This article discusses suicide. If you or someone you know is at risk of suicide, please call the Suicide and Crisis Lifeline at 988. The previous National Suicide Prevention Lifeline at 1-800-273-8255 is also still available. 

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Colorado’s Rural Communities Offer Stark Evidence of Factors Reducing the Nation’s Life Expectancy

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US life expectancy dropped for the second consecutive year in 2021, falling by nearly a year from 2020, according to government data released in August.

In 2019, someone born in America had a life expectancy of almost 79 years. In 2020, the first year of the COVID-19 pandemic, that dropped to 77 years. Last year, the life span dropped again—to 76.1 years. 

Life expectancy estimates the average number of years a baby born in a given year might expect to live, given death rates at that time. It is “the most fundamental indicator of population health in this country,” Robert Hummer, a University of North Carolina researcher focused on population health patterns, told the Associated Press. 

Officials of the Centers for Disease Control and Prevention (CDC) blamed COVID for about half the decline in 2021, a year when vaccinations became widely available, but new coronavirus variants caused waves of hospitalizations and deaths. Other longstanding problems were major contributors as well, though: drug overdoses, heart disease, suicide, and chronic liver disease. 

According to the CDC release, the decline “between 2020 and 2021 was primarily due to increases in mortality due to COVID-19 (50.0 percent of the negative contribution), unintentional injuries (15.9 percent), heart disease (4.1 percent), chronic liver disease and cirrhosis (3.0 percent), and suicide (2.1).” 

“This is the biggest two-year decline—2.7 years in total—in almost 100 years,” reported Kate Sheridan on Stat News. “The COVID-19 pandemic is the primary cause of the decline. However, increases in the number of people dying from overdoses and accidents are also a significant factor.”

A large percentage of the cases of chronic liver disease is caused by alcohol misuse and alcohol use disorder, and a lot of the unintentional injuries are really drug overdose deaths; the increase in suicides is driven by trauma, depression, anxiety, and substance misuse. 

Provisional data from CDC’s National Center for Health Statistics indicate there were an estimated 107,622 drug overdose deaths in the United States in 2021, an increase of nearly 15 percent from the 93,655 deaths estimated for 2020 which in turn amounted to a 29 percent increase over 2019. As recently as 2014, the number of overdose deaths in the US was 47,055. 

COVID-19 may have exacerbated the decline in US life expectancy in the past two years, but the downtrend started quite some time before the pandemic. For decades, US life expectancy was on the upswing. But, as the AP reported in July 2021, that trend stalled in 2015, for several years, before hitting 78 years, ten months in 2019. A person born in Canada could expect to live 82 years in 2019. The life expectancy in Japan was 84 years three years ago. 

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Deaths of Despair

Years before the emergence of the COVID pandemic, Princeton economists Anne Case and Angus Deaton suggested in a 2015 paper and a subsequent book that working-age white men and women without four-year college degrees were dying “deaths of despair” by suicide, drug overdoses, and alcohol-related liver disease at unprecedented rates. 

In a review of the book, Carlos Lozada noted, “even before the coronavirus struck, America was suffering an eviscerating epidemic. Its cause was not a virus; its spread could not be blamed on foreign travelers or college kids on spring break. No masks or gloves could slow its contagion, no vaccine could prevent new cases.”

Although Case and Deaton completed their book before the onset of the COVID pandemic, Lozada found that their diagnosis was “painfully relevant.” 

“The debate over how quickly to ease social distancing restrictions and get the economy moving again forces a reckoning: How do we balance the risk of increased coronavirus infections if we reopen the economy too soon against the risk of more deaths of despair if we do so too late?”

Some researchers observed as early as July 2020 that the unfolding COVID pandemic and the existing addiction epidemic in the US would converge into a “perfect storm”:

“Given the COVID-19 pandemic, tackling the alcohol and substance use disorder crisis may be even more problematic because, as in a perfect storm, a combination of elements serves to worsen the already complex clinical conditions of patients with these disorders. The consequences of this storm may spread long after the pandemic is resolved and may affect a large proportion of the population, beyond individuals with current alcohol and substance use disorders.”

The CDC data show that men were hit harder by this perfect storm: While the decline in life expectancy for the male population due to unintentional injuries was 19.1 percent, it was 14.8 percent for females; in chronic liver disease and cirrhosis, it was 3.4 percent for males versus 2.4 percent for females.

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Colorado’s Rural Communities Especially Hard-Hit

Colorado has some of the nation’s highest rates of substance use disorders and age-adjusted suicides, according to the Centers for Disease Control and Prevention (CDC). Research from the Colorado Health Institute suggests that untreated mental health conditions, stigma and structural racism, prevalent alcohol and marijuana use, and firearm ownership rates are some of the leading factors contributing to Colorado’s suicide and behavioral health problems. Another recent study points to financial insecurity and economic disparity, lacking infrastructure and federal support resources, and perceived breakdowns in community connectedness and family systems as leading causes of “diseases of despair” in rural and urban communities. 

In rural communities throughout Colorado, the problems represented by statistics and data points in research studies can be seen in the real lives of people suffering their effects. 

During recent visits with community workers and care providers in Cedaredge, Grand Junction, Telluride, Hotchkiss, Paonia, Delta, Ridgway, and Durango, Foundry Steamboat team members Amanda Buckner and Amber King heard harrowing reports of staggeringly high rates of substance use disorder and suicide — two neighboring towns reporting ten suicides in just one week. They were told about how many of the people in these communities feel isolated and distant from one another and have limited access to high-paying jobs and healthcare resources. Native American people in these communities, like Native American people throughout the US, continue to suffer myriad and disproportionate socioeconomic problems that contribute to addiction, mental health disorders, and suicide. 

Problematic ideas about addictive disorders also seem to be a common issue embedded in the cultures of some rural Colorado communities. “I grew up and live in a rural Colorado town, and I hear the same misperceptions perpetuated there today. The belief that using substances, especially alcohol, is fine as long as someone is able to function and has a house to live in,” says Amanda Buckner, Foundry Steamboat Community Outreach Manager. “For many families in these areas, substance use has become normalized, even encouraged, within the family system and passes for acceptable behavior. In too many cases, this leads to people self-medicating underlying mental health issues with substances instead of recognizing that they have a problem and seeking treatment."

Amber King, who also grew up in a rural Colorado town, cites the lack of access to a continuum of care in rural communities. “Most people who need help in these communities are hours away from the levels of care and specialized providers they need. They have few financial resources and lack family and peer support needed for people to feel comfortable and safe seeking help.” Challenges unique to rural communities can also prevent people from acknowledging that they are experiencing mental health problems or seeking care. “These towns can be very tight-knit communities with some families going back generations. Residents may know more about the lives of their neighbors than people who live in larger cities, and this lack of perceived anonymity can make it hard for people to feel safe getting help. This issue especially affects first responders, physicians, and other professionals who live in and serve these towns, who perceive a need to maintain a local reputation. When you believe that the people you interact with every day know what’s happening in your life, it can be hard to admit that you have a problem and ask for help,” says King. 

Foundry Steamboat is establishing close and regular ties with rural communities to facilitate connections between caregivers and make it easier for individuals and families to talk about mental and behavioral health problems. Foundry Steamboat team members are hosting ongoing virtual meetings where mental health professionals, community leaders, school officials, and others responsible for the mental health and wellbeing of rural communities can discuss needs, share resource information, and find camaraderie and understanding. Through these efforts, Foundry Steamboat hopes to play a positive role in helping to dispel the stigma surrounding mental health and substance use disorders, expand resources for rural communities, and break down the barriers that make it harder for people to seek treatment and find recovery.