one nation under stress (2019)

Available on HBO max, youtube, google play, Vudu, prime, and apple tv

Synopsis

In the 1960’s, Americans had among the highest life expectancy in the world. Today, the U.S. ranks at the bottom of major developed nations, despite its enormous wealth and spending more on healthcare per capita than any other country in the world.

 Stunned by this tragic fact and a recent study showing mortality rates for Americans overall had steadily increased for the first time in decades, Sanjay, an investigative journalist and neurosurgeon, sets out to find what's happening and why.  

It becomes clear that this problem is uniquely American. While all developed countries have endured similar market forces and recessions, and rates of mental and physical illness, mortality in the United States continues to increase while it decreases in similar countries. And within the United States, the problem seems to be uniquely white. While Black mortality rates remain higher than whites, they are steadily dropping as white mortality rates increase. The Hispanic population has mortality rates already lower than whites, and dropping even more.

 In his search for the underlying problem, “the cause of the cause,” Sanjay hones in on chronic stress worsened by “dashed expectations” as a leading suspect.

 He reads a study by Princeton economists Anne Case and Sir Angus Deaton, who identify drug overdoses, cirrhosis of the liver and suicide as the culprits driving the mortality trend. Case coined the term “deaths of despair” in the report.

 Sanjay’s first stop is his former professor, Cyril Wecht, the renowned pathologist who taught him forensics. Wecht now performs autopsies in Western Pennsylvania, an area with some of the highest mortality rates in the country. He tells Sanjay he is seeing a crisis of “monstrous” proportions and that he believes stress is the leading contributing factor. He says people do not understand that it is primarily whites between the ages of 35 to 55.

 This prompts Sanjay to travel the country meeting with leading stress researchers such as Robert Sapolsky, Sir Michael Marmot, Ichiro Kawachi, primatologists such as Frans de Waal, the economists Anne Case and Sir Angus Deaton, social scientists, physicians and people actually suffering chronic stress and on the brink of becoming deaths of despair. He learns the white working class seem to be the leading edge, but even during the 2-year course of making the film, more studies come out showing the epidemic is now spreading beyond this group.

 By the end of the film, a new study reveals that American life expectancy has declined for a third year in a row. This hasn’t happened in the U.S. for 100 years, not since the flu pandemic that happened during World War I.