The Former USSR, F. Scott Fitzgerald, Mortality Rates, and the Opioid Crisis

The Former USSR, F. Scott Fitzgerald, Mortality Rates, and the Opioid Crisis

A human life is more likely to be lived fully now than at any other point in history. The advances in the last century that have been made in preventing infant mortality, communicable diseases and sanitation are absolutely mind blowing. World mortality rates (the share of the population which dies in a given year) have plummeted from close to 19 per 1,000 in 1950 to 8 per 1,000 today – a 58% decline. Between 1900 and 2015, the United States also saw a steep decline from 17 per 1,000 to 7 per 1,000. That is a decline of 59% (although over a longer time period).

Historical mortality rates for the World and United States.

Success has been so great that it has become startling for any group to see rises in their mortality rates (the percentage of the total population that dies in a given year), particularly in a rich, developed country. But that is precisely what has been happening to the white, non-Hispanic population in the United States.

U.S. mortality rates by race, 25-54-year-olds, 1999 and 2015.

Between 1999 and 2015, while black and Hispanic Americans saw improvements in the adult mortality rate, white Americans saw there rate jump by 14%.

A recent article in the Harvard Business Review took a look at this data and also drew attention to research done by Princeton economists Anne Case and Angus Deaton on the subject. They found that another period of history offers parallel data that can be examined to gain some sense of what is happening today. That parallel was the Soviet Union between 1965 and 1990. The authors present the following chart, which was compiled from the Human Mortality Database.

So, what happened in the Soviet Union after 1965? Educated guesses can be made, but it is always hard to be completely sure how close those guesses approximate reality. To further complicate matters, the Soviet Union often made their official statistics reflect their desire of reality, rather than reality itself. According to the government at the time, they had “liquidated” unemployment, so officially no one was ever jobless.

A pair of Russians enjoy the day.

The most complete database of historical economic production (the Agus Maddison Database) does not show any kind of economic shocks around 1965 that would seem to explain the rise in the mortality rate.

Real GDP per capita, United States, Former USSR, and World (adjusted for 1990 international dollars).
Change in real GDP per capita in the former USSR.

Leading up to this period Nikita Kruschev headed the Communist Party in the USSR. He instituted a number of liberal reforms for the population in an effort to modernize the country away from Stalinism. He ended the Gulag system as it had been put to use previously, investigated and commented on the crimes of the period, and destroyed the cult of the Stalin personality. Between 1953 and 1964 when Kruschev led the country, it was by no means free, but certainly the paranoia and brutality had in many ways subsided.

After Kruschev’s 1962 failure in the Cuban Missile Crisis he was finally forced out in 1964. Succeeding him was Leonid Brezhnev, whose era of leadership is referred to as the “Era of Stagnation.” Economic growth did begin to decline, slowly, year by year until it was completely absent by 1980. More than that, by 1965, the USSR already was on the path of spending money they did not have to try and compete with United States military spending. So, less and less of production was actually going to people.

USA, USSR Military Spending. From Arming America: Attention and Inertia in US National Security Spending by James L. True (1998).

It is also important to be clear about the fact that the real explosion in the mortality rate happened between 1986 and 1994. It is less unclear during this period why the mortality rate would spike so high.

Mikhail Gorbachev tried to address growing problems with alcohol in the USSR by severely restricting its purchase between 1985 and 1987, but abandoned the program because of the amount of money it was costing the state.

Economic anxiety, uncertainty, a loss of national pride, growing inequality – all colliding together – and it seems a growing number of Soviet citizens drank themselves to death.

A couple drive with a child in the backseat while high on Heroin in East Liverpool, OH.

In various forms, those factors are present in different ways today in the United States. Rather than once again being able to easily buy alcohol, Americans were given the option of easily getting their hands of something that would make them feel even better – opiates.

The chart below from the CDC, lays out the numbers pretty simply and shows the enormous shift towards Heroin after crackdowns on prescription opiates around the 2010.

Many of the solutions to today’s problem try to strike at direct causes: reducing prescriptions, getting the message out that Heroin and other opiates are deadly, educating others about substance abuse. The American Surgeon General, Vivek Murthy, said in 2016,

“Addressing the addiction crisis in America will require seeing addiction as a chronic illness, not as a moral failing. Addiction has been a challenge for a long time, but we finally have the opportunity and the tools to address it.”

 

F. Scott and Zelda Fitzgerald.

That is all well and good, but it is important to note that if you want to carry the comparison to the former USSR through, it is important to note that the mortality rate did not begin declining again until 2003. Why then? Oil prices started to go to the moon and Russians once again had money and confidence.

The United States does not have as much of a general economic malaise, the way the former USSR did, but it has been particularly unkind to a single group of people – working class laborers.

I cannot think about failed promises to any group and not immediately bring F. Scott Fitzgerald to mind. His 1922 short-story “Winter Dreams” explored many of the themes his later novel The Great Gatsby would, among them the shattering psychological spiral that comes from the realization that the dreams you once held and felt were promised to you are never going to come true.

“He wanted to care, and he could not care. For he had gone away and he could never go back anymore. The gates were closed, the sun was down, and there was no beauty left but the gray beauty of steel that withstands all time. Even the grief he could have borne was left behind in the country of youth, of illusion, of the richness of life, where his winter dreams had flourished.” – F. Scott Fitzgerald, “Winter Dreams”

“He wanted to care, and could not care,” could well sum of the lives of many washed away in the opiate crisis. Unable to live in a reality that it not theirs, so many seek to skip reality altogether. That root cause must be addressed if the opiate crisis is to ever be solved. Because, while pharmaceutical companies were directly responsible for getting so many Americans hooked on pain killers, it is not hard to envision another drug substituted – even alcohol.

It might be best to leave things with something else Fitzgerald said, this time from “The Curious Case of Benjamin Button,”

“For what it’s worth: it’s never too late or, in my case, too early to be whoever you want to be. There’s no time limit, stop whenever you want. You can change or stay the same, there are no rules to this thing. We can make the best or the worst of it. I hope you make the best of it. And I hope you see things that startle you. I hope you feel things you never felt before. I hope you meet people with a different point of view. I hope you live a life you’re proud of. If you find that you’re not, I hope you have the strength to start all over again.” —   F. Scott Fitzgerald

Where there is life, there is hope. True for a Russian alcoholic, American opiate addict, and even for entire countries.

 

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