By Sean O’Malley
Senior Media Relations Specialist
A few years ago, researchers began to notice something not seen in the United States in modern memory: life expectancy was becoming stagnant and even going down in large segments of the population. In a commentary just published in the Canadian Medical Association Journal, Dr. Jürgen Rehm, CAMH Senior Director, Institute for Mental Health Policy Research, and Senior Scientist, Campbell Family Mental Health Research Institute, explains why this troublesome trend is also a cautionary tale for Canadian policy makers.
I spoke to Dr. Rehm about his findings.
How unusual is a reduction in life expectancy in a country like the United States?
It is extremely rare. The only other times in the past century this happened were during the influenza pandemic of 1918 and the Second World War.
Why is this happening?
The decrease in life expectancy is happening in the rural areas of the U.S. to people we would call the victims of globalization. Those would be people who used to be middle class in small towns who have lost their jobs or their incomes, or their salaries have decreased over the past years.
Is that the same population where we are seeing a spike in so-called “deaths of despair” from alcohol use disorder and suicide that you cite in your commentary?
Yes. And opioid overdoses.
Would that be part of what you call in your commentary the “synergistic effects between socioeconomic status and substance use”?
Exactly. And inequality. In countries where almost everyone is poor, it is much less of a problem than in countries where the top 10 per cent and the bottom 30 per cent are so far apart, but they see each other daily.
When it comes to alcohol, you find there is a much lower prevalence of alcohol use disorders and alcohol problems among poorer Canadians than in the U.S. You suggest that one reason for that could be because alcohol is generally more expensive in Canada. Can you elaborate on that?
Canada is one of the few countries with minimum pricing policies for alcohol that you are not allowed to go below. That has been shown to reduce binge drinking among the poor. We have data from Canada that shows that provinces that raised minimum prices consequently lowered their rates of mortality. That also means if you lower the minimum price, which has been suggested in Canadian politics, it will lead to an increase in mortality.
So raising the price of alcohol saves lives?
Absolutely. I am doing some consulting for the government of Russia, and they have increased their minimum price of vodka quite dramatically as well as limiting marketing and advertising of alcohol. Since they introduced those measures, life expectancy has gone up eight or nine years in men, and there are not a lot of other explanations for this.
I’m not used to seeing such a clear connection between income inequality and mortality rates as illustrated in your commentary.
It’s pretty clear and this association has been corroborated in many countries, which should interest politicians because there can be some pretty easy fixes if you are aware of those dynamics, as well as some policies which should be avoided. Even if we can’t fix the problem of poverty, we can do something about things like alcohol pricing and still have an effect.
So in terms of your three core recommendations, you talk about limiting income inequality, reducing opioid prescriptions and strengthening alcohol control policies. If we don’t do these things, is Canada at risk of having the same decrease in life expectancy?
Absolutely. Then we will be on a slippery slope downwards. We have seen signs pointing in the wrong directions with increases in opioid overdose deaths and deaths fully attributable to alcohol such as alcoholic liver cirrhosis. While we have not reached the levels of the U.S., it is still time to act!