‘Deaths of despair’: Global mortality plummets, but increases among young people in North America due to drugs and suicides

The world’s population is living longer than ever. According to the latest Global Burden of Disease report, published Sunday in The Lancet, life expectancy worldwide is 20 years higher than in the middle of the last century and now averages 76 for women and 71 for men — in wealthy countries, both are over 80. The risk of death is falling across the planet, and populations are generally healthier. But it’s not all good news. The report also reveals unfinished business and crystallizes some of the new challenges facing humanity, such as the increasing burden of mental disorders and the rising mortality rate among adolescents and young adults in North America and Latin America, mainly due to suicide and drug and alcohol abuse.

This macro-research, which compiles data from more than 200 countries for the year 2023, is the first global description of the state of health in the post-pandemic world. After the Covid-19 crisis shook healthcare systems around the world and distorted traditional statistics, becoming the leading cause of death, things — and trends — have returned to normal. Life expectancy, which fell during the pandemic, has recovered. And mortality, exacerbated by this infectious episode, has also declined. Heart attacks and strokes once again lead the most common causes of death, while Covid-19, for its part, falls to 20th place in this ranking.

The report reveals worrying dynamics in some specific territories and age groups. This has been true for young people in North America and Latin America since 2011. The largest increases in mortality have been observed there, especially in the United States, Canada, Mexico, and Brazil: in the last decade, it has risen by almost 32% among the 25-29 age group; and by 50% among those in their thirties. The authors point to the high rates of “deaths of despair” as the cause of these phenomena, a category of mortality “driven by economic, social, and psychological factors” and due primarily to suicide, alcoholism, and drug overdoses.

The United States has been immersed in an opioid epidemic for several years, claiming the lives of tens of thousands of young people: overdose deaths increased by 30% between 2019 and 2020, by 15% between 2020 and 2021, and in 2022, a record number of 111,029 deaths was recorded.

To contextualize the phenomenon in Latin America, Jesús Adrián Álvarez, a doctor in public health, also points to the impact of violence. “Among Latin American men, high homicide rates among young adults add a critical dimension to this mortality burden. This reveals a paradox: despite major investments in public health and social welfare, violence continues to shorten the lives of millions of people in the region,” he explains in a statement to the Science Media Center Spain website.

Over the past decade, the largest increases in mortality among 15- to 19-year-olds and 20- to 24-year-olds were recorded in Eastern Europe — a 54% and 40% increase, respectively. This phenomenon coincides particularly with Russia’s invasion of Ukraine: since then, mortality among these age groups in both countries (especially Ukraine) has skyrocketed.

Another area of wartime massacres is highlighted in the work: those perpetrated by Israel in Gaza. Although regional mortality rates in North Africa and the Middle East are no longer the highest, they note that “Palestine had the highest mortality rate and risk of dying before age 70 due to conflict and terrorism in the world.” Furthermore, they highlight for the Gaza Strip “an estimated loss of 30 years of life expectancy during the first 12 months of the war, a conservative estimate that practically halves pre-conflict life expectancy.”

Alert for Trump’s cuts

The study also serves as a wake-up call to the world about the effects of the Trump administration’s policy of cutting development aid. The authors note that the U.S. government contributed 22.6% of all development assistance for health in 2023, and the accompanying editorial recalls that the United States Agency for International Development (USAID, nearly dismantled by Trump after his return to office) alone was responsible for a 15% reduction in age-standardized all-cause mortality and a 32% reduction in under-five mortality, primarily in low- and middle-income countries, and particularly in Africa.

“To maintain progress or even avoid setbacks in under-five mortality in high-risk populations, it will be imperative to mitigate the effects of these funding cuts, while also expanding other sources of funding, such as those from nongovernmental organizations,” the researchers note. The editorial emphasizes that some preliminary estimates indicate that development assistance for health decreased by more than 50% between 2021 and 2025.

Drugs, violence and depression on the rise

The authors assume that “diabetes, substance use disorders, violence, and heat waves” are currently some of the fastest-growing threats to human health. In fact, since 2013, annual deaths linked to environmental exposure to cold and heat have increased by 6%; those related to substance use have increased by 5%; those related to diabetes have increased by 3%; and those associated with conflict and terrorism have increased by 1%.

However, the research also highlights the rise in mental health disorders: death and disability associated with anxiety and depression have increased by 63% and 26%, respectively, since 2010. The pandemic may have played a role, but the researchers go further: “There are several competing and complementary theories to explain this increase, including increased social media use, cyberbullying, child abuse, climate despair and the rising cost of living and income inequality, and greater awareness of mental health.”

According to the study, nearly half of global mortality and morbidity in 2023 was attributable to 88 risk factors. Specifically, the variables associated with greater health outcomes were elevated systolic blood pressure, particulate pollution, high blood sugar, smoking, low birth weight, premature birth, elevated body mass index (BMI), and high cholesterol, among others.

Population growth and aging, coupled with the transformation of the most worrisome risk factors, is changing the rules of the game. Government partnerships and health programs promoted over the past three decades have curbed the scourge of numerous infectious diseases (tuberculosis, respiratory and enteric infections, diphtheria, tetanus, etc.), to the point that non-communicable diseases, such as diabetes and ischemic heart disease, now account for almost two-thirds of total mortality and morbidity worldwide. “The rates of non-communicable diseases are increasing, especially in low- and middle-income countries. The speed and magnitude of this epidemiological transition from infectious to non-communicable diseases is a cause for urgent concern,” The Lancet admits in an accompanying editorial.

Everything is changing, and the world has entered a new era of global health challenges, reflects Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and author of the research, in a statement: “The evidence presented in the study is a wake-up call, urging government and healthcare leaders to respond quickly and strategically to the disturbing trends that are reshaping public health needs.”

The lowest-income countries, although they have also improved their health status in recent decades, remain light years behind those in more affluent areas. For example: in Spain, Italy, and France, life expectancy is 85 years for women and 83 for men; while in sub-Saharan Africa, the average is 66 and 62 years, respectively. In the most deprived areas, two threats to health are beginning to coexist: the historic scourge of communicable diseases — such as tuberculosis, malaria, and other infections, whose incidence has decreased in recent decades but continues to kill millions of people — with the spread of other non-communicable diseases, such as obesity and diabetes.

Epidemiologist Jaume Marrugat, who was not involved in this research, welcomes the good news, such as the increase in life expectancy and the decrease in communicable diseases, but also expresses his “concern” about the risk of going backwards: “A large part of the improvement in communicable diseases is related to vaccination, and we are very concerned that there are countries with leaders who do not encourage vaccination. It has taken a long time for vaccines to free us from many diseases, and we run the risk of them rising again. This generates anxiety.”

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