‘Missing Americans’: The U.S. early death epidemic
By Margaret O’Hara/New Mexico Health Journalism Fellowship
A panel at HJ26 encouraged journalists to acknowledge the big picture of death in America.
As policymakers grapple with compounding epidemics — of obesity, opioid use, gun violence, climate-related illness and death — a panel of experts urged reporters to reframe these public health emergencies as pieces of an epidemic of “missing Americans,” one causing the early deaths of hundreds of thousands of Americans each year.
Those deaths aren’t inevitable, as evidenced by lower mortality rates in other high-income countries. Rather, they are the result of decades of policy choices that have left the U.S. population “saturated in premature illness, disability and death, much of it concentrated in midlife,” said Laudan Aron, a senior fellow in the Health Policy Division at the Urban Institute.
“We are talking about a society organized in ways that are quietly destroying the fabric of millions of families, and we’re doing it in ways that remain largely invisible to our public discourse and our journalism,” Aron said.
Between 1999 and 2022, the U.S. saw more than 12.6 million “excess deaths” — or deaths that would not have occurred in other high-income countries — according to research conducted by Jacob Bor, associate professor of global health and epidemiology at Boston University School of Public Health. He found these excess deaths, which largely occurred between the ages 45 and 64, were driven by circulatory and metabolic diseases, drug poisonings, alcohol-related deaths and suicides.
Bor’s research also identified racial disparities within the crisis of excess deaths, with American Indian people and Alaska Natives in their 20s and 30s facing mortality rates eight times higher than the average of other wealthy nations. For Black Americans, it’s five times higher.
But the phenomenon affects everyone: White Americans in their 20s and 30s die at rates three times higher than residents of other high-income nations, Bor’s research found. Nearly 70% of missing Americans were white.
“What we’re seeing here is a mortality crisis that’s actually affecting us all, and that’s a message that is incredibly important to get out there in terms of generating the political will to do something about it,” Bor said.
Michelle Williams, a professor of epidemiology and population health at Stanford University School of Medicine, argued we already know the “prescription” to cure these early deaths. They’re preventable with policy interventions like expanded child tax credits, harm reduction infrastructure, environmental regulation and early childhood programs.
She encouraged journalists to incorporate the early death epidemic into their work by comparing U.S. mortality with international peers, closely covering the dismantling of regulations, and reporting on effective preventability initiatives and the return on upstream investment. All of that, Williams said, will give the public a better understanding of this collective loss.
“I want to see town halls between now and 2028 activated by people who are armed not just with their emotional, personal thoughts, but with the collective understanding that they are part of a disparity that is highly, highly preventable,” Williams said.
Margaret O’Hara is the public health reporter at the Santa Fe New Mexican newspaper.
