County Health Rankings: Drug overdoses driving turnaround in premature death rates

To get a clearer sense of just how bad our drug overdose problem has gotten, look no further than this year’s County Health Rankings. The annual report found that after years of declining premature deaths, that rate is on the rise and due primarily to overdose deaths. It means we could be seeing the first generation of American kids with shorter life expectancies than their parents.

“We often think of the opioid crisis either as happening in very rural communities or as an urban issue,” Kate Konkle, Action Center Team director for County Health Rankings & Roadmaps, told me. “But this is an issue everywhere and particularly in suburban and small metro counties. The good thing is we’re hearing lots of communities talk about this problem — they’re aren’t hiding it or ignoring it.”

Released March 29, the 2017 County Health Rankings measure health in every U.S. county and examine a variety of factors that influence people’s health, such as high school graduation rates, smoking rates, income and access to health care. This year, the “dramatic increase” in premature deaths topped announcements about the report’s release. Specifically, between 2014 and 2015, 85 percent of the increase in premature deaths was attributable to growing early death rates among people ages 15 to 44. Drug overdoses were the top factor driving that rate upward, though homicide, suicide and traffic crashes were even bigger factors for those ages 15 to 24.

In just one decade, large suburban counties went from having the lowest premature death rate due to drug overdoses to having the highest. That’s “alarming,” said Konkle, also an associate researcher at the University of Wisconsin Population Health Institute.

Getting into the numbers, the rankings report found that in 2015, more than 1.2 million people died prematurely, an increase of more than 39,000 people over the previous year. Such rates are highest — and have consistently been highest — among blacks, American Indians and Alaska Natives. Rural counties are home to the highest premature death rates, followed by small metro areas. (How exactly does the report define premature death? Like this: “Rather than examine overall death rates, we look at deaths that occur among people under age 75. These deaths are considered premature because loss of life prior to age 75 is often preventable.”)

Intentional and unintentional injuries — which include homicide, suicide, drug overdose and traffic fatalities — were the top drivers of the premature death increase among youth and younger adults. That’s in contrast to premature deaths due to HIV, cancer and heart disease, which have gone down. In 2015, among those ages 15 to 24, suicide and homicide rates — high percentages of which involved firearms — were highest among Asians and Pacific Islanders and blacks, respectively.

Konkle noted that while drug overdoses are a critical issue for young people in many communities, violence is the main injury threat in others. For example, in some communities, black teens are more likely to lose their lives to firearm-related deaths, many of which are suicides, than drug overdoses. The differences, she said, underscore the need for local engagement and locally tailored responses.

Brand new to this year’s rankings report is a measure on “disconnected youth,” defined as people ages 16 to 24 who are not in school or working. Researchers write of the new measure:

These years represent a critical stage in an individual’s journey toward independence, self-sufficiency, and civic engagement in adulthood. Disconnection can have health and economic costs not just for youth, but for their communities. Youth disconnected from opportunity — meaning the chance to advance in school, gain work experience, form relationships, and build social supports in the community — represent untapped potential to strengthen the social and economic vibrancy of our communities.

Konkle said adding the new measure reflected a renewed recognition that “we need to pay attention to and take care of our young people…and help communities think about avenues for reconnecting kids and making sure they don’t get off the path in the first place.” Here’s what researchers found: About 4.9 million youth and young adults — or one in eight — aren’t working or in school. Rates were highest among American Indians, Alaska Natives, blacks and Hispanics as well as in rural counties in the American West and South. Areas with high rates of youth disconnection were also home to high rates of child poverty, unemployment, teen births and low educational attainment.

“This represents so much creativity and skills that aren’t being tapped into,” Konkle told me. “Each community may have slightly different challenges based on when kids are leaving and where they’re falling out of the system. This data are just a starting point for each community — then they need to dig deeper to see where they’re falling short on creating opportunities for young people.”

However, the rankings report can offer help on that end as well, as it highlights successful local programs that are making a difference. For example, on the issue of youth disconnection, researchers highlighted an effort within the Menominee Nation in Wisconsin, where schools created classroom safe zones where students can develop positive coping techniques. Such efforts have helped dramatically turned around the community’s high school dropout rate: In 2008, less than 60 percent of students at Menominee Indian High School graduated, whereas during the 2015-2016 school year, the graduation rate was at 92 percent.

“We think of this report as a call to action,” Konkle said. “The data is a starting point — it’s not a full picture of everything happening in a community. We give you the numbers, but there are people living behind those numbers. What’s the rest of the story?”

She went on to say: “This helps us remember that health is local, and people have the power to make change happen in their communities.”

To access the new 2017 County Health Rankings, which are a joint endeavor of the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute, as well as a host of interactive tools, visit

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.


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