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'American Carnage' Is Real

Justin Fox is a Bloomberg View columnist. He was the editorial director of Harvard Business Review and wrote for Time, Fortune and American Banker. He is the author of “The Myth of the Rational Market.”
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You've heard about the "American carnage." But how bad is it out there, really?

Pretty horrible, actually.

I am referring of course to what was probably the most memorable phrase in President Donald Trump's inaugural address. Here it is in context:

Americans want great schools for their children, safe neighborhoods for their families, and good jobs for themselves. These are just and reasonable demands of righteous people and a righteous public.

But for too many of our citizens, a different reality exists: mothers and children trapped in poverty in our inner cities; rusted-out factories scattered like tombstones across the landscape of our nation; an education system flush with cash, but which leaves our young and beautiful students deprived of all knowledge; and the crime and the gangs and the drugs that have stolen too many lives and robbed our country of so much unrealized potential.

This American carnage stops right here and stops right now.

He's talking about a bunch of different things there, but "carnage" means the killing of lots of people, so let's focus on that. First, the murder rate:

Murder in the U.S.
Homicides per 100,000 population
 
Sources: FBI, FiveThirtyEight
* Estimate based on data from 82 cities.

The numbers through 2015 are from the Federal Bureau of Investigation's annual "Crime in the U.S." reports, which are based on data reported by local police departments. The 2016 report won't be out until September; an FBI report released earlier this month said homicides were up 5.2 percent in the first half of 2016 compared with the same period a year before. Crime analyst Jeff Asher, writing in FiveThirtyEight, estimated on the basis of full- and partial-year data from 82 cities that the full-year increase will probably come out closer to 8 percent.

The two things that seem clearest from the chart are that (1) the murder rate is a lot lower than it was in the 1970s and 1980s and (2) it has risen significantly over the past two years. Trump isn't particularly careful in his use of statistics, and on the campaign trail he sometimes conflated the two -- resulting at one point in FactCheck.org declaring that his claim that the murder rate is the "highest it's been in 45 years" was false while Politifact judged that his statement that "We have an increase in murder within our cities, the biggest in 45 years" was true (it's actually 44 years -- the one-year percentage increase in 2015 was the biggest since 1971 -- but close enough). 

So there is something alarming going on with violent crime, although it's too early to tell how alarmed we should be. It appears to be concentrated in a few big cities. Chicago, with its shocking 59 percent increase in homicides in 2016, grabbed most of the headlines. But as Asher writes, it's not alone:

Among the notable rises outside of Chicago were increases of 56 percent in Memphis, 61 percent in San Antonio, 44 percent in Louisville, 36 percent in Phoenix and 31 percent in Las Vegas. Taken together, those six cities accounted for 76 percent of the overall big city murder rise in 2016.

That's one big source of carnage, responsible for 15,696 deaths in 2015. Another that Trump referenced in his speech is drugs. There, according to the Centers for Disease Control and Prevention, the trend lines have all been headed in the wrong direction for a while now:

Drug Overdoses in the U.S.
Overdose deaths per 100,000 population, age-adjusted
 
Sources: CDC/National Center for Health Statistics; National Vital Statistics System, Mortality

Health statisticians are in the habit of adjusting the death rates in time series like these for the age composition of the population. That means these numbers become less comparable with the homicide data the farther you get from the age-adjustment base year of 2000. Still, the contrast is so great that I'm going to compare them anyway: In 1999, the drug overdose death rate and the homicide rate were similar -- 6.1 per 100,000 population to 5.7 respectively. In 2015, the drug overdose rate was more than triple the homicide rate -- 16.3 to 4.9.

This isn't all about OxyContin, the prescription opioid from Purdue Pharma Inc. that has been deservedly blamed for many problems. The non-opioid overdose death rate has almost doubled since 1999, and while the prescription-opioid death rate rose from 1.2 per 100,000 from 1999 to 4.9 in 2011, it has declined slightly since, while the overdose death rate from heroin (which is pretty hard to get a prescription for, except in Canada) has gone from 1 per 100,000 in 2010 to 4.1 in 2015. In absolute numbers, 52,404 Americans died of drug overdoses in 2015.

These numbers are just ... horrifying. I actually cried as I made the above chart. Same with this one:

Suicides in the U.S.
Suicides per 100,000 population, age-adjusted
 
Sources: CDC/National Center for Health Statistics; National Vital Statistics System, Mortality

What really got to me was this "key finding" near the beginning of the article from which these numbers were taken:

The percent increase in suicide rates for females was greatest for those aged 10–14, and for males, those aged 45–64.

Overall, men are far more prone to suicide than women, but the female suicide rate has been rising faster. In 1999, there were 4.5 times as many suicides by men in the U.S. as by women; in 2014, that ratio was down to 3.6. Men are most likely to kill themselves with guns, women by poisoning. In total, there were 44,193 suicides in the U.S. in 2015 (it looks like a bit more than 10 percent of these were by drug overdose, so there is some double-counting here).

There are other kinds of carnage, too: An estimated 35,092 people died from motor vehicle accidents in the U.S. in 2015, according to the National Highway Traffic Safety Administration. That was up 7.2 percent from the year before -- the biggest such increase in almost 50 years -- although the overall trend since the early 1970s is down. Here, to give a sense of relative trends and scale, are the numbers (as opposed to the rates per 100,000 population) of deaths from the four categories discussed so far:

Quantifying American Carnage
U.S. deaths per year, by cause
 
Sources: CDC, NHTSA, FBI
* There is some overlap in the drug-overdose and suicide numbers.

That's still not the end of it. In 2014, according to the CDC, 38,851 people died of unintentional poisoning in the U.S., and 31,959 of unintentional falls. Accidental gun deaths appear to be relatively rare: The Gun Violence Archive tracked 469 in 2016.

It is the homicides, drug overdoses and suicides, though, that seem to best fit what Trump was talking about in his speech. It's hard to tell yet whether the recent rise in the homicide rate is a blip or the sign of a new trend, but the rise in drug deaths and suicides has been going on for a decade-plus -- and I've got to figure that the weak post-2000 U.S. economy is at least partly at fault.

The effect has been most pronounced among what you might call Trump's core demographic: In a paper that got a lot of deserved attention in 2015, Princeton University economists Anne Case and Angus Deaton found that the death rate for 45-to-64-year-old, non-Hispanic white Americans had been rising since the late 1990s -- contrary to the trend in every other developed country they looked at, as well as among other ethnic groups in the U.S. The three main causes they identified were "suicide, drug and alcohol poisoning (accidental and intent undetermined), and chronic liver diseases and cirrhosis."

That is, again, horrifying. And you really can't fault anybody for calling it "American carnage."

  1. I would have linked to the official text at whitehouse.gov, but if you haven't been to the site since Trump took office you will be hit with a splash page asking for your email address, and if you click "Continue to Website" you will be directed to the home page instead of the page with the text of the inaugural address.

  2. I was able to find the number of suicides for 2015, but could only get the age-adjusted rate through 2014.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

To contact the author of this story:
Justin Fox at justinfox@bloomberg.net

To contact the editor responsible for this story:
Brooke Sample at bsample1@bloomberg.net