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American life expectancy at birth declined for the second consecutive year in 2016, fueled by a staggering 21 percent rise in the death rate from drug overdoses, the Centers for Disease Control and Prevention reported Thursday.
The United States has not seen two years of declining life expectancy since 1962 and 1963, when influenza caused an inordinate number of deaths. In 1993, there was a one-year drop during the worst of the AIDS epidemic.
“I think we should take it very seriously,” said Bob Anderson, chief of the Mortality Statistics Branch at the National Center for Health Statistics, which is part of the CDC. “If you look at the other developed countries in the world, they’re not seeing this kind of thing. Life expectancy is going up.”
The development is a dismal sign for the United States, which boasts some of the world’s highest spending on medical care, and more evidence of the toll the nation’s opioid crisis is exacting on younger and middle-aged Americans, experts said.
More than 42,000 Americans died of opioid overdoses alone in 2016, a 28 percent increase over 2015. When deaths from drugs such as cocaine, methamphetamine and benzodiazepines are included, the overall increase was 21 percent.
A multiyear decline in life expectancy is more commonly associated with AIDS epidemics in southern and eastern Africa or wars in Syria and Afghanistan, said Majid Ezzati, a professor of public health at Imperial College London who has studied life expectancy.
“The story does come down to young people,” he said. “It’s the overdose story, to a large extent.”
Of the nation’s 10 leading causes of death, significant increases last year came in unintentional injuries (which include drug overdoses), Alzheimer’s disease and suicides. (National Center for Health Statistics)
The data a year ago set off alarms when they showed that in 2015 the United States experienced its first decline in life expectancy since that 1993 dip. Experts pointed then to the “diseases of despair” — drug overdoses, suicides and alcoholism — as well as small increases in deaths from heart disease, strokes and diabetes.
The 2016 data shows that just three major causes of death are responsible: unintentional injuries, Alzheimer’s disease and suicides, with the bulk of the difference attributable to the 63,632 people who died of overdoses. That total was an increase of more than 11,000 over the 52,404 who died of the same cause in 2015.
Deaths from fentanyl and other synthetic opioids more than doubled from the previous year. Heroin and prescription opioid overdose deaths also rose, but more modestly.
At the same time, a long decline in deaths from heart disease continued a six-year trend of leveling out, Anderson said. The small decrease last year in the rate of the nation’s leading cause of death no longer canceled the drug epidemic’s impact on life expectancy, Anderson said.
“The key factor is the increase in drug overdose deaths,” he said.
Overall, life expectancy dropped by a tenth of a year, from 78.7 to 78.6. It fell two-tenths of a year for men, who have much higher overdose death rates, from 76.3 to 76.1 years. Women’s life expectancy held steady at 81.1 years.
The number of people who fatally overdosed on fentanyl and other synthetic opiates soared from 9,580 in 2015 to 19,413 in 2016. Deaths due to heroin were up nearly 20 percent, and deaths from other opioid painkillers such as hydrocodone and oxycodone were up 14 percent.
“It’s even worse than it looks,” said Keith Humphreys, an addiction specialist at Stanford University. Given that research has shown official figures could be undercounting the true number of opioid deaths by 20 percent or more, “we could easily be at 50,000 opioid deaths last year,” he said. “This means that even if you ignored deaths from all other drugs, the opioid epidemic alone is deadlier than the AIDS epidemic at its peak.”
And while only limited provisional data is available for 2017, things don’t look any better.
“My guess is that when all of the data are in that the [2017] trend line will be at least as steep as for 2016, if not steeper,” Anderson said.
Opioid death rates continue to increase sharply in the United States, with a 28 percent rise in 2016. (National Center for Health Statistics)
While drug mortality has been increasing among all age groups since 1999, it’s highest among those ages 25 to 54. Their fatal overdose rate for all drugs was roughly 35 cases per 100,000 individuals in 2016, compared with 12 deaths per 100,000 for people under 24 and six deaths per 100,000 among seniors 65 and older.
Men of all ages (26 deaths per 100,000) are twice as likely to die of a drug overdose as women (13 per 100,000). At the state level, West Virginia stands alone as the epicenter of overdose mortality, with 52 deaths per 100,000 residents in 2016. The next two states, New Hampshire and Ohio, each saw 39 deaths per 100,000 last year.
“This is no longer an opioid crisis,” said Patrick Kennedy, a former Rhode Island congressman who was a member of President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis. “This is a moral crisis . . . we know how to answer this problem, but we can’t get around our own prejudices.”
Kennedy said medication-assisted therapies, including newer injectable drugs that block opioid cravings, are crucial to curbing the crisis. But there is “a bias in recovery circles” against such treatments, with the attitude that “you’re not supposed to take medications — that’s not called sobriety,” he said.
On July 31, the commission recommended Trump declare the crisis a national emergency, a designation that could have made emergency funding available. Instead, the president in October declared a public health emergency; he has since devoted little additional resources to the problem.
“He gave a fantastic speech,” Kennedy said of Trump. “But so far he’s all talk and no follow-through.” The political dithering cost 174 deaths a day from drug overdoses in 2016 — one every 8½ minutes, he said.
The 10 leading causes of death accounted for roughly three-fourths of the 2.7 million deaths last year. Rates for heart disease, cancer, chronic lower respiratory diseases, strokes, diabetes, influenza and pneumonia, and kidney disease fell, as did the nation’s overall death rate.
The 9.7 percent jump in unintentional injuries, which includes drug overdoses, motor vehicle crashes and other kinds of accidents, pushed that category into third place overall among causes of death. Alzheimer’s disease deaths rose by 3.1 percent and suicides increased by 1.5 percent.
Last year, some experts attributed the rising toll of Alzheimer’s disease to more frequent reporting of it. But Anderson said a second year of substantial increases probably indicates that more people are dying of the disease.
“As people avoid [cancer and heart disease], they’re going to survive long enough to die of Alzheimer’s,” he said.
The report also noted a small but statistically insignificant decline in infant mortality.
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This article first appeared on Just Security.
The Trump Administration this week formally accused the North Korean government of responsibility for the WannaCry ransomware attacks that hobbled hundreds of thousands of computers “in more than 150 countries” in May 2017.
The accusation came first in a Wall Street Journal op-ed by U.S. Homeland Security Advisor Tom Bossert Monday night. At a press briefing on Tuesday, Bossert explained that North Korea’s “malicious behavior is growing more egregious, and . . . [t]he attribution is a step towards holding them accountable . . .”
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He noted, “We do not make this allegation lightly. We do so with evidence, and we do so with partners. Other governments and private companies agree. The United Kingdom, Australia, Canada, New Zealand, and Japan have seen our analysis, and they join us in denouncing North Korea for WannaCry.”
This undated picture released from North Korea’s official Korean Central News Agency (KCNA) on December 09, 2017 shows North Korean leader Kim Jong-Un visiting Mount Paektu in Ryanggang Province. AFP/Getty
The attribution is in many ways unsurprising. Private companies alleged North Korean involvement within days of the ransomware’s spread, and the Washington Post reported in June that the National Security Agency had concluded that North Korea was behind the WannaCry worm.
Nonetheless, the attribution raises several important questions.
1. Where’s the evidence?
Attribution by op-ed doesn’t lend itself to technical detail. Prior U.S. attributions, particularly the attribution of the Sony hack to North Korea three years ago, have come in for criticism for providing insufficient detail to support accusations, and this attribution is the least-supported to date.
When asked in the press briefing about the basis for the U.S. accusation, Bossert said, “What we did was, rely on — and some of it I can’t share, unfortunately — technical links to previously identified North Korean cyber tools, tradecraft, operational infrastructure.”
This may be sufficient given the accusations against North Korea by the private sector, and even the UK government, over the last few months. But it does little to set an example or establish an evidentiary best practice for states to follow in attributing future cyberattacks to states or state-sponsored actors.
It is especially unlikely to satisfy states that pushed for a statement in the 2015 UN Group of Governmental Experts report that “accusations of organizing and implementing wrongful acts brought against States should be substantiated.”
2. What should be the respective roles of the government and private companies?
Although Bossert announced no governmental action besides the attribution itself, he praised the actions of private companies.
He said, “We applaud our corporate partners, Microsoft and Facebook especially, for acting on their own initiative last week without any direction by the U.S. government or coordination to disrupt the activities of North Korean hackers. Microsoft acted before the attack in ways that spared many U.S. targets.”
This praise is consistent with prior U.S. government statements emphasizing the important role that private parties play in cybersecurity, but it’s rendered more interesting here because of the circumstances of WannaCry.
As the New York Times reported in May, the ransomware exploited a vulnerability in Microsoft Windows that was revealed when the Shadow Brokers divulged hacking tools stolen from the National Security Agency. Microsoft patched the vulnerability before WannaCry’s release, but the ransomware spread widely on unpatched systems.
In a blog post in May, Microsoft President Brad Smith argued that the ransomware “provides yet another example of why the stockpiling of vulnerabilities by governments is such a problem” and that “an equivalent scenario with conventional weapons would be the U.S. military having some of its Tomahawk missiles stolen.”
Smith said Tuesday that Microsoft “helped disrupt the malware [the hackers known as the Lazarus] group relies on, cleaned customers’ infected computers, disabled accounts being used to pursue cyberattacks and strengthened Windows defenses to prevent reinfection.”
Facebook similarly said that it deleted accounts linked to the hackers and notified others who were in contact with those accounts.
The importance of private actions to the mitigation of the threats from North Korea illustrates what I have called the “public-private cybersecurity system” in the United States.
This system gives private parties a quasi-governmental role, casting them as crime fighters and national security defenders, and blurs the line between the government and the private sector in ways that raise important issues about accountability, transparency, and other public values.
As the WannaCry incident shows, threats to public values may come from governmental or private actors—and so can protective measures.
But figuring out how to manage public-private cybersecurity to best protect individuals, institutions, and society at large is becoming increasingly crucial as the blurring of public and private roles may now be close to explicit U.S. government policy.
At the White House press briefing, Jeanette Manfra, the Department of Homeland Security’s Assistant Secretary for Cybersecurity and Communications, said : “Our adversaries are not distinguishing between public and private, so neither should we.”
3. Did North Korea violate international law?
Once again, governments have missed an opportunity to clarify the bounds of international law in cyberspace.
Bossert’s op-ed and comments at the press briefing strongly condemn North Korea’s actions, but do not clarify whether the United States regards them as a violation of international law.
In a press release, the UK Foreign Office Minister for Cyber, Lord Ahmad of Wimbledon, issued a similar condemnation and said, “International law applies online as it does offline.” But he stopped short of saying that WannaCry violated international law.
States agreed in the UN Group of Governmental Experts that “[a] State should not conduct or knowingly support [information and communications technology] activity contrary to its obligations under international law that intentionally damages critical infrastructure or otherwise impairs the use and operation of critical infrastructure to provide services to the public” (para. 13(f)).
WannaCry clearly impaired the use of critical infrastructure: it severely disrupted the functioning of UK hospitals, among many other affected entities.
So were North Korea’s actions “contrary to its obligations under international law” or not?
The silence on the international law questions could mean that governments do not think that there was an international law violation. Or it could mean there is disagreement within different governments or between different governments about whether there was an international law violation and if so, which principle of international law was violated.
Yet another possibility is that states do agree that WannaCry violated international law, but are making a policy choice not to call North Korea’s actions a legal violation in order to avoid creating public expectations about the need for governments to respond. This may be particularly attractive for the United States, which escaped much of WannaCry’s impact.
Nonetheless, if international law is to develop, at some point states must determine and publicly explain how international law applies to attacks like WannaCry, the Sony Pictures hack, and Russian election interference.
By refraining from legal characterization of governments’ actions in cyberspace, states are missing the chance to develop international law, which could ultimately justify additional responses to bad actions by states, beyond just naming and shaming.
Kristen Eichensehr is an Assistant Professor at UCLA School of Law, Affiliate Scholar at Stanford Law School’s Center for Internet and Society and Former Special Assistant to the Legal Adviser of the U.S. Department of State.
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