Does Reducing Internal Distress Get Adequate and Proper Place in USA Elections

trump harris

For any society to be able to reduce its internal distress significantly the first step is to come face to face honestly and sincerely with the level and causes of this distress. Such honest introspection is particularly expected in a country like the USA which has high levels of internal distress, is supposedly functioning with higher levels of democracy and transparency, at least at more obvious surface levels, and has availability of high levels of scholarship for the study of internal distress and a strong data base for this.  What is more, election times are supposed to witness the peak of a thoughtful and intense engagement with internal distress as rival parties and candidates are supposed to debate and promise various effective ways of reducing this internal distress in important ways.

            However the present and several preceding elections in the USA reveal that such a sincere and intense engagement with the most important aspects of reduction of internal distress is often missing here, even though frivolous and in fact entirely avoidable issues often get a lot of attention. The USA is a country very well-endowed by resources and exceptionally favoured by history and geography. So questions arise regarding why a large number of people here face severe economic difficulties and constraints and perhaps an even larger number face social distress.

           Senator Bernie Sanders wrote recently (The Guardian, August 5, 2024), “In the midst of all the political gossip on TV and in newspapers (leading up to the elections of 2024), what Americans will not encounter is a serious discussion of the multiple economic crises facing the 60% of our fellow-citizens who live pay-check to pay-check—the working class of this country. What you will not hear about is why, in the richest country in the history of the world, so few have so little. What you will not hear about is the pain, the stress, the anxiety that tens of millions of Americans experience on a daily basis and how governmental decisions can improve their lives.” As stated earlier, the distress related to social disintegration can be even more serious than the problems created by economic difficulties and anxiety related to this.  

       Concern has been expressed by health experts in the USA that life-expectancy in this country has been reducing steadily in comparison to levels attained in several other rich countries. This has led some researchers to explore the number of excess deaths in the USA (or number of ‘missing Americans’) which they define as the deaths which are in excess of the number that would have taken place if the life-expectancy rates in the USA had remained at par with those of comparable rich countries.

        One such important recent study by Jacob Bor, Andrew C. Stokes et al was published in the journal PNAS Nexus on May 29, 2023. This study has estimated the number of such excess deaths in the USA in 2019 at 622,534. During the next two years the number of such excess deaths went up to over a million, but as these were COVID years and a number of other issues become involved, we will go here only by the lower number of excess deaths recorded for a normal year at over 600,000. So what this study is saying that on the basis of comparisons with other rich countries, the USA should have been able to achieve the sort of life expectancy that results in avoiding over 600,000 deaths in a year.

        Earlier another study by David Brady on only poverty related mortality published in the USA in JAMA Internal Medicine in April 2023 (for over 15 years age group) had estimated that there are 183,000 poverty related deaths in a year in the USA.

     UN data tells us that at a time when maternal death rate was declining in most countries, in the USA maternal death rate increased to a shocking extent from 12 to 21 during 2000-2020.

        More such data can be provided to show that the number of excess, easily avoidable deaths in the USA is shockingly high at well over half a million every year. A very big contribution to human welfare can be made by taking steps to ensure that these avoidable deaths are actually avoided.

        The steps that are needed for improvements are well-known in a country so blessed with eminent scholars. In a nutshell, health services have to be improved in a big way for all weaker sections without any discrimination, inequalities must be reduced in a big way so that the poorer people have much better access to nutrition, environment and safety must be much better protected, shelter and health and overall social conditions need to be improved to make way for better physical and mental health while avoiding all harmful addictions.

        The bigger question is—when these solutions are well-known, why have not these been adopted and why the situation in some importance respects continues to deteriorate? This is the really crucial question which needs to go beyond the analysis generally available in academic papers as this concerns important political issues of injustice. We need to ask why billions are easily available in the USA for weapons but even millions are not available for some important aspects of social justice, why billions worth of tax gifts can be given to the rich but millions worth of essential expenditure for the poorest is more difficult to find.

        In the context of the USA, a study by the Urban Institute in 2018 found that nearly 40 per cent of adults and their families in USA struggled to afford at least one basic need for health care, housing, utilities or food in 2017, even in normal conditions of high employment levels.     In this study based on a well-being and basic needs survey in the age-group 18-64, 23% said that they were food insecure in the last 12 months. 18% struggled to pay medical bills while almost the same percentage decided to go without some required medical treatment due to costs.

        In a population of about 330 million people and 128 million households in the USA, around 45% persons suffer from chronic diseases, many from multiple chronic diseases, related to a significant extent to increasing exposure to various hazardous substances. Regularity of medicines is very important for treatment, but price of medicines in the USA is often much higher than in comparable countries. Nearly 40% of people of USA are likely to suffer from cancer in their lifetime, based on data of prevailing trends. Nearly 40 million medically consulted injuries and poisoning cases are reported in a year. 12 million vehicles are involved in crashes in one year.

     An important reason why a lot of chronic diseases exist, particularly among teenagers and children, is that some big business interests have caused the spread of hazardous products and technologies as well as intoxicants among common people on a large scale, and children and teenagers are the most vulnerable in this context. Similarly the domination of high profit interests leads to medicines and care being extremely expensive.

        With the advent of COVID and much higher unemployment levels, the situation in terms of struggle to meet basic needs worsened. What is more, in 2020 it was reported that child poverty levels have been found to be 1.5 times higher than adult poverty levels. As for senior citizens, the Elderly Economic Security Standard Index found that in 2016 a majority of them lacked the “financial resources required to meet basic needs.”

        A very large number of people are unable to afford expensive housing and the rising rents. The Eviction Lab, Princeton University, has estimated that there are 3.7 million eviction cases in the USA in a typical year.

        Important as these aspects of economic deprivation are for a large number of people in the country, social distress including social disintegration in the USA may be even more worrying. Various aspects of social distress are analysed by the experts here in very capable and academically advanced ways but unfortunately often also in isolated ways so that a holistic view of the social crisis does not emerge.

          Nearly 28 per cent of US households are single person households. A survey before the onset of COVID revealed that almost half of the adults feel lonely sometimes or all the time. Increasing loneliness has been associated with significant increase of dementia, coronary disease and stroke.

        Nearly 50% of all US marriages end in divorce or separation. In households with children, 50% of divorces lead to push towards poverty. Children suffer very adverse short-term and long-term impacts of divorce and separation.

        10 to 12 million persons, mostly women, are physically abused in a year by an intimate partner, nearly 20 per minute. On a typical day, about 20,000 phone calls are placed on domestic violence helplines, mostly by women.  A report on child abuse is made every 10 seconds. Authorities trace 656,000 victims of child maltreatment in a year, but the problem is bigger. More than 4 million referrals are made to child protection agencies in a year. 

        About 10 million people face incarceration in a year. Over 1.2 million violent crimes are reported in a year, while the actual number is higher.

        According to the US National Survey, year 2023, on Drug Use and Health, 48.5 million Americans (16.7%), aged 12 or older, battled a substance use disorder in the past year. While 10.2 per cent had an alcohol abuse disorder, 9.7% had a drug abuse disorder, while 2.7% suffered from both disorders. An analysis of survey data for 2022 revealed that 17.7 million people use marijuana daily or near daily (this number was less than a million in 1992), while 14.7 million consume alcohol on daily or near daily basis. The New York Times reported recently, “From Washington state to West Virginia, psychiatrists treat rising numbers of people whose use of the drug (marijuana) has brought on delusions, paranoia and other symptoms of psychosis. And in the emergency departments of small community hospitals and large academic medical centres alike, physicians encounter patients with severe vomiting induced by the drug—a potentially devastating condition that once was rare but now, they say, is common.” 

        1 in 4 adults –26%–suffer from a diagnosable mental disorder in a given year, several from more, according to the National Institute of Mental Health Disorders. A 2019 study published in JAMA Paediatrics analysing official data reported that 1 in 6 children are affected by a mental health disorder.  During the last decade, a big rise in depression, even self-harm has been reported among adolescents, even before the onset of COVID.

        1.6 million suicide attempts are made in a year, many of which leave behind a trail of long-lasting, traumatic injuries and disabilities. During the last decade suicide among 10 to 14 year old girls doubled, while emergency room admissions for suicidal ideation and attempts by children and adolescents also roughly doubled during the same period.

        The latest official statistics of ‘Youth Risk Behaviour Survey’ (YRBS), USA, 2011-2021 released recently by the Centres for Disease Control and Prevention, (CDC), USA, have revealed truly alarming levels of distress among US youth.

        The YRBS statistics tell us that in year 2021 42% of US high school students “experienced persistent feelings of sadness or hopelessness”. When this figure was reported at 28% in 2011 this was considered to be quite high and hence brought forth calls for several remedial actions. Despite these, the number has increased persistently and steadily during the decade—30% in 2013 and 2015, 31% in 2017, 37% in 2019 and 42% in 2021. In the case of female students, this percentage is even higher—in 2021 as many as 57% of female high school students experienced persistent feelings of sadness and hopelessness.

        Further, in 2021, the YRBS tells us, 29% of high school students experienced poor mental health. In the case of female students, 41% experienced poor mental health.

        What is even more alarming in the YRBS data is that in 2021, as many as 22% high school students in the USA “seriously considered attempting suicide”. Here also we see an overall increasing trend from 16% in 2011 to 22% in 2021. In the case of female students this number was as high as 30% in year 2021. In other words, almost one-third of female high students in the USA were so distressed as to “seriously consider attempting suicide” during this year.

        In fact the YRBS statistics tell us that as many as 18% of high school students in the USA had actually “made a suicide plan” in 2021. This also had an overall increasing trend from 13% in 2011 to 18% in 2021. In the case of female students this percentage was again higher at 24 in year 2021.

        Most sadly, the YRBS survey tells us that as many as 10% of high school students in the USA actually attempted suicide in 2021. This means that one out of 10 USA high school students attempted suicide in 2021. This percentage increased from 8 in 2011 to 10 in 2021. The number of female students who attempted suicide in 2021 was again higher at 13%.

        Another aspect of distress suffered more by female students related to sexual violence. 18% of female students experienced sexual violence by anyone during the past one year.

        These high levels of distress are extremely troubling and have increased despite remedial actions proposed by eminent experts in the past. Instead of merely repeating such advice, there is clearly need for deeper introspection and more sincere efforts to find real causes and solutions. More than individual consultations, efforts to find what ails the entire society are needed.

      Teenagers are more sensitive and innocent members of society, and if 42 per cent of high school students feel persistently sad and without hope and 10 per cent attempt suicide in a year, then this means that a society is being rejected by a very large number of its own children as being unliveable. If even such a cry of great distress by its own children does not awaken a society to finding out what has gone very seriously wrong with that society, nothing else will. So it is very important to focus on fast increasing social distress and disintegration (on real causes of his, not just symptoms such as excess or misuse of social media or mobiles and related gadgets).

     Instead of trying to find what is wrong with these children, the society should find out what is wrong with itself, with the entire society.  While eminent experts are deeply concerned about this issue, they may be missing some wider important issues due to examining issues more closely in a narrower framework.

        In particular it is important to examine the links of the increasing internal distress of USA society with the increasing aggression of the USA at international level. As this writer has also emphasized earlier, this linkage needs to be recognized and will help the peace movement within the USA to mobilize people to create a society which is at peace with itself and with the entire world, devoted more to reducing its own distress as a higher priority.

        Another question that arises relates to the higher distress suffered by female students (compared to male students) according to almost all criteria. If the USA is supposed to be a society based on gender justice, then why is this happening? This should be seen in the context of high levels of violence and distress suffered by women and female children in other contexts also in the USA, for which a lot of additional data is available. However confining ourselves only to YRBS data for the time being, isn’t it alarming that as many as 57% of female high school students experience persistent feelings of sadness or hopelessness, 41% experience poor mental health, 18% experience sexual violence in a year, 30% seriously consider attempting suicide in a year, 24% make a suicide plan in a year and 13% actually attempt suicide in a year, all this at levels much higher than male students.

        The USA has frequently criticized gender injustice in other countries but should it not also look inwards to ask why girls in the USA are so distressed despite the outer appearance of a very free and liberated society. 

        Other than YRBS data, there have been several other indications of the deep distress of children and adolescents within US society. This is evident from the call given twice in recent times by the top child health organizations in the country for declaring a mental health national emergency for children and adolescents, given the scale of these problems.

      In some contexts social problems are also related to economic deprivation, which in turn is related to high levels of inequalities. The bottom 50% of the people of the USA currently have only 1.5 per cent of the country’s wealth. It will not be difficult to find resources for them as wealth and income are currently so highly concentrated at the top levels in the USA. What is more military spending by the USA is extremely high. Most US official figures mention military expenditure in a year of around 880 billion dollars, but other defence analysts also mention higher figures mention going up to 1.4 trillion or 1400 billion dollars. Without sacrificing defence considerations in any realistic sense and with some overdue reforms to curb corruption, wastage and overpricing by contractors, it should be possible to cut the military spending by about one-half or so, making available between 400 to 700 billion dollars annually for meeting essential welfare needs of American and other people. A figure of just 20 billion dollars has been frequently mentioned in terms of significantly meeting the needs of homeless people in the USA, and a somewhat similar figure would go a long way in reducing hunger to a significant extent in the USA.

   Clearly very big gains are waiting to be achieved at the level of the USA and at world level if only the USA can become a country which is much more oriented towards peace, justice and welfare. On the other hand, an idea of the highly destructive consequences of USA’s existing policy distortions is conveyed by the fact that in terms of direct as well as indirect deaths the War on Terror alone has caused 4.5 million deaths (this estimate of Brown University also needs updating and include some other counties as well) and has cost the USA 8000 billion dollars (about a billion dollars a day or 12000 dollars per second over a 22 year period).

  Reforms are needed in all countries but it is reforms in the USA for creating a society based on peace and welfare which are most urgently needed and can benefit the entire humanity. Hence the people of the USA who are dedicated to peace, justice and environment protection have a very big responsibility for bringing these reforms.


 For resolving these problems of internal distress, it is important to strengthen forces of peace and justice and once these forces are strengthened, this will also contribute to reducing forever wars.

 It is important to campaign for such changes all the time with continuity, but elections are a particularly good time to mobilize people and obtain the commitment of politicians and political parties for important aims and programs of justice, peace and environment protection.           

 Bharat Dogra is Honorary Convener, Campaign to Save Earth Now. His recent books include Protecting Earth for Children, Planet in Peril, Earth without Borders and A Day in 2071.

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