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‘There’s something terribly wrong’: Americans are dying young at alarming rates

Death rates from suicide, drug overdoses, liver disease and dozens of other causes have been rising over the past decade for young and middle-aged adults, driving down overall life expectancy in the United States for three consecutive years, according to a strikingly bleak study published Tuesday that looked at the past six decades of mortality data.

The report, published in the Journal of the American Medical Association, was immediately hailed by outside researchers for its comprehensive treatment of a still-enigmatic trend: the reversal of historical patterns in longevity.

The United States, despite massive expenditures on health care, has seen increasing mortality and falling life expectancy for people ages 25 to 64, who should be in the prime of their lives, while other wealthy nations have generally experienced continued progress in extending longevity. Although earlier research emphasized rising mortality among non-Hispanic whites, the broad trend detailed in this study cuts across gender, racial and ethnic lines. By age group, the highest relative jump in death rates from 2010 to 2017 - 29% - has been among people ages 25 to 34.

The findings are sure to fuel political debate about causes and potential solutions, because the geography of rising death rates overlaps to a significant extent with states and regions that are hotly contested in the run-up to the 2020 presidential election.

About a third of the estimated 33,000 "excess deaths" that the study says occurred since 2010 were in just four states: Ohio, Pennsylvania, Kentucky and Indiana - the first two of which are critical swing states in presidential elections. The state with the biggest percentage rise in death rates among working-age people in this decade - 23.3% - is New Hampshire, the first primary state.

"It's supposed to be going down, as it is in other countries," said the lead author of the report, Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University. "The fact that that number is climbing, there's something terribly wrong."

He said many factors are at play. The opioid epidemic is a major driver of the worrisome numbers, but far from the sole cause. The study found that improvements in life expectancy, largely because of lower rates of infant mortality, began to slowdown in the 1980s, long before the opioid epidemic became a national tragedy.

The 33,000 excess deaths are an estimate based on the number of all-cause midlife deaths from 2010 to 2017 that would be expected if mortality was unchanged vs. the number of deaths actually recorded by medical examiners.

"Some of it may be due to obesity, some of it may be due to drug addiction, some of it may be due to distracted driving from cellphones," Woolf said. Given the breadth and pervasiveness of the trend, "it suggests that the cause has to be systemic, that there's some root cause that's causing adverse health across many different dimensions for working-age adults."

The all-cause death rate - meaning deaths per 100,000 people - rose 6% from 2010 to 2017 among working-age people in the United States.

Men, overall, have higher all-cause mortality than women, but the report pulls out some disturbing trends. Women are succumbing to diseases once far more common among men,even as men continue to die in greater absolute numbers.

The risk of death from drug overdoses increased 486% for midlife women between 1999 and 2017; the risk increased 351% for men in that same period. Women also experienced a bigger relative increase in risk of suicide and alcohol-related liver disease.

Increasing midlife mortality began among whites in 2010, Hispanics in 2011 and African Americans in 2014, the study states.

Outside researchers praised the study for knitting together so much research into a sweeping look at U.S. mortality trends.

"This report has universal relevance. It has broad implications for all of society," said Howard Koh, a professor of public health at Harvard University who was not part of the research team.

The report reveals a broad erosion in health, with no single "smoking gun," said Ellen Meara, a professor at the Dartmouth Institute for Health Policy and Clinical Practice.

"There's something more fundamental about how people are feeling at some level - whether it's economic, whether it's stress, whether it's deterioration of family," she said. "People are feeling worse about themselves and their futures, and that's leading them to do things that are self-destructive and not promoting health."

The JAMA report looked at life expectancy and mortality across the country from 1959 through 2017. Final life expectancy numbers for 2018 will soon be released by the U.S. Centers for Disease Control and Prevention. The general trend: Life expectancy improved a great deal for several decades, particularly in the 1970s, then slowed down, leveled off, and finally reversed course after 2014, decreasing three years in a row.

The average life expectancy in the United States fell behind that of other wealthy countries in 1998 and since then, the gap has grown steadily. Experts refer to this gap as America's "health disadvantage."

There are some factors that manifest themselves only gradually, such as the effects of smoking. For example, in the late 1960s and early '70s, cigarette companies aggressively marketed to women, and the health effects of that push may not show up for decades.

Princeton professors Anne Case and Angus Deaton, whose much-publicized report in 2015 highlighted the death rates in middle-aged whites, published a paper in 2017 pointing to a widening gap in health associated with levels of education, a trend dating to the 1970s. Case told reporters their research showed a "sea of despair" in the United States among people with only a high school diploma or less. She declined to comment on the new report.

Obesity is a significant part of the story. The average woman in America today weighs as much as the average man half a century ago, and men now weigh about 30 pounds more. Most people in the United States are overweight - an estimated 71.6% of the population ages 20 and older, according to the CDC. That figure includes the 39.8% who are obese, defined as having a body mass index of 30 or higher in adults (18.5 to 25 is the normal range). Obesity is also rising in children; nearly 19% of the population ages 2 to 19 is obese.

"These kids are acquiring obesity in their early teen years, sometimes under the age of 10," said S. Jay Olshansky, a professor of public health at the University of Illinois at Chicago. "When they get up into their 20s, 30s and 40s, they're carrying the risk factors of obesity that were acquired when they were children. We didn't see that in previous generations."

"This isn't a one-time phenomenon," he added. "It's going to echo through time."


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'Quick wins' needed to keep climate goals in reach
U.N. says greenhouse gas emissions hit a new high last year despite a nearglobal vow to reduce them

GLOBAL WARMING

GENEVA (AP) — Countries need to begin making steep cuts to their greenhouse gas emissions immediately or risk missing their agreed targets for limiting global warming, with potentially dire consequences, senior United Nations officials said Tuesday.

A report by the U.N. Environment Program, published days before governments gather in Madrid for an annual meeting on climate change, showed the amount of planet-heating gases being pumped into the atmosphere hitting a new high last year, despite a near-global pledge to reduce them.

Man-made greenhouse gas emissions rose in 2018 to 55.3 billion metric tons of carbon dioxide, according to the U.N.'s annual "emissions gap" report. While much of the increase came from emerging economies such as China and India, some of those emissions are the result of manufacturing outsourced from developed countries.

"We need quick wins to reduce emissions as much as possible in 2020," said the agency's chief, Inger Andersen. "We need to catch up on the years in which we procrastinated."

To stop average global temperatures from increasing by more than 1.5 degrees Celsius (2.7 Fahrenheit) this century compared with pre-industrial times, worldwide emissions of carbon dioxide, methane and other greenhouse gases will have to drop by 7.6% each year in the coming decade, the agency said. Scientists say the 1.5 C target — contained in the 2015 Paris climate accord — would avert some of the more extreme changes in global weather patterns predicted if temperatures rise further.

"What we are looking at is really that emissions need to go down by 55% by 2030," said John Christensen, lead author and director of the UNEP-Danish Technology Institute Partnership.

Even the less ambitious goal of capping global warming at 2 C (3.6 F) would require annual emissions cuts of 2.7% between 2020 and 2030, UNEP said.

That seems unlikely. At present, national pledges would leave the world 3.2 degrees Celsius (5.8 Fahrenheit) warmer by 2100 than pre-industrial times, with dramatic consequences for life on Earth, the U.N. agency said. Getting the world back on track to 1.5 C would require a fivefold increase in measures pledged so far, it calculated.

Last week, UNEP published a separate report that found that countries are planning to extract more than twice the amount of fossil fuels from the ground than can be burned in 2030 if the 1.5 C target is to be met. This includes countries such as Norway, which touts its green credentials while it continues to drill for oil in the North Sea.

Officials appealed to governments that have already laid out targets for reducing their emissions to see if they can do more. However, governments' plans to reduce emissions haven't been universally welcomed.

A $60 billion package of measures agreed to by the German government recently has been criticized as a further burden on businesses, while environmentalists say it is too little, too late. Presenting a study Tuesday showing that average surface air temperatures in the country have already risen by 1.5 C since 1881, German Environment Minister Svenja Schulze insisted that Europe's industrial powerhouse "is one of the countries that is doing a lot."

"There are other countries which are quitting climate accords," she added, without explicitly naming the United States, which under President Donald Trump announced its withdrawal from the Paris Agreement.

Experts agree that the longer countries continue burning fossil fuels, the more warming will be "locked in" as emissions stay in the atmosphere for years or even decades.

"There has never been a more important time to listen to the science," U.N. Secretary-General Antonio Guterres said of the UNEP report. "Failure to heed these warnings and take drastic action to reverse emissions means we will continue to witness deadly and catastrophic heatwaves, storms and pollution."


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Ted Carter expected to be offered close to $1 million a year for NU president's job

The University of Nebraska’s next president could be paid close to $1 million a year under the terms of a proposed contract.

Walter “Ted” Carter, former superintendent of the U.S. Naval Academy, is expected to win the appointment to the presidency at the NU Board of Regents’ meeting in Lincoln on Dec. 5.

The board’s agenda will be divulged Wednesday, and two individuals close to the situation, who spoke on the condition of not being named, say he will be offered somewhere near $1 million a year. Carter, 60, was the sole finalist for the job.

The regents have made it clear for months that they are willing to pay well above former NU President Hank Bounds’ $540,000 a year.

Rod McDavis, head of the search firm that assisted NU in the hunt for the next president, told regents and the search committee several months ago that the going rate for system presidencies like NU’s is around $1 million a year.

At no point have members of the Board of Regents balked at the notion that they will pay the next president close to a seven-figure annual contract.

Under state law, the regents were required to name only one finalist. State law was changed about three years ago so that the regents wouldn’t have to name four finalists.

Carter has had a 30-day public review period, during which he traveled the state and made speeches to groups in many communities. The public has been encouraged to provide feedback. The 30-day review just ended.

Regents have praised Carter as an excellent leader who, as a young man, trained in the renowned Top Gun fighter pilot school. He holds an American record for most landings onto aircraft carriers.

He became head of the Naval War College about seven years ago and then served as the Naval Academy’s president for five years.

Photos: Walter E. 'Ted' Carter

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Nebraska's lethal injection drugs have expired, and apparently the state isn't seeking new ones

LINCOLN — The State of Nebraska’s stock of lethal injection drugs has expired, and it appears no effort has been made to restock the drugs since the August 2018 execution of Carey Dean Moore.

A review of public records found no attempt to obtain replacement drugs, and a state corrections official confirmed that Nebraska lacks the drugs at this time to carry out the death penalty.

When asked about the lack of such substances, a spokesman for Gov. Pete Ricketts — a staunch proponent of capital punishment — expressed no concern, and said the state was monitoring the status of the legal appeals pending by the 12 men on Nebraska’s death row.

State Sen. Ernie Chambers of Omaha, the state’s leading opponent of the death penalty, said the lack of lethal injection drugs confirms to him that the execution of Moore — the first in Nebraska in 21 years — was for political purposes and didn’t reflect a long-term commitment to resuming capital punishment.

“All that the governor wanted was to make some political hay,” Chambers said.

He added that he isn’t surprised the state has not sought to obtain new drugs. He noted that just prior to Moore’s execution on Aug. 14, 2018, state officials told a judge that unless the execution was allowed to proceed, one of the four drugs, potassium chloride, would expire, and the state would likely be unable to obtain the drug again.

Carey Dean Moore was executed by lethal injection on Aug. 14, 2018.

But there may be a more practical reason, according to a national expert on capital punishment.

Robert Dunham of the Washington, D.C.-based Death Penalty Information Center said that because Nebraska has no execution dates set, the state may be purposely waiting so it doesn’t buy drugs that expire before they can be used.

“They don’t want to look for something that would take a tremendous amount of effort to obtain, and then have them expire without ever being used,” Dunham said.

It also could be months before any of Nebraska’s death row inmates exhaust their legal appeals. And it’s unclear whether any of the condemned men would drop their attempts, as Moore did, thus hastening their path to the execution chamber.

Moore, 60, was put to death after spending 38 years on death row. He was convicted of the 1979 slayings of Omaha cabdrivers Reuel Van Ness and Maynard Helgeland.

Spokespersons for the Nebraska Department of Correctional Services and Ricketts declined to respond to a question about why the state lacked the drugs necessary to carry out an execution.

The state used four drugs to execute Moore: diazepam, fentanyl, cisatracurium and potassium chloride. It was the first time nationally that the four drugs had been used in an execution. All drugs used in lethal injections have a shelf life, with some being as long as two to four years and others being much shorter. Drugs produced by a compounding pharmacy can have a shelf life of only a few weeks or months.

Laura Strimple, the corrections spokeswoman, confirmed that the expiration dates had passed on the four drugs used in the Moore execution, and that “the state has not acquired any new substances.”

State records obtained by the ACLU of Nebraska through public records requests also indicated no efforts to obtain new drugs or seek alternative substances.

Danielle Conrad, executive director of the ACLU, said it has filed a series of records requests in the interest of “government transparency.” She said it was an attempt to ensure that the most grave function of the state, an execution, is carried out using drugs from reputable sources.

The ACLU, along with the media in Nebraska, including The World-Herald, have also joined in a lawsuit to compel the state to reveal the source of its execution drugs. The State Supreme Court has yet to rule in the case, though a lower court judge said the records should be made public.

Conrad said the state has “a very checkered history in their attempt to obtain legal injection drugs.”

In 2010, federal authorities destroyed one batch of Nebraska’s lethal injection drugs because the state lacked the proper importer’s license. In 2015, the state paid a broker from India $54,000 for another batch of drugs, but never received a shipment.

Last year, two drug companies sought to delay Moore’s execution until it was determined if any drugs they manufactured were being used. Several pharmaceutical companies have adopted policies in recent years banning the use of their drugs in capital punishment.

But in Moore’s case, a federal judge refused the request by Fresenius Kabi and Sandoz Inc. to postpone Moore’s execution. Their lawsuit was dropped after the execution was carried out.

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Nationally, states have struggled to obtain lethal injection drugs as manufacturers of the substances have either stopped providing the drugs or clamped down on their use in executions.

One bit of information revealed by the ACLU’s records requests was that a British company, Hikma Pharmaceuticals, wrote to Nebraska officials asking them to attest if the state had any Hikma drugs that it planned to use in a lethal injection.

A Hikma spokesman said that such a letter is sent annually by the company to every death penalty state to ensure that their drugs are not being used in connection with capital punishment.

“We strongly object to the use of any of our products for capital punishment, and we reinforce this position annually,” through the letters, said Hikma spokesman Steven Weiss.

Weiss said the state responded that it had no Hikma drugs.

The only other record revealed by the public records request showed that the state this fall applied to renew its federal Drug Enforcement Administration certificate to handle the controlled substances used in executions. Strimple said the renewal request is made annually and is pending.

The 12 men on Nebraska’s death row and their crimes

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