni sili.

Drugače rečeno, nizko izobražena bela populacija v srednji starosti se vse bolj predaja brezupu, ki ga utaplja v alkoholu in drogah ali radikalno končuje s samomori. To pa ima na drugi strani za posledico tudi zmanjšan obseg delovne sile in s tem manjši gospodarski potencial. Ta slika ameriškega liberalnega kapitalizma postaja zares zaskrbljujoče morbidna.

Spodaj je še nekaj dodatne razlage avtorjev.

Although the epidemic of pain, suicide, and drug overdoses preceded the financial crisis, ties to economic insecurity are possible. After the productivity slowdown in the early 1970s, and with widening income inequality, many of the baby-boom generation are the first to find, in midlife, that they will not be better off than were their parents. Growth in real median earnings has been slow for this group, especially those with only a high school education. However, the productivity slowdown is common to many rich countries, some of which have seen even slower growth in median earnings than the United States, yet none have had the same mortality experience (lanekenworthy.net/shared-prosperity and ref. 30). The United States has moved primarily to defined-contribution pension plans with associated stock market risk, whereas, in Europe, defined-benefit pensions are still the norm. Future financial insecurity may weigh more heavily on US workers, if they perceive stock market risk harder to manage than earnings risk, or if they have contributed inadequately to defined-contribution plans (31).

Our findings may also help us understand recent large increases in Americans on disability. The growth in Social Security Disability Insurance in this age group (32) is not quite the near-doubling shown in Table 2 for the Behavioral Risk Factor Surveillance System (BRFSS) measure of work limitation, but the scale is similar in levels and trends. This has been interpreted as a response to the generosity of payments (33), but careful work based on Social Security records shows that most of the increase can be attributed to compositional effects, with the remainder falling in the category of (hard to ascertain) increases in musculoskeletal and mental health disabilities (34); our morbidity results suggest that disability from these causes has indeed increased. Increased morbidity may also explain some of the recent otherwise puzzling decrease in labor force participation in the United States, particularly among women (35).

The mortality reversal observed in this period bears a resemblance to the mortality decline slowdown in the United States during the height of the AIDS epidemic, which took the lives of 650,000 Americans (1981 to mid-2015). A combination of behavioral change and drug therapy brought the US AIDS epidemic under control; age-adjusted deaths per 100,000 fell from 10.2 in 1990 to 2.1 in 2013 (12). However, public awareness of the enormity of the AIDS crisis was far greater than for the epidemic described here.

A serious concern is that those currently in midlife will age into Medicare in worse health than the currently elderly. This is not automatic; if the epidemic is brought under control, its survivors may have a healthy old age. However, addictions are hard to treat and pain is hard to control, so those currently in midlife may be a “lost generation” (36) whose future is less bright than those who preceded them.

Vir: Case & Deaton, PNAS 2015

 

 

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