Addressing life expectancy decline driven by COVID-19, opioid crisis

Jean-Marie Robine

May 11, 2023 – How is the human lifespan being shortened by epidemics such as COVID-19 and the opioid crisis, and what kind of health policies can help mitigate the problem?

These were the main questions addressed at the 7th Cutter Symposium, held on May 5 at Harvard T.H. Chan School of Public Health. Organized by the Department of Epidemiology, the event included talks by three experts. The event was moderated by Albert Hofman, Stephen B. Kay Family Professor of Public Health and Clinical Epidemiology and chair of the Department of Epidemiology.

The Cutter Lectures, covering topics in preventive medicine, have been held since 1912 thanks to a bequest from John Clarence Cutter, a doctor and graduate of Harvard Medical School.

The first presenter was Elizabeth Arias, a researcher at the National Center for Health Statistics at the Centers for Disease Control and Prevention, who gave an overview of life expectancy trends in the U.S. Arias noted that from 2019–2021, the abrupt decline in life expectancy due to COVID-19 was inequitable across races and ethnicities, with the biggest decreases in the Indigenous, Black, and Hispanic populations. Arias also said that from 2010–2019, unintentional injuries—a category that includes drug overdose—had a negative impact on life expectancy across all racial and ethnic groups.

Jean-Marie Robine, an emeritus research professor at the French National Institute of Health and Medical Research, shared his observations about life expectancy trends in western European countries. According to Robine, significant factors decreasing lifespan have included COVID-19 and flu epidemics, as well as heatwaves.

Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health Leadership, shifted the conversation to health policies that can help address the opioid crisis. Koh said that, first and foremost, substance use disorder needs to be considered a matter of public health. “We have to view this as a chronic disease, not as a moral issue,” he said.

Koh’s policy recommendations included limiting pharmaceutical companies’ influence on clinicians and regulatory agencies; educating clinicians about the benefits and risks of prescribing opioids; integrating addiction treatment into health care and social support systems; and promoting ways to reduce harm, such as using syringe service programs and fentanyl testing strips. Koh also emphasized the role of the criminal justice system, saying that people should not be incarcerated for simple possession or use of illicit opioids, and that drug courts should offer treatment as an alternative to incarceration.

He concluded, “If we have more of a public health approach to all this, we’re hoping that more people can reach their highest attainable standard of health.”

– Jay Lau

Photo: Anna Webster