Issue Category: Public Health Funding

U.S. Experienced Highest Ever Combined Rates of Deaths Due to Alcohol, Drugs, and Suicide During the COVID-19 Pandemic

Deaths spanned ages, racial and ethnic groups, and geography but disproportionally harmed young people and people of color

Solutions are known and must be implemented

(Washington, DC – May 24, 2022) – Deaths associated with alcohol, drugs, and suicide took the lives of 186,763 Americans in 2020, a 20 percent one year increase in the combined death rate and the highest number of substance misuse deaths ever recorded for a single year, according to a report released today by Trust for America’s Health (TFAH) and Well Being Trust.  In addition, provisional data from the Centers for Disease Control and Prevention show drug overdose deaths continued to increase in 2021.

While alcohol, drug, and suicide deaths have been increasing for decades, the 2020 increase was unprecedented and driven by a 30 percent increase in the rate of drug-induced deaths and a 27 percent increase in the rate of alcohol-induced deaths.  Combined rates of alcohol, drug, and suicide deaths increased in all 50 states except New Hampshire, and for the first time two states – West Virginia and New Mexico – surpassed 100 deaths per 100,000 state residents from alcohol, drugs, and suicide combined in a single year.

  • The overall drug-induced death rate increased by 30 percent, largely driven by increases in deaths due to use of synthetic opioids and psychostimulants. The rate of drug-induced death rose for all but one population group – those over 75 years of age. There were particularly large increases in communities of color, among youth (17 years old and younger) and young adults (18-34 years of age) and in the South and West regions of the country.
  • Alcohol-induced death rates increased by 27 percent, and the increase spanned demographic groups and parts of the country, including in all 50 states and the District of Columbia. Increases were particularly high among young adults, American Indians/Alaska Native and Asian communities, and for those living in the Midwest.
  • Overall suicide rates declined by 3 percent but that trend was not universal. The decline occurred among white people but suicide deaths for the year increased among American Indian, Black, and Latino people. Suicide rates for adults ages 35-74, declined, but rates for youth and young adults increased.

“With the trends continuing to go in the wrong direction we must ask ourselves, what will it take to move to robust and comprehensive action? The story behind these data is beyond devastating and heartbreaking to those families who have suffered loss,” said Dr. Benjamin F. Miller, President, Well Being Trust. “Let’s begin to address this crisis with the urgency it deserves by bringing care to where people are. From schools to primary care to our workplaces, let’s ensure that all places are equipped to address mental health and substance misuse. This is not just the responsibility of the mental health and addiction field – but all our responsibility.”

TFAH and Well Being Trust have been reporting alcohol-induced, drug-induced and suicide deaths as part of their Pain in the Nation initiative since 2017.  In the initiative’s inaugural 2017 report, alcohol, drug and suicide deaths accounted for 55,403 deaths per year, as compared to the 186,763 deaths associated with alcohol, drugs or suicide in this year’s report. According to the report authors and other experts, the stunning increase in alcohol and drug deaths in 2020 was exacerbated by: a continued rise in synthetic opioid and psychostimulant overdoses and the anxiety, stress, grief, disruption to substance misuse recovery programs, and financial hardship many individuals and families experienced during the COVID-19 pandemic.

The report includes recommendations for steps the federal, state, and local governments should take to begin to reverse the deaths of despair crisis.  They include:

Invest in programs that promote health and prevent substance misuse and suicide:

  • Support in-school programs focused on students’ mental health and preventing substance use.
  • Strengthen trauma-informed and culturally competent and linguistically appropriate programs within all youth-serving agencies, including the juvenile justice system.
  • Strengthen the continuum of crisis intervention programs with a focus on the newly established “988” lifeline.
  • Expand CDC comprehensive suicide-prevention efforts, including measures to strengthen economic supports, promote connectedness, and create protective environments.
  • Build programs that address the social determinants of health and promote resilience in children, families and communities including those focused on the prevention of adverse childhood experiences.

Address the substance misuse and overdose crises:

  • Promote harm-reduction policies to reduce overdose and blood-borne infections, including increasing access to syringe service programs, naloxone, and fentanyl test strips.
  • Preserve and extend programs that create more flexible access to substance use disorder treatment during the pandemic.
  • Direct funding from the opioid litigation settlement to primary prevention of youth substance misuse.
  • Lower excessive alcohol use through policies that limit where and when alcohol can be served/purchased and by the use of alcohol excise taxes.

Transform the mental health and substance abuse prevention system

  • Increase access to mental health and substance use treatment through full enforcement of the Mental Health Parity and Addiction Equity Act.
  • Combat stigma about mental health issues and access to service.
  • Modernize physical and mental health services by aligning service delivery, provider payment, quality measures, and training toward the whole health of individuals and integrated care.
  • Build grassroots community capacity for early identification and intervention for individuals with mental health and substance use disorders, including through community-based or non-traditional settings.

“It is imperative that officials at every level of government act on the recommended policies in this report.  The data are shockingly clear – lives are at risk in every community due to alcohol, drugs, and suicide and communities that experience disadvantage because of long-standing social, economic and environmental inequities suffer a disproportionate impact. There is an urgent need for action in order to save lives,” said J. Nadine Gracia, M.D., MSCE, President and CEO of the Trust for America’s Health.

Read the full report

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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. 

Well Being Trust is an impact philanthropy dedicated to advancing the mental, social, and spiritual health of the nation.

TFAH’s Portal of COVID-19 Resources

The following is a list of TFAH resources and documents related to the novel coronavirus read of COVID-19 and better equip the nation’s public health system to deal with this and future health emergencies.

Press Releases and Statements

20 Public Health Organizations Condemn Herd Immunity Scheme for Controlling Spread of SARS-CoV-2   The virus that causes COVID-19 has infected at least 7.8 million people in the United States and 38 million worldwide. It has led to over 215,000 deaths domestically, and more than 1 million globally – with deaths continuing to climb… read more (October 14, 2020)

Newly Announced Order for Hospitals to Bypass CDC and Send Coronavirus Patient Information Directly to Washington Database Likely to Worsen Pandemic Response Rather than Improve It  The U.S. Centers for Disease Control and Prevention (CDC), as the nation’s lead public health agency, is uniquely qualified to collect, analyze and disseminate information regarding infectious diseases… read more (July 16, 2020)

Nearly 350 Public Health Organizations Implore HHS Secretary Azar to Support CDC’s Critical Role in the COVID-19 Pandemic Response  The expertise of the U.S. Centers for Disease Control and Prevention (CDC) and all public health agencies is critical to protecting Americans’ health during the COVID-19 crisis, said a letter to Health and Human Services Secretary Alex Azar from 347 health and public health organizations released today… read more (July 7, 2020)

Public Health Needs Our Support “As our nation’s struggles to manage the continued surge of COVID-19 cases, we need to strengthen the public health response… read more (June 23, 2020)

Summary of CDC Morbidity and Mortality Weekly Report on COVID-19 Impact Patterns This is the first data reported on U.S. patients and is consistent with findings from other countries. Key takeaways… read more (March 31, 2020)

Trust for America’s Health Statement in Response to Congressional Passage of the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”)
“Congress took an important step today to begin giving public health the resources it needs now to respond to the COVID-19 pandemic. We are seeing in real-time the impact of the chipping away at public health budgets over the past 15 years… read more (March 27, 2020)

Cross-Sector Group of Eighty-eight Organizations Calls on Congress to Address Americans’ Mental Health and Substance Misuse Treatment Needs as Part of COVID-19 Response
A cross-sector group of 88 organizations from the mental health and substance misuse, public health and patient-advocacy sectors are jointly calling on the Trump Administration and Congress to address the immediate and long term mental health and substance misuse treatment needs of all Americans as part of their COVID-19 response… read more (March 20, 2020)

55 Organizations Call for Passage and Fast Implementation of Paid Sick Leave for all Workers as a Critical Part of COVID-19 Response
A cross-sector group of 55 public health, health, labor, business, and social policy organizations are jointly calling on the Trump Administration and Congress to pass and quickly implement a federal paid sick leave law that provides 14 days of such leave to all workers, available immediately… read more (March 13, 2020)

TFAH Applauds Passage of Supplemental Funding for COVID-19 Response: Now Funding Must Move Quickly to States and Other Entities
TFAH applauds Congress’ fast action in approving the Coronavirus Preparedness and Response Supplemental Appropriations Act (H.R 6074). We now call on the tasked federal agencies to move quickly to send the appropriated monies to the agencies and localities working at the frontlines of the COVID-19 crisis… read more (March 5, 2020)

TFAH Statement on COVID-19 Preparations
Now that the U.S. has transitioned from the planning phase to the response phase of the COVID-19 outbreak, the Federal Executive Branch and Congress as well as state and local governments and other stakeholders should prioritize… read more (March 3, 2020)

Congressional Testimony and Sign-on Letters

Commentaries and Op-Eds

Additional News Coverage We Recommend

Coronavirus in the U.S.: Latest Map and Case Count

as compiled by the New York Times

 

 

CDC COVID-19 Information Resources

COVID-19 and Response: Webinars and Briefings

Related Reports

TFAH Recognizes National Minority Health Month

Trust for America’s Health (TFAH) is proud to support National Minority Health Month (NMHM) 2022 and its critical focus on addressing health inequities. This year’s NMHM theme Give Your Community a Boost! notes the importance of ensuring that everyone eligible to receive the COVID-19 vaccine is vaccinated, including all eligible booster doses. Being vaccinated is the best way to protect yourself and your loved ones against severe illness from COVID-19.

“Ensuring that communities of color have equitable access to and reliable sources of information about the COVID-19 vaccine is vital to promoting and protecting the health and well-being of the community,” said TFAH President and CEO, Dr. J. Nadine Gracia. “People of color have been disproportionately impacted by the pandemic, due to longstanding social, economic, and health inequities that led to higher rates of job loss, less access to essential resources for remote learning, and higher rates of infections, hospitalizations, and deaths. We need to focus on two priorities: protecting everyone from COVID-19 now and ensuring that no community is at heightened risk during the next public health emergency. ”

Additional Readings:

TFAH’s 2020 policy brief Building Trust in and Access to a COVID-19 Vaccine Within Communities of Color and Tribal Nations reports on challenges to building vaccine trust and access in communities of color and tribal communities and recommends solutions.

TFAH’s 2022 Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism reports on state-level public health emergency readiness and the connection between health equity and emergency preparedness.

TFAH’s Leveraging Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity recommends policy action that if adopted will address the social determinants of health that currently drive poor health in many communities.

Read more about TFAH’s policy recommendations to rebuild the nation’s public health system and invest in the social determinants of health and health equity in our Blueprint report: The Promise of Good Health for All: Transforming Public Health in America. A Blueprint for the 2021 Administration and Congress.

Congressional Briefing and National Webinar: Ready or Not 2022: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism

As the nation enters its third year of the COVID-19 pandemic, this year’s report calls for urgent investment to create a public health system able to protect all Americans’ health during emergencies. The report measures states’ degree of preparedness to respond to a wide spectrum of health emergencies and to provide ongoing public health services.

A panel of subject matter experts discussed the nation’s readiness for public health emergencies, examined the findings of the report, and discussed key recommendations for policymakers.

Resources:

Trust for America’s Health

Office of Minority Health, Centers for Disease Control and Prevention

Articles shared by Céline Gounder, MD, ScM, FIDSA

TFAH Recognizes National Public Health Week, April 4 – 10, 2022

Trust for America’s Health is proud to participate in National Public Health Week and its 2022 theme “Public Health is Where You Are.”

Public health’s mission is to promote health and protect people from health risks, including diseases and natural or man-made disasters. Prevention and disease surveillance are central to that mission, as are population-level health interventions including addressing the social determinants of health. Public health practitioners work at the community level to ensure that everyone has an opportunity for optimal health. A critical premise of that work is engaging with and empowering communities, including identifying and addressing root causes of health inequities and barriers to good health.

The COVID-19 pandemic has illustrated the urgent need to grow the public health workforce and ensure that it has the tools it needs to fulfill its mission. TFAH and other public health leaders have called for an annual investment of $4.5 billion to support public health infrastructure and workforce. Much of what we spend as a nation on healthcare today is spent on preventable illness and injury. Rebuilding the public health system would help address health inequities,  would make the country better prepared for future health emergencies, and would improve health outcomes.

Additional Readings:

TFAH’s 2022 Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism report for more information on public health emergency readiness and the connection between health equity and emergency preparedness.

TFAH’s annual report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2021 tracks the dearth of funding for public health and the impact that scarcity has had on the public health infrastructure, readiness, and workforce.

 

Nuevo Reporte: Pocos estados han clasificaron en el nivel de rendimiento superior de la preparación de salud pública en el 2021

La pandemia de COVID-19 continúa ilustrando la necesidad crítica de invertir en la infraestructura de la salud pública y los factores sociales determinantes de la salud

 

(Washington, DC – 10 de marzo del 2022) – A medida que la nación atraviesa su tercer año de pandemia del COVID-19, un nuevo informe demuestra la necesidad de una inversión urgente para crear una infraestructura de salud pública capaz de proteger la salud de todos los estadounidenses durante emergencias. El informe, publicado hoy por Trust for America’s Health, mide el desempeño de los estados basado en 10 indicadores claves de preparación para emergencias e identifica diferencias considerables en la preparación de los estados para responder durante emergencias. El informe incluye recomendaciones de políticas públicas para fortalecer la seguridad sanitaria de la nación.

El informe Ready or Not 2022: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism (Protegiendo la Salud Pública de Enfermedades, Desastres y Bioterrorismo), mide el grado de preparación de los estados para responder a un amplio número de emergencias de salud, ofreciendo continuos servicios de salud pública, incluyendo vigilancia sanitaria,  vacunación contra la influenza estacional, agua potable entre otros servicios de salud ampliados durante emergencias. El reporte clasifica los estados y el Distrito de Columbia en tres niveles de rendimiento: alto, medio y bajo, colocando 17 estados y DC en el nivel de alto rendimiento, 20 estados en el nivel de rendimiento medio y 13 estados en el nivel de bajo rendimiento. Durante el 2020, 20 estados y el Distrito de Columbia se ubicaron en el nivel de alto rendimiento.

Gráfico de niveles de rendimiento de los estados (2021) AQUÍ (manuscrito tabla 2 – página 10)

 

Este año el reporte indicó que 12 estados mejoraron su clasificación de desempeño, mientras que 16 estados descendieron en su clasificación. Las clasificaciones de todos los estados son relativas a las de otros estados.

Tres estados, Ohio, Pensilvania y Carolina del Sur mejoraron su desempeño en dos niveles.

Nueve estados mejoraron en un nivel: Alabama, Arizona, Florida, Illinois, Iowa, Missouri, New Hampshire, New Jersey y New York.

Dieciséis estados bajaron un nivel: Delaware, Georgia, Idaho, Kentucky, Luisiana, Maine, Minnesota, Mississippi, Montana, Nebraska, Nuevo México, Carolina del Norte, Oklahoma, Oregón, Rhode Island y Wisconsin.

Además, el informe demostró:

  • La mayoría de los estados tenían planes para expandir la asistencia médica y la salud publica mejorando sus capacidades de laboratorios en las emergencias.
  • La mayoría de los estados están acreditados en las áreas de salud pública, manejo de emergencias o ambas.
  • Una gran mayoría de estadounidenses que reciben agua para su hogar a través de un sistema de agua comunitario tenían acceso a agua segura.
  • Solo alrededor de la mitad de la población de los EE. UU. cuenta con un sistema integral de salud pública local.
  • Las tasas de vacunación contra la gripe estacional han aumentado significativamente en los últimos años, pero siguen siendo inferiores a la meta establecida por Healthy People 2030.
  • Poco más de la mitad de los trabajadores utilizaron algún tipo de tiempo libre remunerado. La necesidad de tiempo libre remunerado se ha vuelto particularmente necesario durante la pandemia, ya que muchos trabajadores se enfermaron o tuvieron que cuidar a un familiar enfermo.
  • En promedio, sólo el 28 por ciento de los hospitales obtuvo una calificación de máxima calidad de seguridad por parte del paciente durante el año, comparado a un 31 por ciento registrado el año anterior.

“La conclusión principal de este informe es que la inversión es insuficiente en el sistema de salud pública de la nación y los ataques a su autoridad han tenido consecuencias mortales durante la pandemia del COVID-19. Se necesitan acciones e inversiones con urgencia. Los hallazgos de este reporte pueden ayudar a funcionarios federales y estatales a identificar las deficiencias en la preparación de la salud pública y los pasos necesarios para proteger vidas de una manera más eficiente y lograr una mejor economía durante una próxima emergencia de salud”, dijo J. Nadine Gracia, MSCE, presidenta y directora ejecutiva de Trust for America’s Health.

El informe midió el desempeño de los estados durante un año que presentó altas demandas en el sistema de salud pública de la nación. Además de considerarnos en medio de la pandemia del COVID-19,  se debe tomar en cuenta que en el 2021 se registraron altas temperaturas récord de calor en muchos lugares, y como consecuencia hubo inundaciones extensas, incendios forestales en todo el oeste de los EE. UU., una temporada de huracanes muy activa y tornados inusuales y mortales en diciembre en ocho estados. Al mismo tiempo, cientos de funcionarios de salud pública experimentaron agotamiento, amenazas a su seguridad e intentos de limitar sus autoridades de salud pública, los cuales renunciaron, se jubilaron o fueron despedidos.

Es cierto que se logró un progreso crítico en la lucha contra el COVID-19 durante 2021, particularmente a través de la disponibilidad generalizada de vacunas y una respuesta federal más coordinada, pero es un hecho que la pandemia resaltó las formas en que las desigualdades en salud ponen a las comunidades de color y de bajos ingresos en mayor riesgo y peores resultados de salud durante una emergencia.

“Las desigualdades sociales, económicas y de salud debilitan la capacidad de una comunidad para prepararse, responder y recuperarse de una emergencia de salud pública. Si entramos en la próxima crisis de salud pública con la misma magnitud de inequidades en temas de salud pública en nuestras comunidades como ha sido evidenciado durante esta pandemia, el impacto será similar:  evitar la pérdida de vidas, el impacto desproporcionado en comunidades de color y comunidades de bajos ingresos, y las perturbaciones sociales y económicas generalizadas. Es imposible separar una sólida preparación para emergencias de salud pública y la equidad en salud”, dijo la Dra. Gracia.

Entre las recomendaciones del informe, se detacan:

  • El Congreso y los estados deben proporcionar fondos estables, flexibles y suficientes para la salud pública, incluida la infraestructura, los sistemas de datos y la fuerza laboral de salud pública.
  • El Congreso debe crear una Comisión COVID-19 para revisar y abordar las brechas en la respuesta a la pandemia, y los líderes en todos los niveles del gobierno deben rechazar los intentos de debilitar a las autoridades de salud pública.
  • Los legisladores deben tomar medidas para prevenir brotes de enfermedades invirtiendo en infraestructura de vacunación, programas de resistencia a los antibióticos y otorgando licencias pagadas a todos los trabajadores.
  • El Congreso debe crear programas para ayudar a construir comunidades resilientes invirtiendo en la equidad en la salud y los determinantes sociales de la salud, incluidos los programas antipobreza y los programas que generan seguridad financiera para las familias.
  • El Congreso debe invertir en el desarrollo y trabajar en medidas medicas de protección para permitir el desarrollo rápido y el despliegue efectivo de productos que salvan vidas durante emergencias, y los legisladores federales y estatales y los líderes de los sistemas de atención médica deben trabajar juntos para priorizar la coordinación y la comunicación efectivas durante las emergencias.
  • La Casa Blanca, el Congreso y los estados deben desarrollar planes y proporcionar fondos para minimizar los impactos del cambio climático en la salud y hacerlo de manera que aborde la equidad en el sistema de salud publica.

Trust for America’s Health es una organización no partidista y sin fines de lucro que promueve la salud óptima para cada persona y comunidad y hace de la prevención de enfermedades y lesiones una prioridad nacional.  Twitter: @HealthyAmerica1