A Centers for Disease Control and Prevention estimate suggests that 20%-40% of premature deaths in this country are preventable. But what does that mean, exactly? According to an analysis by America’s Health Rankings, the government arrives at this number by measuring those who die a premature death of a potential preventable cause before the age of 75. It is a weighted scale with deaths at younger ages contributing more to the ultimate premature death rate. The causes listed for preventable deaths are well known by now — cancer, heart disease, drug overdose, smoking and obesity have long been on the list, as well as things like not wearing seatbelts or motorcycle helmets and other factors that can increase the risk of unintentional injuries. “Inadequate social support also contribute(s) to premature death,” says the AHR analysis, or living in “(isolated) rural counties compared with urban counties.”
So, how do we go about preventing a preventable death? “Intervention strategies that encourage individuals to seek preventive medical care and achieve healthy lifestyles can be effective in reducing premature death,” they say. “Lifestyle changes such as smoking cessation or healthy eating and exercise … can help prevent premature deaths by reducing risk factors,” the report adds.
In fact, the U.S. Department of Health and Human Services has recently invested in a program called Healthy People 2030 with the goal of setting data-driven national objectives to improve health and well-being over the next decade. One overarching goal is to “attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death,” says the AHR analysis.
But here’s the rub: Healthy People 2030 does not have a specific goal for reducing premature death. It is focused on setting goals for addressing the many contributors to premature death. It seems to me, in gathering all the potential factors associated with a preventable death, public health policy folks do not always do a very good job of connecting the dots between causes, intervention and treatments.
Suicide prevention is a good case in point. According to new data from the National Center for Health Statistics, part of the CDC, suicide today is the second-leading cause of death for people aged 10-34, and the numbers have been increasing steadily since 1999, even during a time when “mental-health conditions and suicide risks have been an area of greater focus for health officials,” reports a recent story in the Wall Street Journal. A 2017 report by the RAND Corporation suggests health care policy makers may be looking for answers in the wrong place.
“For years, public-service campaigns have stressed that suicide is preventable, that people can save a life if they just catch the warning signs early enough. But a recent Rand study found that the truth is much more complicated,” writes RAND communications analyst Doug Irving.
“The idea that there should be telltale warning signs when someone is sliding into suicidal distress has been so well publicized that it’s now accepted as fact. But the research is surprisingly thin,” he says.
Rajeev Ramchand is a senior behavioral scientist at RAND. In late 2015, Ramchand and a small team of researchers embedded themselves with the coroner’s office in New Orleans, reports Irving. “They were there to study suicide up close, not in case files and medical summaries, but face to face with people who had lost loved ones, listening to their stories … One clear pattern emerged: In almost none of the cases did the usual warning signs provide a reliable signal that a life was spiraling toward suicide.”
“That’s not to say those warning signs weren’t present,” he adds. “In fact, most of the people had withdrawn, become anxious or aimless, said they had no reason to live or even talked openly about suicide. The problem was that those were not new behaviors … More than two-thirds of the people in the study had a diagnosed mental illness; more than half were using illegal drugs. For their families, the warning signs were a daily fact of life, not a new red flag.”
“We have to be careful about these warning signs and not create the false hope that people can just be vigilant for them,” says Ramchand. “(They) are really way more complicated than they appear on their face.”
Ramchand still believes most suicides are preventable. “But it requires digging deeper into depression, mental illness, and other known risk factors that don’t fit so neatly on a public-service brochure,” he says. Based on the study’s findings comes a message for the families and friends who have lost loved ones to suicide: “They are not to blame,” he says. “They didn’t miss anything.”
Flash forward to September 2022, and we don’t seem all that much closer to finding an answer to the problem. “Suicide is a complex, multifaceted problem whose causes can defy generalization,” writes Lenny Bernstein of The Washington Post. Bernstein says that new data reveals an unusual monthly pattern for suicides. “Again, the reasons are largely unknown,” he writes. “The tale of this pandemic in terms of mental health is going to be many, many years to process,” adds Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness, an advocacy group.
Reports the Wall Street Journal, “Some 47,600 people in the U.S. died by suicide in 2021, making it the nation’s 11th-highest cause of death, according to provisional CDC estimates.” According to the American Foundation for Suicide Prevention, in the United States, suicide is the 12th leading cause of death.
As recently reported on ABC’s “Good Morning America,” in July, a new three-digit phone number, 988, was launched to make mental health care more accessible. Jessica Rosenworcel, chairwoman of the Federal Communications Commission, said at the time the hope was it would be easy to remember. “Now we have to make it clear to the entire country that it is a sign of strength to call it and use it, and not a sign of weakness,” she said in making the announcement.