Pandemic has worsened several US societal problems
While revealing aspects of inequality, the pandemic has also overshadowed a range of societal problems at crisis levels
Mass shootings during the first week of June that killed or wounded 77 people in 16 separate incidents were part of the rise in gun violence seen across the country since the outbreak of COVID-19. While the pandemic has both amplified and illuminated areas of racial, gender and economic inequality, it has also overshadowed a range of worsening societal problems that had already reached crisis levels prior to COVID-19.
What next
Economic recovery will ease some of the stresses that have accelerated many societal challenges in the United States but it will not resolve the underlying causes. The Biden administration's policy agenda on inequality attempts to ameliorate some of the economic causes of mental health and addiction. However, both areas suffer from long-standing chronic underfunding that is unlikely to be reversed without an extensive policy intervention, something which remains a low priority. The costs of continuing inaction on these problems will weigh on future growth and productivity.
Subsidiary Impacts
- Surging firearm sales during the pandemic and changing perceptions of policing will have long-term impacts on violence levels.
- The impact of the pandemic has reversed some recent success in containing the opioid epidemic and flattening suicide rates.
- Mental health services are at risk of cuts as they have lower reimbursement rates for providers than other healthcare provisions.
Analysis
More than 19,000 people have died from gunshots this year between January 1 and June 9, some 10,500 of them by their own hand. More than 440 children under eleven and 175 police have been killed or wounded.
In 2020, murders rose by 21% year-on-year, easily outstripping the previous largest recorded one-year rise of 12.7% in 1968. The murder rate in the country's 50 largest cities rose by 42% last year. Although the overall murder rate is nearly 40% below the peak in the 1990s, the recent increases are significant, with several factors contributing to the rise.
Surging gun ownership
Retail firearm sales in 2020 were up 90% year-on-year according to the firearm manufacturers trade association, with an estimated 5 million people buying a weapon for the first time.
Social unrest
Portland, Oregon, one of the most prominent cities for protests against policing policies last summer, averaged nine shootings a month over the first six months of 2020, but 35 and 36 in July and August, respectively. Shootings in New York City increased to 316 in July 2020 compared to 123 in July 2019.
Strain of the pandemic
Boston University researchers identified a combination of pandemic fatigue and the worsening economic and psychological strain of life under lockdown as one driver of a further wave of violence in the latter third of 2020.
Guns as health issue
In April, President Joe Biden categorised gun violence as a public health epidemic. He has ordered the Justice Department to crack down on 'ghost guns' (untraceable, self-assembly firearms ordered as easy-to-complete kits online) and on after-market devices that increase the firepower of a weapon.
Biden has categorised gun violence as a public health epidemic
However, the president has limited power to impose gun controls as this lies mostly with Congress and the states. As such, Biden is pushing Congress to tighten loopholes in background checks for gun buyers and take other measures but is hampered by the very slim margins by which Democrats control both houses.
Despite the recent legal challenges facing the National Rifle Association (NRA), the gun lobby remains powerful and is challenging these measures on constitutional grounds (see UNITED STATES: NRA prevented from declaring bankruptcy - May 12, 2021). Meanwhile, states such as Texas are easing rather than tightening their gun laws by, for example, allowing the unlicensed carrying of handguns.
Abuse and addiction
Substance abuse, including opioid addiction, was a public health crisis before the pandemic but many kinds of drug use increased once it started. A study of urine samples by Millennium Health, a laboratory specialising in drug testing, found double-digit increases in the use of non-prescribed fentanyl, methamphetamine, heroin and cocaine during the first months of the pandemic.
Meanwhile, physical distancing, quarantining and other public health measures proved challenging for patients in treatment for, or recovering from, substance use disorders because they disrupted access to medication and other support services (see UNITED STATES: COVID will strain healthcare provision - July 31, 2020).
Overdose increases
Overdoses are poorly tracked nationally and likely underreported. However, in 2015-19 overdose deaths increased faster than any other type of injury death, according to the National Center for Health Statistics, up 35% to more than 70,000. Since the pandemic started, fatal and non-fatal overdoses are up by at least a further 15%, with epicentres shifting from urban to suburban and rural locations, according to a University of Baltimore mapping programme.
The cost of substance abuse to the US economy has reached USD500bn a year in treatment and indirect costs, including productivity loss due to absenteeism and premature mortality and morbidity, according to the latest (2019) triennial report by the Recovery Centers of America, a privately owned provider of addiction treatment (see UNITED STATES: Deaths of despair will drag GDP lower - February 6, 2020). One-fifth of the cost was accounted for by law enforcement.
Unemployment increases risk
All these costs will have inevitably grown during the pandemic, not least because recent research shows associations between unemployment and non-labour force participation and the risk of drug overdose. This implies that policy responses will need to expand beyond the clinical to be included in general policies to provide jobs and tackle economic inequalities.
Mental health
Levels of mental illness were also rising before COVID-19 struck. However, social isolation and family illness and death, together with economic insecurity, increased the number of people reporting symptoms of depression, anxiety and insomnia, and elevated suicidal thoughts. Risk factors are greatest for those with poor social support, financial difficulties or housing instability exacerbated by the pandemic, but companies are realising that even those with secure employment are experiencing higher levels of stress (see UNITED STATES: Corporate duty of care faces revamp - February 3, 2021).
Levels of mental illness were rising before the pandemic
A survey by the Centers for Disease Control (CDC) found that, three months into the pandemic, 31% of respondents reported symptoms of anxiety or depression, 13% reported starting or increasing substance use, 26% reported stress-related symptoms and 11% reported serious thoughts of suicide in the previous 30 days. Overall, two out of five adults reported at least one of these symptoms, with the most vulnerable groups including essential workers, unpaid caregivers for adults, and those receiving treatment for pre-existing psychiatric conditions.
Mental health problems correlate with increased homelessness, incarceration, substance abuse and use of hospital emergency departments, all of which impose a financial cost on municipalities, states and the federal government.
Biden policy response
The Biden administration plans to tackle both the supply and demand for addictive substances while extending treatment availability. It is currently allocating USD4bn to expanding access to mental health services, with further block grants to states of USD1.65bn for substance abuse and USD825mn for mental health services.
Among the initiatives it is pursing are programmes to partner mental health and addiction professionals with police departments and first responders. A consequence of inadequate mental health services is that police are usually the first to respond to someone in a mental health and substance abuse crisis. Such situations account for an estimated 20% of police calls for service.
