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LIFE EXPECTANCY AND MORTALITY RATES IN THE UNITED STATES, 1959-2017

1 Center on Society and Health, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond.

H Schoomaker

2 Center on Society and Health, Virginia Commonwealth University School of Medicine, Richmond.

3 Now with Eastern Virginia Medical School, Norfolk.

Associated Data

US life expectancy has not kept pace with that of other wealthy countries and is now decreasing.

To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and from a new analysis of state-level trends.

Life expectancy data for 1959–2016 and cause-specific mortality rates for 1999–2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25–64 years), stratified by sex, race-ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined.

Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminates a period of increasing cause-specific mortality among adults ages 25–64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010–2017, midlife all-cause mortality rates increased from 328.5 deaths/100,000 to 348.2 deaths/100,000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010–2017 was associated with an estimated 33,307 excess US deaths, 32.8% of which occurred in four Ohio Valley states.

CONCLUSIONS

US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (e.g., drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, which began as early as the 1990s and produced the largest relative increases in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the root causes.

INTRODUCTION

Life expectancy at birth, a common measure of a population’s health, 1 has decreased in the US for three consecutive years. 2 This has attracted recent public attention, 3 but the core problem is not new, and has been building since the 1980s. 4 , 5 Although life expectancy in developed countries has increased for much of the past century, US life expectancy began to lose pace with other countries in the 1980s 6 , 7 and, by 1998, had declined to a level below the average life expectancy among Organisation for Economic Cooperation and Development countries. 8 While life expectancy in these countries has continued to increase, 9 , 10 US life expectancy stopped increasing in 2010 and has been decreasing since 2014. 2 , 11 Despite excessive spending on health care, vastly exceeding that of other countries, 12 the US has a longstanding health disadvantage relative to other high-income countries that extends beyond life expectancy to include higher rates of disease and cause-specific mortality rates. 6 , 7 , 10 , 13

This Special Communication has two aims: to examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and from a new analysis of state-level trends.

DATA ANALYSIS

This report examines longitudinal trends in life expectancy at birth and mortality rates (deaths per 100,000) in the US population, with a focus on midlife , defined here as adults ages 25–64 years. This age range was chosen because the literature has reported increases in mortality rates among both young adults (as young as age 25 years) and middle-aged adults (up to age 64 years); midlife mortality is used as shorthand for both age groups combined (ages 25–64 years). Life expectancy at birth is an estimate of the number of years a newborn is predicted to live, based here on period life table calculations that assume a hypothetical cohort is subject throughout its lifetime to the prevailing age-specific death rates for that year. 14 All-cause mortality and cause-specific mortality rates for key conditions were examined, using the International Classification of Disease (ICD-10) 15 codes detailed in the online Supplement . Age-specific rates were examined for age groups of 10 years or less, whereas age-adjusted rates were examined for broader age groups. Age-adjustment rates were provided, and calculated, by the National Center for Health Statistics, using methods described elsewhere. 16

Data sources

Life expectancy data were obtained from the National Center for Health Statistics 17 and US Mortality Database. 18 The latter was used for long-term trend analyses because it provided complete life tables for each year from 1959 to 2016 and at multiple geographic levels. 19 The analysis examined two time periods. First, life expectancy was examined from a long-term perspective (from 1959 onward) to identify when life expectancy trajectories began to change in the US and the 50 states. Second, knowing from the literature that mortality rates for specific causes (e.g., drug overdoses) began increasing in the 1990s, a detailed analysis of cause-specific mortality trends was conducted for 1999–2017. Mortality rates were obtained from CDC WONDER. 20 Pre-1999 mortality data, although available, were not examined because the priority was to understand the conditions responsible for current mortality trends and because changes in coding in the transition from ICD-9 to ICD-10 15 could introduce artefactual changes in mortality rates. Methods that are available to make these conversions were therefore not pursued.

Analytic methods

Life expectancy and mortality data were stratified by sex and across the five racial-ethnic groups used by the US Census Bureau 21 : non-Hispanic (NH) American Indians and Alaskan Natives (AIAN), NH Asians and Pacific Islanders (API), NH blacks (or African Americans), NH whites, and Hispanics. Mortality rates were stratified by geography, including rates for the nine US Census divisions (New England, Mid-Atlantic, East North Central, West North Central, South Atlantic, East South Central, West South Central, Mountain, and Pacific), the 50 states, and urban and rural counties as defined in the online Supplement . Data for the District of Columbia and US territories were not examined.

Changes in mortality rates between two years (two-point comparisons) were deemed significant based on 95% confidence intervals. Trends in life expectancy and mortality over time were examined to identify changes in slope and points of retrogression —a period of progress (increasing life expectancy or decreasing mortality) followed by stagnation (slope statistically equivalent to zero) or a significant reversal. Temporal trends were analyzed using the Joinpoint Regression Program, 22 which models consecutive linear segments on a log scale, connected by joinpoints where the segments meet (i.e., years when slopes changed significantly). A modification of the program’s Bayesian Information Criteria method (called BIC3 23 ) was substituted for the Monte Carlo permutation tests to reduce computation time. Slopes (annual percent rate change [APC]) were calculated for the line segments linking joinpoints, and the weighted average of the APCs (the average annual percent change [AAPC]) was calculated for three time periods: 1959–2016, 2005–2016, and 2010–2016 for life expectancy and 1999–2017, 2005–2017, and 2010–2017 for mortality rates. Slopes were considered increasing or decreasing if the estimated slope differed significantly from zero. The statistical significance of the APCs and the change in APCs between consecutive segments was determined by two-sided t-testing (p ≤ 0.05). Specific model parameters are available in the online supplement .

Excess deaths attributed to the increase in midlife mortality during 2010–2017 were estimated by multiplying the population denominator for each year by the mortality rate of the previous year, repeating this for each year from 2011 to 2017, and summing the difference between expected and observed deaths. 24 , 25 , 26 Excess deaths were estimated for each state and census division, allowing for estimates of their relative contribution to the national total.

LITERATURE REVIEW

To add context to the vital statistics described above and more fully characterize what is known about observed trends, the epidemiologic literature was examined for other research on US and state life expectancy and mortality trends. Using PubMed and other bibliographic databases, studies published between January 1990 and August 2019 that examined life expectancy or midlife mortality trends or that disaggregated data by age, sex, race-ethnicity, socioeconomic status, or geography were examined, along with the primary sources they cited. Research on the factors associated with the specific causes of death (e.g., drug overdoses, suicides) responsible for increasing midlife mortality was also reviewed. Research on the methodological limitations of epidemiological data on mortality trends was also examined.

To review contextual factors that may explain observed mortality trends and the US health disadvantage relative to other high-income countries, epidemiologic research was augmented by an examination of relevant literature in sociology, economics, political science, history, and journalism. A snowball technique 27 , 28 was used to locate studies and reports on: (1) the history and timing of the opioid epidemic; (2) the contribution of modifiable risk factors (e.g., obesity) to mortality trends; (3) changes in the prevalence of psychological distress and mental illness; (4) the evidence linking economic conditions and health, (5) relevant economic history and trends in income and earnings, wealth inequality, and austerity during the observation period; (6) changes in subjective social status (e.g., financial precarity) and social capital; and (7) relevant Federal and state social and economic policies, including the role of geography (e.g., rural conditions) and state-level factors. The study was exempt from institutional review under 45 CFR 46.101(b)(4).

LIFE EXPECTANCY

Life expectancy values for 1959–2016 are provided online ( Table e1 ) for the United States, nine census divisions, and 50 states. Between 1959 and 2016, US life expectancy increased by almost 10 years, from 69.9 years in 1959 to 78.9 years in 2016, with the fastest increase (highest APC) occurring during 1969–1979 (APC=0.48, p < 0.01) ( Figure 1 ). Life expectancy began to advance more slowly in the 1980s and plateaued in 2011 (after which the APC differed non-significantly from zero). The NCHS reported that US life expectancy peaked (78.9 years) in 2014 and subsequently decreased significantly for three consecutive years, reaching 78.6 years in 2017. 2 , 9 The decrease was greater among men (0.4 years) than women (0.2 years) and occurred across racial-ethnic groups; between 2014 and 2016, life expectancy decreased among non-Hispanic (NH) whites (from 78.8 to 78.5 years), NH blacks (from 75.3 years to 74.8 years), and Hispanics (82.1 to 81.8 years). 17

ALL-CAUSE MORTALITY

The recent decrease in US life expectancy was largely related to increases in all-cause mortality among young and middle-aged adults. During 1999–2017, infant mortality decreased from 736.0 deaths/100,000 to 567.0 deaths/100,000, mortality rates among children and early adolescents (ages 1–14 years) decreased from 22.9 deaths/100,000 to 16.5 deaths/100,000 ( Figure 2 ), and age-adjusted mortality rates among adults ages 65–84 years decreased from 3,774.6 deaths/100,000 to 2,875.4 deaths/100,000. 20

Source: CDC WONDER.

Table e2 presents age-specific, all-cause mortality rates for infants, children ages 1–4 years, and subsequent age deciles. Individuals ages 25–64 years (and even those ages 15–24 years) experienced retrogression: all-cause mortality rates were in decline in 2000, reached a nadir in 2010, and increased thereafter. The increase was greatest in midlife—among young and middle-aged adults (ages 25–64 years), whose age-adjusted all-cause mortality rates increased by 6.0% during 2010–2017 (from 328.5 deaths/100,000 to 348.2 deaths/100,000) ( Figure 3 ). The increase in midlife mortality was greatest among younger adults (ages 25–34 years), whose age-specific rates increased by 29.0% during this period (from 102.9 deaths/100,000 to 132.8 deaths/100,000). 20 Rising death rates among middle-aged adults (ages 45–64 years) were less related to mortality among those ages 45–54 years, which decreased (from 407.1 deaths/100,000 to 401.5 deaths per 100,000), than among those ages 55–64 years, whose age-specific rates increased during 2010–2017 (from 851.9 deaths/100,000 to 885.8 deaths/100,000). 20

The lowest mortality rates per 100,000 (and corresponding years) are listed in parentheses; 2017 mortality rates are listed in brackets. Source: CDC WONDER.

CAUSE-SPECIFIC MORTALITY

Although all-cause mortality in midlife did not begin increasing in the US until 2010, midlife mortality rates for specific causes (e.g., drug overdoses, hypertensive diseases) began increasing earlier ( Figure 4 ). 29 , 30 Table e3 presents absolute and relative changes in age-specific mortality rates by cause of death between 1999 and 2017 (and between 2010 and 2017) for every age group (by age decile), from infancy onward. The table shows that mortality rates increased primarily in midlife for 35 causes of death. The increase in cause-specific mortality was not always restricted to midlife; younger and older populations were often affected, although typically not as greatly (in relative or absolute terms) as those ages 25–64 years.

* Other transport accidents include land, water, air, space, and other transport accidents ( V80-V99 ).

** Other heart disease ( I30-I51 ) includes arrhythmias and heart failure.

Other causes of death (and corresponding ICD-10 codes) include diabetes mellitus ( E10-E14 ), mental and behavioral disorders due to psychoactive substance use ( F10-F19 ), hypertensive diseases ( I10-I15 ), accidental drug poisoning ( X40-X44 ), intentional self-harm (suicide) ( X60-X84 ), and assault (homicide) ( X85-Y09 ). Source: CDC WONDER.

Year-by-year midlife mortality rates by cause for 1999–2017 ( Table e4 ) show that retrogression occurred across multiple causes of death, in which progress in lowering midlife mortality was reversed. From 1999 to 2009, these cause-specific increases were not reflected in all-cause mortality trends because they were offset by large, co-occurring reductions in mortality from ischemic heart disease, cancer, HIV infection, motor vehicle injuries, and other leading causes of death. 31 , 32 , 33 However, increases in cause-specific mortality rates before 2010 slowed the rate at which all-cause mortality decreased (and life expectancy increased) and eventually culminated in a reversal. The end result was that all-cause mortality increased after 2010 (and life expectancy decreased after 2014). 34 , 35

Drug overdoses, alcoholic liver disease, and suicides

A major cause of increasing midlife mortality was a large increase in fatal drug overdoses, beginning in the 1990s. 28 , 33 , 36 Between 1999 and 2017, midlife mortality from drug overdoses increased by 386.5% (from 6.7 deaths/100,000 to 32.5 deaths/100,000). 20 Age-specific rates increased for each age subgroup: rates for those ages 25–34 years, 35–44 years, and 45–54 years increased by 531.4% (from 5.6 deaths/100,000 to 35.1 deaths/100,000), 267.9% (from 9.5 deaths/100,000 to 35.0 deaths/100,000), and 350.9% (from 7.2 deaths/100,000 to 32.7 deaths/100,000), respectively. The largest relative increase in overdose deaths (909.2%, from 2.3 deaths/100,000 to 23.5 deaths/100,000) occurred among those ages 55–64 years. 20 Midlife mortality rates also increased for chronic liver disease and cirrhosis; 29 , 32 , 37 , 38 during 1999–2017, age-adjusted death rates for alcoholic liver disease increased by 40.6% (from 6.4 deaths/100,000 to 8.9 deaths/100,000); age-specific rates among young adults ages 25–34 years increased by 157.6% (from 0.6 deaths/100,000 to 1.7 deaths/100,000). 20 The age-adjusted suicide rate at ages 25–64 years increased by 38.3% (from 13.4 deaths/100,000 to 18.6 deaths/100,000), and by 55.9% (from 12.2 deaths/100,000 to 19.0 deaths/100,000) among those ages 55–64 years. 20 As others have reported 39 , suicide rates also increased among those younger than age 25 years. Table e3 shows that, across all age groups, the largest relative increase in suicide rates occurred among children ages 5–14 years (from 0.6 deaths/100,000 to 1.3 deaths/100,000).

Organ system diseases and injuries

The increase in deaths caused by drugs, alcohol, and suicides was accompanied by significant increases in midlife mortality from organ system diseases and injuries, some beginning in the 1990s. 26 , 29 , 32 Data for several examples are provided online ( Tables e3 and e4 ). For example, between 1999 and 2017, age-adjusted midlife mortality rates for hypertensive diseases and obesity increased by 78.9% (from 6.1 deaths/100,000 to 11.0 deaths/100,000) and 114.0% (from 1.3 deaths/100,000 to 2.7 deaths/100,000) ( Table e4 ), respectively. 20 The increase in mortality from hypertension is consistent with other reports. 40 Early studies reported increasing midlife mortality from heart disease and lung (notably chronic pulmonary) disease, hypertension, stroke, diabetes, and Alzheimer disease, 29 , 32 , 41 but the trend appears to be even broader. According to one study, the increase in midlife mortality among NH whites during 1999–2016 was associated with an estimated 41,303 excess deaths due to drug overdoses (N=33,003) and suicides (N=8,300) but also more than 30,000 excess deaths from organ system diseases (e.g., hypertensive diseases [N=5,318], alcoholic liver disease [N=3,901], infectious diseases [N=2,149], liver cancer [N=1,931]), mental and behavioral disorders, obesity, pregnancy, and injuries (e.g., pedestrian-vehicle accidents). 26 Table e3 shows that the increase in organ disease mortality extended beyond midlife and, for certain diseases, was more pronounced in older age groups. For example, the largest increases in mortality from degenerative neurologic diseases (e.g., Alzheimer disease) occurred among those ages 75 and older.

Decomposition analyses, which quantify the relative contribution of specific causes of death to mortality patterns, have confirmed the large role played by organ system diseases. 10 , 29 , 31 For example, a decomposition analysis of the decline in US life expectancy between 2014 and 2015 found that respiratory and cardiovascular diseases contributed almost as much as external causes (including drug overdoses) among US women; among men, drug overdoses explained almost all of the life expectancy decline. 10 In a more recent decomposition analysis, Elo et al. 31 examined changes in life expectancy among US whites between 1990–1992 and 2014–2016, stratifying the results by sex and geography. Deaths from mental and nervous system disorders were second only to drug overdoses in influencing changes in life expectancy and were the leading contributors to decreased life expectancy among white females. Among white females, respiratory disease mortality was a larger contributor to changes in life expectancy than either suicides or alcohol-related causes and accounted for more deaths in rural areas than drug overdoses ( Table e5 ).

SEX-RELATED PATTERNS

Absolute and relative increases in midlife mortality rates were higher among men than women. 20 Between 2010 and 2017, men ages 25–44 years experienced a larger relative increase in age-specific mortality rates than did women of that age, whereas women aged 45–64 years experienced a slightly larger relative increase in mortality than men of their age (see Figure e1 ). Similarly, although men across age groups generally had higher cause-specific mortality rates and larger relative increases in mortality than did women, a pronounced female disadvantage emerged for certain major causes of death. For example, between 1999 and 2017, the relative increase in midlife fatal drug overdoses was 485.8% among women (from 3.5 deaths/100,000 to 20.2 deaths/100,000), 1.4 times higher than among men (350.6%, from 10.0 deaths/100,000 to 44.8 deaths/100,000). The relative increase in midlife mortality among women was 3.4 times higher for alcoholic liver disease (increasing from 3.2 deaths/100,000 to 5.8 deaths/100,000 among women and from 9.8 deaths/100,000 to 12.2 deaths/100,000 among men) and 1.5 times higher for suicide (increasing from 5.8 deaths/100,000 to 8.7 deaths/100,000 among women and 21.3 deaths/100,000 to 28.6 deaths/100,000 among men). This is consistent with reports elsewhere of gender-specific influences on mortality and a growing health disadvantage among US women, including smaller gains in life expectancy than among US men, larger relative increases in mortality from certain causes, and inferior health outcomes in comparison with women in other high-income countries. 11 , 31 , 42 , 43 , 44 , 45 , 46

RACIAL AND ETHNIC PATTERNS

Figure 5 stratifies mortality rates by race-ethnicity for adults ages 25–64 years, and Figure e2 does this for age subgroups (25–44 years and 45–64 years). Midlife mortality rates among NH AIAN and NH blacks exceeded those of other racial and ethnic groups, 20 consistent with other reports. 47 , 48 During 1999–2017, (other curves have the same overall direction of NH AIAN from beginning to end of the period – this paragraph needs to be carefully reviewed and edited to match the figure) – retrogression occurred in all racial-ethnic groups except NH AIAN adults, who experienced steady increases in midlife mortality rates on a larger relative scale than any other group. 5 , 20 , 32 , 36 Retrogression in the NH white population preceded its occurrence in NH black and Hispanic populations ( Figure 5 ), perhaps explaining why early studies reported that midlife mortality rates had not increased in these groups and focused their research on the white population. 29 , 32 , 35 , 36 , 40 Mortality patterns varied significantly by race-ethnicity and age, as illustrated online ( Figure e3 ), where absolute and relative changes in age-specific mortality rates for men and women are plotted separately for 20 combinations of race and age. Among the findings are that rates generally decreased after 1999 among NH API adults over age 35 and Hispanic adults over age 45 and—as Masters et al. reported 28 —that rates increased after 2010 among NH white women aged 45–54 years—but not men of that age.

Consistent with the larger US population, populations of color began experiencing increases in cause-specific mortality rates long before experiencing the retrogression in all-cause mortality. 20 , 29 , 36 Midlife death rates in these populations increased across multiple, diverse conditions. One study reported that midlife mortality rates increased for 12 causes in the NH AIAN population, 17 causes in NH black population, 12 causes in the Hispanic population, and six causes in the NH API population. 26 Each of these groups experienced large increases in fatal drug overdoses; between 2010 and 2017, the largest relative increase (171.6%) occurred among NH blacks ( Figure 6 ). 27 , 49 As shown online in Table e6 , each of the five racial and ethnic groups also experienced increases in midlife deaths from alcoholic liver diseases, suicides, and hypertensive diseases, among others. 26 , 47 For example, in the NH black population, midlife mortality from neurologic diseases increased from 10.2 deaths/100,000 to 14.1 deaths/100,000 between 1999 and 2017. The reversal (retrogression) in mortality rates that occurred among NH black and Hispanic populations erased years of progress in lowering mortality rates (and reducing racial-ethnic disparities). The increase intensified recently for certain conditions (notably drug overdoses 50 ), with non-whites experiencing larger relative and absolute year-to-year increases in death rates than whites. 26

Source: CDC WONDER. Values in parentheses denote relative increases in age-adjusted mortality rates by race-ethnicity between 2010 and 2017. AIAN = American Indians and Alaskan Natives, API = Asians and Pacific Islanders (API), NH = non-Hispanic.

SOCIOECONOMIC PATTERNS

Although an extensive literature links health to education, wealth, and employment, 32 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 direct evidence of their association with changes in life expectancy or mortality is limited, hampered by limited data to link deaths and socioeconomic history at the individual level. A growing body of evidence, however, indicates that the decline in US life expectancy and mortality risks have been greater among individuals with limited education (e.g., less than high school) and income. 32 , 35 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 The gradient in life expectancy based on income has also widened over time, 68 with outcomes at the lower end of the distribution explaining much of the US disadvantage relative to other countries. 69

GEOGRAPHIC PATTERNS

Census divisions and states.

The range in life expectancy across the 50 states widened after 1984, reaching 7.0 years in 2016 ( Figure 1 ). 18 States’ life expectancy rankings also shifted over time, as illustrated in Figure 7 . In 1959, Kansas had the nation’s highest life expectancy (71.9 years), but its position declined over time, ranking 29 th by 2016. In 1959, life expectancy in Oklahoma (71.1 years), 10 th highest in the nation, exceeded that of New York (69.6 years), which ranked 35 th . By 2016, New York’s life expectancy (80.9 years) was 3 rd in the nation and Oklahoma’s life expectancy (75.8 years) ranked 45 th . State life expectancy trajectories often changed acutely after the 1990s, a finding that was more apparent when it occurred in adjacent states. For example, life expectancy in Colorado and Kansas differed by only 0.3 years in 1990 but increased to 1.5 years in 2016; the difference between Alabama and Georgia increased from 0.1 years to 2.3 years. 18

Source: US Mortality Database. Graph highlights divergences in state-level life expectancy that began in the 1990s, featuring neighboring states (Alabama/Georgia and Colorado/Kansas). Values in parentheses refer to state life expectancy rankings (among the 50 states) in 1959, 1990, and 2016, respectively. As the 1990s began, life expectancy in Oklahoma exceeded that of New York.

The recent decrease in US life expectancy and increase in midlife mortality rates was concentrated in certain states, with the largest changes observed in New England and East North Central states and smaller changes in the Pacific and West South Central divisions ( Figure 8 ). The chart book in the online supplement contains 120 graphs of life expectancy (and all-cause mortality) trends for the US, nine census divisions, and 50 states, as modeled by Joinpoint Regression Program. It shows that, in the years leading up to 2016, life expectancy trended downward in four census divisions and 31 states—beginning in 2009 (N=3), 2010 (N=4), 2011 (N=6), 2012 (N=9), 2013 (N=6), and 2014 (N=3)—and decreased significantly (based on APC) in Kentucky, Ohio, and New Hampshire.

Estimated number of deaths caused by year-to-year increases in age-adjusted mortality rates among adults ages 25–64 years during 2010–2017. The map displays the number of estimated excess deaths (numerator) and not the population size (denominator) to clarify which states contributed the largest absolute number of deaths and exerted the largest influence on national trends. For example, although New Hampshire experienced a large (23.3%) relative increase in midlife mortality rates between 2010 and 2017, that state had a relatively small population (0.4% of US population) and therefore accounted for only 1.2% of excess deaths in the US. See text for more details about methods used to calculate excess deaths.

Table 1 presents APC and AAPC data for life expectancy trends in the US, nine census divisions, and 50 states. The table displays the APC for the two most recent time intervals, how the slope changed between intervals, and the AAPC for 2010–2016. For example, life expectancy in New Hampshire increased significantly (APC = 0.2) from 1978 to 2012 but decreased significantly thereafter (APC = −0.4), with the joinpoint year of 2012 marking a statistically significant (p ≤ 0.05) unfavorable reduction in slope (−6.3E-3). For the period of 2010–2016, the slope was significantly negative (AAPC = −0.20). Unfavorable reductions in slope occurred from 2009 onward in 38 states—i.e., life expectancy either decreased more rapidly or increased more slowly—and the slope change was significant (p < 0.05) in every census division and in 29 states. The largest decreases in life expectancy (based on AAPC for 2010–2016) occurred in New Hampshire, Kentucky, Maine, Ohio, West Virginia, South Dakota, New Mexico, Utah, Indiana, Mississippi, and Tennessee. Other states did not experience decreases in life expectancy; for example, life expectancy increased significantly in the Pacific division and in 13 states (Virginia, Delaware, South Carolina, Texas, Hawaii, New York, Oregon, New Jersey, Montana, Wyoming, Alabama, Arkansas, and Oklahoma).

Joinpoint analysis of life expectancy trends--US, census divisions, and states

Table 2 shows the increase in midlife mortality rates during 1999–2017. The table’s green and red colors signify favorable (negative APC) and unfavorable (positive APC) mortality trends based on joinpoint analysis (bolded boxes represent joinpoints). Many states experienced retrogression—declining mortality followed by a mortality reversal. For example, in Connecticut, a period of decreasing midlife mortality during 1999–2008 (green shading) was followed by a statistically stable period in 2008–2014 (clear shading)—during which the lowest mortality rate (253.7 deaths/100,000) was reached in 2011—and then by a significant increase in midlife mortality during 2014–2017 (red shading). The remaining columns explain that midlife mortality in Connecticut increased by 9.0% between 2010 and 2017 (p ≤ 0.05), that what appeared to be a long-term decrease in mortality during 1999–2017 (AAPC = −0.6) obscured progressively less favorable trends in recent time periods (AAPC = 0.2, 2005–2017; AAPC = 1.3, 2010–2017), and that the increase in mortality (APC = 3.2) in the most recent time period (2014–2017) was dually significant, differing significantly from zero (*) and from the slope of the prior segment (ǂ). The final column notes that year-to-year changes in mortality during 1999–2017 caused an estimated 441 excess midlife deaths in Connecticut.

Age-adjusted all-cause mortality rates, adults ages 25–64 years, for the US, census divisions, and states (1999–2017)

Table presents age-adjusted, all-cause mortality rates (per 100,000) among US adults ages 25–64 years for 1999–2017, along with the relative increase in mortality rates between 1999 and 2017, and the slopes modeled by the Joinpoint Regression Program. See text and Supplement for methods. Slopes presented here include the average annual percent change ( AAPC ) for three time periods—1999–2017, 2005–2017, and 2010–2017—and the annual percent change ( APC ) for the most recent linear trend in the joinpoint model. Also shown are the estimated number of excess deaths in the US caused by year-to-year changes in midlife mortality rates between 1999 and 2017. Green shading depicts years during which mortality rates decreased (statistically significant negative APC), red shading denotes years of increasing mortality (statistically significant positive APC), and cells with no color depict periods when the APC did not differ significantly from zero. Cells with bolded borders denote joinpoint years, when changes occurred in the modeled linear trends. Underlined mortality rates denote the lowest mortality rates (nadir) for 1999–2017. Asterisks (*) denote a slope (APC or AAPC) that differed significantly from zero (p < 0.05) and hashtags (ǂ) denote a statistically significant slope change estimate, a measure of the change in slope from that of the previous time period; see Table e7 for 95% confidence intervals. NA = Not applicable; joinpoint plotted a single trend line for 1999–2017, thus no last segment. Mortality rates obtained from CDC WONDER.

The increase in midlife mortality was geographically widespread. Table 2 shows that the AAPC for 2010–2017 was positive in eight census divisions and all but four states (California, New York, Oregon, and Texas). Thirty-seven states experienced statistically significant increases in midlife mortality (positive APC) in the years leading up to 2017. However, the trend was concentrated in certain states. Between 2010 and 2017, the largest relative increases in mortality occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%, Massachusetts 12.1%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%), as well as in New Mexico (17.5%), South Dakota (15.5%), Pennsylvania (14.4%), North Dakota (12.7%), Alaska (12.0%), and Maryland (11.0%). In contrast, the nation’s most populous states (California, Texas, and New York) experienced relatively small increases in midlife mortality.

Five states (Iowa, New Mexico, Oklahoma, West Virginia, and Wyoming) experienced a nearly continuous increase in midlife mortality (only positive APC segments) throughout 1999–2017, the largest (33.8%) occurring in West Virginia. Thirty-eight states experienced progress (declining mortality) as the millennium began, followed by retrogression (time segments beginning in 1999–2003 with negative APCs, followed by periods of increasing mortality with positive APCs). These reversals occurred earlier in some states than others; for example, midlife mortality rates in Iowa and North Dakota reached a nadir in 2004, whereas nadirs in New Jersey and New York did not occur until 2014 and 2015, respectively. Cause-specific mortality trends also varied by state, sometimes in opposite directions. For example, whereas rates of firearm-related suicides increased nationwide during 1999–2017, they remained stable or decreased in California, Connecticut, Maryland, New Jersey, and New York. 20

Between 2010 and 2017, year-to-year changes in midlife mortality accounted for an estimated 33,307 excess US deaths ( Table 2 ). Population sizes influenced states’ individual contribution to national mortality trends. For example, although several New England states (New Hampshire, Maine, and Vermont) experienced large (20–23%) relative increases in midlife mortality during 2010–2017, these states accounted for only 3.0% of excess deaths due to their small populations. The East North Central division accounted for 28.6% of excess deaths, and Ohio, Pennsylvania, Indiana, and Kentucky (which include 10.8% of the US population) accounted for the largest number of excess deaths: these four states accounted for approximately one third (32.8%) of excess deaths. Eight of the 10 states with the largest number of excess deaths were in the Industrial Midwest or Appalachia.

Counties and cities

As a group, rural US counties experienced larger increases in all-cause midlife mortality than did metropolitan counties, 29 , 31 but more complex patterns emerged when county data were disaggregated by population size, sex, race-ethnicity, age, and causes of death. For example, although the relative increase in midlife drug overdose deaths during 1999–2017 among NH whites was higher in rural (749.4%, from 4.0 deaths/100,000 to 33.8 deaths/100,000) than metropolitan (531.2%, from 6.7 deaths/100,000 to 42.5 deaths/100,000) counties, the largest relative increase in overdose deaths (857.8%, from 4.7 deaths/100,000 to 45.2 deaths/100,000) occurred in the suburbs of large cities (populations ≥1 million), where Hispanic populations also experienced their largest increase in midlife overdose deaths. 20 Among NH blacks, the largest increase in overdose deaths occurred in small cities (populations < 250,000), but the largest increase among blacks aged 55–64 years was in large cities. 29 The largest increase in midlife suicides among NH AIAN and Hispanic adults was in metropolitan areas, whereas the largest increase among non-Hispanic blacks and whites occurred in rural counties. 20 Among young whites (ages 25–34 years), the largest increase in suicides occurred in the suburbs. 29 Mortality patterns for men and women also varied significantly across urban and rural areas, with residents of large cities experiencing the greatest increases in life expectancy. 31

Geographic disparities in mortality were associated with demographic characteristics, and with community contextual factors independent of individual and household characteristics. For example, a multivariate analysis of drug-related mortality in 2006–2015 found that drug deaths were higher in counties with certain demographic characteristics (e.g., older adults, active duty military or veterans, Native Americans) and in counties with mining-dependent economies, high economic and family distress indices, vacant housing, or high rent. Mortality rates were lower in counties with more religious establishments, recent in-migrants, and dependence on public sector (i.e., government) employment. 70 Similarly, studies in five states (California, Kansas, Missouri, Minnesota, and Virginia) found that increases in midlife mortality from “stress-related conditions” (drug overdoses, alcohol poisoning, alcoholic liver disease, and suicides) were highest in counties with prolonged exposure to high poverty, unemployment, and stagnant household income. Examples included the Central Valley and northern rural counties of California 71 , the Ozark and Bootheel regions of Missouri 72 , and the southwestern coalfields of Virginia. 73

US life expectancy increased from 1959 to 2014 but the rate of increase was greatest in 1969–1979 and slowed thereafter, losing pace with other high-income countries, plateauing in 2011, and decreasing after 2014. A major contributor was an increase in all-cause mortality among young and middle-aged adults, which began in 2010, and an increase in cause-specific mortality rates in this midlife age group, which began as early as the 1990s and involved deaths from drug overdoses, alcohol abuse, and suicides, and diverse organ system diseases, such as hypertensive diseases and diabetes. Although NH whites experienced the largest absolute number of deaths, all racial groups and the Hispanic population were affected. For certain causes of death (e.g., fatal drug overdoses, alcoholic liver disease, and suicide), women experienced larger relative increases in mortality than men, although the absolute mortality rates for these causes were higher in men than women.

By 2010, increases in cause-specific mortality rates at ages 25–64 years had reversed years of progress in lowering mortality from other causes (e.g., ischemic heart disease, cancer, HIV infection)—and all-cause mortality began increasing. The trend began earlier (e.g., the 1990s) in some states and only recently in others (e.g., New York, New Jersey). Gaps in life expectancy across states began widening in the 1980s, with substantial divergences occurring in the 1990s. Changes in life expectancy and midlife mortality were greatest in the eastern US—notably the Ohio Valley, Appalachia, and upper New England—whereas many Pacific states were less affected. The largest relative increases in midlife mortality occurred among adults with less education and in rural areas or other settings with evidence of economic distress or diminished social capital.

POTENTIAL EXPLANATIONS

The increase in midlife mortality after 1999 was greatly influenced by the increase in drug overdoses. Heroin use increased substantially in the 1960s and 1970s, as did crack cocaine abuse in the 1980s, disproportionately affecting (and criminalizing) the black population. 74 , 75 Mortality from drug overdoses increased exponentially from the 1970s onward. 76 The sharp increase in overdose deaths that began in the 1990s primarily affected whites and came in three waves: (1) the introduction of OxyContin in 1996 and overuse of prescription opioids, followed by (2) increased heroin use, often by patients who became addicted to prescription opioids, 77 and (3) the subsequent emergence of potent synthetic opioids (e.g., fentanyl analogues)—the latter triggering a large post-2013 increase in overdose deaths. 27 , 78 , 79 That whites first experienced a larger increase in overdose deaths than non-whites may reflect their greater access to health care (and thus prescription drugs). 5 , 80 That NH black and Hispanic populations experienced the largest relative increases in fentanyl deaths after 2011 81 may explain the retrogression in overdose deaths observed in these groups. 48 Geographic differences in the promotion and distribution of opioids may also explain the concentration of midlife deaths in certain states. 82

However, the increase in opioid-related deaths is only part of a more complicated phenomenon and does not fully explain the increase in midlife mortality rates from other causes, such as alcoholic liver disease or suicides (85.2% of which involve firearms or other non-poisoning methods 83 ). Opioid-related deaths also cannot fully explain the US health disadvantage, which began earlier (in the 1980s) and involved multiple diseases and non-drug injuries. 5 , 6 , 7 Two recent studies estimated that drug overdoses accounted for 15% or less of the gap in life expectancy between the US and other high-income countries in 2013 and 2014, respectively. 84 , 85

The National Research Council examined the US health disadvantage in detail and identified nine domains in which the US had poorer health outcomes than other high-income countries: these included not only drug-related deaths but also adverse birth outcomes, injuries and homicides, adolescent pregnancy and sexually transmitted infections, HIV and AIDS, obesity and diabetes, heart disease, chronic lung disease, and disability. 7 Compared to the average mortality rates of 16 other high-income countries, the US has lower mortality from cancer and cerebrovascular diseases but higher mortality rates from most other major causes of death, including: circulatory disorders (e.g., ischemic heart and hypertensive diseases), external causes (e.g., drug overdoses, suicide, homicide), diabetes, infectious diseases, pregnancy and childbirth, congenital malformations, mental and behavioral disorders, and diseases of the respiratory, nervous, genitourinary, and musculoskeletal systems. 86 According to one estimate, if the slow rate of increase in US life expectancy persists, it will take the US more than a century to reach the average life expectancy that other high-income countries had achieved by 2016. 10

Tobacco use and obesity

Exposure to behavioral risk factors could explain some of these trends. Although tobacco use in the US has decreased, higher smoking rates in prior decades could have produced delayed effects on current tobacco-related mortality and life expectancy patterns, especially among older adults. 6 , 87 , 88 For example, a statistical model that accounted for the lag between risk factor exposure and subsequent death estimated that much of the gap in life expectancy at age 50 that existed in 2003 between the US and other high-income countries—41% of the gap in men and 78% of the gap in women—was attributable to smoking. 89 Smoking explained 50% or more of the geographic differences in mortality within the US in 2004. 87 , 90 However, it is unclear whether smoking, which has declined in prevalence, continues to have as large a role in current life expectancy patterns or in explaining increases in mortality among younger adults is unclear.

The obesity epidemic, a known contributor to the US health disadvantage, 6 could potentially explain an increase in midlife mortality rates for diseases linked to obesity, such as hypertensive heart disease 91 and renal failure. 92 As long ago as 2005, the increasing prevalence of obesity prompted Olshansky et al. to predict a forthcoming decrease in US life expectancy. 93 By 2011, Preston et al. estimated that increases in obesity had reduced life expectancy at age 40 by 0.9 years. 94 Elo et al. noted that changes in obesity prevalence had the largest correlation with geographic variations in life expectancy of any variable they examined. 31

However, neither smoking nor obesity can fully explain current mortality patterns, such as those among younger adults and increasing mortality from conditions without known causal links to these risk factors. Suggesting that other factors may be at play, Muennig and Glied noted that Australia and other countries with patterns of smoking and obesity similar to the US achieved greater gains in survival between 1975 and 2005. 13

Deficiencies in health care

Deficiencies in the health care system could potentially explain increased mortality from some conditions. Although the US health care system excels on certain measures, countries with higher life expectancy outperform the US in providing universal access to health care, removing costs as a barrier to care, care coordination, and amenable mortality. 95 , 96 , 97 In a difficult economy that imposes greater costs on patients 98 , adults in midlife may have greater financial barriers to care than children and older adults, who benefit from the Children’s Health Insurance Program and Medicare coverage, respectively. 99 Although poor access or deficiencies in quality could introduce mortality risks among patients with existing behavioral health needs or chronic diseases, these factors would not account for the underlying precipitants (e.g., suicidality, obesity), which originate outside the clinic. Physicians contributed to the overprescription of opioids 100 , and iatrogenic factors could potentially explain increases in midlife mortality from other causes, but empirical evidence is limited. Nor would systemic deficiencies in the health care system explain why midlife death rates increased for some chronic diseases while decreasing greatly for others (e.g., ischemic heart disease, cancer, and HIV infection).

Psychological distress

Despair has been invoked as a potential cause for the increase in deaths related to drug, alcohol, and suicides (referred to by some as ‘deaths of despair’). 29 , 35 , 65 , 101 Some studies suggest that psychological distress, anxiety, and depression have increased in the US, especially among adolescents and young adults. 65 , 102 , 103 , 104 , 105 , 106 , 107 , 108 Psychological distress and mental illness are risk factors for substance abuse and suicides 82 , 109 , 110 and may complicate organ system diseases, as when hopelessness erodes motivation to pursue health care or manage chronic illnesses. 111 Chronic stress has neurobiological and systemic effects on allostatic load and end organs and may increase pain sensitivity (and thus analgesic needs). 112 , 113 , 114 , 115 However, the evidence that the prevalence of psychological distress or mental illness increased during the relevant time period is inconclusive. Epidemiological data about mental illness have methodological limitations, 116 , 117 and some surveillance studies report no increase in prevalence rates. 118 , 119 Moreover, even if the prevalence of certain mental illnesses did increase, a causal link to the full spectrum of midlife mortality deaths has not been established.

Socioeconomic conditions

Three lines of evidence suggest a potential association between mortality trends and economic conditions, the first being timing. The US health disadvantage and increase in midlife mortality began in the 1980s and 1990s, a period marked by a major transformation in the nation’s economy, substantial job losses in manufacturing and other sectors, contraction of the middle class, wage stagnation, and reduced intergenerational mobility. 120 , 121 , 122 , 123 , 124 , 125 Income inequality widened greatly, surpassing levels in other countries, concurrent with the deepening US health disadvantage. 126 , 127 , 128 , 129 , 130 , 131 , 132 The second line of evidence concerns affected populations: those most vulnerable to the new economy (e.g., adults with limited education, women) experienced the largest increases in death rates. The third line of evidence is geographic: increases in death rates were concentrated in areas with a history of economic challenges, such as rural America 133 , 134 and the Industrial Midwest, 135 , 136 and were lowest in the Pacific division and populous states with more robust economies (e.g., Texas, New York). One theory for the larger life expectancy gains in metropolitan areas is an increase in the population with college degrees. 31

Socioeconomic pressures and unstable employment could explain some of the observed increases in mortality spanning multiple causes of death. Financial hardship and insecurity limit access to health care and the social determinants of health (e.g., education, food, housing, transportation) and increase the risk of chronic stress, disease, disability, pessimism, and pain. 100 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 One study estimated that a 1% increase in county unemployment rates was associated with a 3.6% increase in opioid deaths. 145 However, the evidence to date has not proven that economic conditions are responsible for the recent increase in midlife mortality; 146 correlations with state and local indicators (e.g., employment, poverty rates) are not always consistent, and the causal link between income inequality and health is debated. 147 , 148

The causes of economic despair may be more nuanced; perceptions and frustrated expectations may matter as much as absolute income or net worth. 149 , 150 For example, ethnographers describe the dismay among working-class whites over their perceived loss of social position and uncertain future, 100 , 151 , 152 , 153 , 154 , 155 a popular (but unsubstantiated) thesis for why this historically privileged population experienced larger increases in midlife deaths than did minority groups (e.g., NH blacks) with greater social and economic disadvantages. 156 , 157 , 158 , 159 Also unclear is the extent to which household socioeconomic status acts as a proxy for important contextual conditions in communities (e.g., social environment, services infrastructure, economy, labor market) that also shape health. 5 , 81 , 160 , 161 , 162 , 163

The above explanations are not independent and collectively shape mortality patterns; major contributors like smoking, drug abuse, and obesogenic diets are shaped by environmental conditions, psychological distress, and socioeconomic status. The same economic pressures that force patients to forego medical care can also induce stress and unhealthy coping behaviors and can fracture communities. Fenelon, whose research quantified the contribution of smoking to mortality, also noted that it may “represent one critical piece of a broader cultural, socioeconomic, and behavioral puzzle that has implications for numerous health-related behaviors and outcomes.” 89

Methodologic considerations

Any theory for decreasing life expectancy, whether opioids, despair, poverty, or social division, must account for the timing of exposure and lagged effects on outcomes. Whereas observed increases in mortality could occur shortly after increased exposure to certain causes, such as fentanyl or lethal firearms, increases in premature mortality from chronic conditions may require decades of prolonged exposure ( Table e8 ). Some mortality patterns exhibit period effects, such as the increase in opioid deaths that began in the 1990s, and affected multiple age cohorts, whereas other causes show cohort-based variation. For example, Masters et al. identified a specific cohort—NH whites born in the 1950s—at heightened risk of midlife mortality from obesity, heart disease, diabetes, and hypertension. 28 Zang et al. documented a heightened mortality risk among cohorts born during 1973–91. 164

Any theory for decreasing US life expectancy must explain why this trend is less pronounced in other industrialized countries. 10 A National Research Council panel, charged with this question, focused its research on how the US differs in terms of health care, unhealthy behaviors, socioeconomic factors, the physical and social environment, and public polices and priorities. 7 Social protection policies deserve special attention: countries with higher life expectancy spend more of their budgets on social services 143 , 165 and outperform the US in terms of education, child poverty, and other measures of wellbeing. 5 , 7

Causal theories must also explain why US mortality trends have affected some states (and counties) more than others, and why their trajectories often diverged in the 1990s. The causes of geographical disparities may be compositional, as when states became more populated by people with risk factors for midlife mortality (e.g., rural whites with limited education) or large, growing cities that skew state averages. State statistics are also influenced by demographic shifts (e.g., immigration, depopulation, and in-migration) and economic trends. For example, the divergence in life expectancy between Oklahoma and New York ( Figure 7 ) may reflect the fate of different economies, one reliant on agriculture and mining and the other on service industries (e.g., finance, information technology). The clustering of midlife deaths in certain states, such as recent increases in upper New England states or rural areas, may reflect differences in drug abuse rates and in the distribution and marketing of illicit drugs. 27 , 81 , 145 , 166 , 167 , 168

To some extent, however, divergent state health trajectories may reflect different policy choices. 169 Policy differences seem more likely to explain disparities between adjacent states (e.g., Colorado/Kansas, Alabama/Georgia; Figure 7 ), where marked regional differences in demography or economies are uncommon. Many states diverged in the 1990s, soon after neoliberal policies aimed at free markets and devolution shifted resources (e.g., block grants) and authorities to the states. 120 , 170 , 171 , 172 States enacted different policies on the social determinants of health, such as education spending, minimum wage laws, earned income tax credits, economic development, mass transit, safety net services, and public health provisions (e.g., tobacco taxes, Medicaid expansion, preemption laws, gun control). 173 , 174 , 175 , 176 , 177 , 178 These decisions may have had health implications. 179 For example, Dow et al. found that changes in state policies on minimum wage and earned income tax credits predicted non-drug suicide trends. 180 In this study, the five states that experienced stable or reduced rates of firearm-related suicides during 1999–2017, countering the national trend, were those with stricter gun control laws. 181

RESEARCH AND POLICY CONSIDERATIONS

Moving from speculation to evidence about root causes will require innovative research methods, including cohort studies, multivariate modeling, investigation of migration effects, and the application of machine learning to historical datasets. Fully understanding the timing of US mortality trends will also require interdisciplinary research involving epidemiology, demography, sociology, political science, history, economics, and the law. Clarifying the role of state policies may be especially important, given the divergent state trajectories reported here.

The implications of increasing midlife mortality are broad, affecting working-age adults and thus employers, the economy, health care, and national security. The trends also affect children, whose parents are more likely to die in midlife and whose own health could be at risk when they reach that age, or sooner. Recent data suggest that all-cause mortality rates are increasing among those ages 15–19 years and 20–24 years (increasing from 44.8 deaths/100,000 to 51.5 deaths per 100,000 and from 83.4 deaths/100,000 to 95.6 deaths/100,000, respectively, during 2013–2017) ( Figure 2 ). Evidence-based strategies to improve population health seem warranted, such as policies to promote education, increase household income, invest in communities, and expand access to health care, affordable housing, and transportation. 182 , 183 , 184 , 185 , 186 The increase in mortality from substance abuse, suicides, and organ system diseases argues for strengthening of behavioral health services and the capacity of health systems to manage chronic diseases. 187

LIMITATIONS

This review and analysis have several limitations. First, mortality data are subject to errors, among them inaccurate ascertainment of cause of death, race misclassification and undercounting, and numerator-denominator mismatching. 188 , 189 These are especially problematic in interpreting AIAN mortality rates, although disparities persist in this population even in studies that circumvent these challenges. 190 Other limitations include the weak statistical power of annual state mortality rates and their inability to account for sub-state variation, the limits of age adjustment, age-aggregation bias, and the omission of cause-specific mortality data from before 1999. 191 Purported rate increases may also reflect lagged selection bias. 192 Second, errors in coding, such as the misclassification of suicides as overdoses 193 , or changes (or geographic differences) in coding practices could also introduce errors. For example, some increases in maternal mortality rates may reflect heightened surveillance and the addition of a pregnancy checkbox on death certificates. 194 , 195 , 196 Changes in coding or awareness may explain the increase in age-adjusted mortality rates from mental and nervous system disorders, an international trend. 197 Third, state mortality rates may also reflect demographic changes, such as immigration patterns (and the immigrant paradox 198 , 199 , 200 ) or the out-migration of highly educated, healthy individuals. 5

Supplementary Material

Online supplement, acknowledgments.

The authors thank Latoya Hill, MPH and Christine M. Orndahl, BS for sharing their expertise with the Joinpoint Regression Program and for their extensive assistance with data analysis and mapping. This project was partially funded by grant R01AG055481-03 from the National Institute on Aging.

May 3, 2023

Contemplating Mortality: Powerful Essays on Death and Inspiring Perspectives

The prospect of death may be unsettling, but it also holds a deep fascination for many of us. If you're curious to explore the many facets of mortality, from the scientific to the spiritual, our article is the perfect place to start. With expert guidance and a wealth of inspiration, we'll help you write an essay that engages and enlightens readers on one of life's most enduring mysteries!

Death is a universal human experience that we all must face at some point in our lives. While it can be difficult to contemplate mortality, reflecting on death and loss can offer inspiring perspectives on the nature of life and the importance of living in the present moment. In this collection of powerful essays about death, we explore profound writings that delve into the human experience of coping with death, grief, acceptance, and philosophical reflections on mortality.

Through these essays, readers can gain insight into different perspectives on death and how we can cope with it. From personal accounts of loss to philosophical reflections on the meaning of life, these essays offer a diverse range of perspectives that will inspire and challenge readers to contemplate their mortality.

The Inevitable: Coping with Mortality and Grief

Mortality is a reality that we all have to face, and it is something that we cannot avoid. While we may all wish to live forever, the truth is that we will all eventually pass away. In this article, we will explore different aspects of coping with mortality and grief, including understanding the grieving process, dealing with the fear of death, finding meaning in life, and seeking support.

Understanding the Grieving Process

Grief is a natural and normal response to loss. It is a process that we all go through when we lose someone or something important to us. The grieving process can be different for each person and can take different amounts of time. Some common stages of grief include denial, anger, bargaining, depression, and acceptance. It is important to remember that there is no right or wrong way to grieve and that it is a personal process.

Denial is often the first stage of grief. It is a natural response to shock and disbelief. During this stage, we may refuse to believe that our loved one has passed away or that we are facing our mortality.

Anger is a common stage of grief. It can manifest as feelings of frustration, resentment, and even rage. It is important to allow yourself to feel angry and to express your emotions healthily.

Bargaining is often the stage of grief where we try to make deals with a higher power or the universe in an attempt to avoid our grief or loss. We may make promises or ask for help in exchange for something else.

Depression is a natural response to loss. It is important to allow yourself to feel sad and to seek support from others.

Acceptance is often the final stage of grief. It is when we come to terms with our loss and begin to move forward with our lives.

Dealing with the Fear of Death

The fear of death is a natural response to the realization of our mortality. It is important to acknowledge and accept our fear of death but also to not let it control our lives. Here are some ways to deal with the fear of death:

Accepting Mortality

Accepting our mortality is an important step in dealing with the fear of death. We must understand that death is a natural part of life and that it is something that we cannot avoid.

Finding Meaning in Life

Finding meaning in life can help us cope with the fear of death. It is important to pursue activities and goals that are meaningful and fulfilling to us.

Seeking Support

Seeking support from friends, family, or a therapist can help us cope with the fear of death. Talking about our fears and feelings can help us process them and move forward.

Finding meaning in life is important in coping with mortality and grief. It can help us find purpose and fulfillment, even in difficult times. Here are some ways to find meaning in life:

Pursuing Passions

Pursuing our passions and interests can help us find meaning and purpose in life. It is important to do things that we enjoy and that give us a sense of accomplishment.

Helping Others

Helping others can give us a sense of purpose and fulfillment. It can also help us feel connected to others and make a positive impact on the world.

Making Connections

Making connections with others is important in finding meaning in life. It is important to build relationships and connections with people who share our values and interests.

Seeking support is crucial when coping with mortality and grief. Here are some ways to seek support:

Talking to Friends and Family

Talking to friends and family members can provide us with a sense of comfort and support. It is important to express our feelings and emotions to those we trust.

Joining a Support Group

Joining a support group can help us connect with others who are going through similar experiences. It can provide us with a safe space to share our feelings and find support.

Seeking Professional Help

Seeking help from a therapist or counselor can help cope with grief and mortality. A mental health professional can provide us with the tools and support we need to process our emotions and move forward.

Coping with mortality and grief is a natural part of life. It is important to understand that grief is a personal process that may take time to work through. Finding meaning in life, dealing with the fear of death, and seeking support are all important ways to cope with mortality and grief. Remember to take care of yourself, allow yourself to feel your emotions, and seek support when needed.

The Ethics of Death: A Philosophical Exploration

Death is an inevitable part of life, and it is something that we will all experience at some point. It is a topic that has fascinated philosophers for centuries, and it continues to be debated to this day. In this article, we will explore the ethics of death from a philosophical perspective, considering questions such as what it means to die, the morality of assisted suicide, and the meaning of life in the face of death.

Death is a topic that elicits a wide range of emotions, from fear and sadness to acceptance and peace. Philosophers have long been interested in exploring the ethical implications of death, and in this article, we will delve into some of the most pressing questions in this field.

What does it mean to die?

The concept of death is a complex one, and there are many different ways to approach it from a philosophical perspective. One question that arises is what it means to die. Is death simply the cessation of bodily functions, or is there something more to it than that? Many philosophers argue that death represents the end of consciousness and the self, which raises questions about the nature of the soul and the afterlife.

The morality of assisted suicide

Assisted suicide is a controversial topic, and it raises several ethical concerns. On the one hand, some argue that individuals have the right to end their own lives if they are suffering from a terminal illness or unbearable pain. On the other hand, others argue that assisting someone in taking their own life is morally wrong and violates the sanctity of life. We will explore these arguments and consider the ethical implications of assisted suicide.

The meaning of life in the face of death

The inevitability of death raises important questions about the meaning of life. If our time on earth is finite, what is the purpose of our existence? Is there a higher meaning to life, or is it simply a product of biological processes? Many philosophers have grappled with these questions, and we will explore some of the most influential theories in this field.

The role of death in shaping our lives

While death is often seen as a negative force, it can also have a positive impact on our lives. The knowledge that our time on earth is limited can motivate us to live life to the fullest and to prioritize the things that truly matter. We will explore the role of death in shaping our values, goals, and priorities, and consider how we can use this knowledge to live more fulfilling lives.

The ethics of mourning

The process of mourning is an important part of the human experience, and it raises several ethical questions. How should we respond to the death of others, and what is our ethical responsibility to those who are grieving? We will explore these questions and consider how we can support those who are mourning while also respecting their autonomy and individual experiences.

The ethics of immortality

The idea of immortality has long been a fascination for humanity, but it raises important ethical questions. If we were able to live forever, what would be the implications for our sense of self, our relationships with others, and our moral responsibilities? We will explore the ethical implications of immortality and consider how it might challenge our understanding of what it means to be human.

The ethics of death in different cultural contexts

Death is a universal human experience, but how it is understood and experienced varies across different cultures. We will explore how different cultures approach death, mourning, and the afterlife, and consider the ethical implications of these differences.

Death is a complex and multifaceted topic, and it raises important questions about the nature of life, morality, and human experience. By exploring the ethics of death from a philosophical perspective, we can gain a deeper understanding of these questions and how they shape our lives.

The Ripple Effect of Loss: How Death Impacts Relationships

Losing a loved one is one of the most challenging experiences one can go through in life. It is a universal experience that touches people of all ages, cultures, and backgrounds. The grief that follows the death of someone close can be overwhelming and can take a significant toll on an individual's mental and physical health. However, it is not only the individual who experiences the grief but also the people around them. In this article, we will discuss the ripple effect of loss and how death impacts relationships.

Understanding Grief and Loss

Grief is the natural response to loss, and it can manifest in many different ways. The process of grieving is unique to each individual and can be affected by many factors, such as culture, religion, and personal beliefs. Grief can be intense and can impact all areas of life, including relationships, work, and physical health.

The Impact of Loss on Relationships

Death can impact relationships in many ways, and the effects can be long-lasting. Below are some of how loss can affect relationships:

1. Changes in Roles and Responsibilities

When someone dies, the roles and responsibilities within a family or social circle can shift dramatically. For example, a spouse who has lost their partner may have to take on responsibilities they never had before, such as managing finances or taking care of children. This can be a difficult adjustment, and it can put a strain on the relationship.

2. Changes in Communication

Grief can make it challenging to communicate with others effectively. Some people may withdraw and isolate themselves, while others may become angry and lash out. It is essential to understand that everyone grieves differently, and there is no right or wrong way to do it. However, these changes in communication can impact relationships, and it may take time to adjust to new ways of interacting with others.

3. Changes in Emotional Connection

When someone dies, the emotional connection between individuals can change. For example, a parent who has lost a child may find it challenging to connect with other parents who still have their children. This can lead to feelings of isolation and disconnection, and it can strain relationships.

4. Changes in Social Support

Social support is critical when dealing with grief and loss. However, it is not uncommon for people to feel unsupported during this time. Friends and family may not know what to say or do, or they may simply be too overwhelmed with their grief to offer support. This lack of social support can impact relationships and make it challenging to cope with grief.

Coping with Loss and Its Impact on Relationships

Coping with grief and loss is a long and difficult process, but it is possible to find ways to manage the impact on relationships. Below are some strategies that can help:

1. Communication

Effective communication is essential when dealing with grief and loss. It is essential to talk about how you feel and what you need from others. This can help to reduce misunderstandings and make it easier to navigate changes in relationships.

2. Seek Support

It is important to seek support from friends, family, or a professional if you are struggling to cope with grief and loss. Having someone to talk to can help to alleviate feelings of isolation and provide a safe space to process emotions.

3. Self-Care

Self-care is critical when dealing with grief and loss. It is essential to take care of your physical and emotional well-being. This can include things like exercise, eating well, and engaging in activities that you enjoy.

4. Allow for Flexibility

It is essential to allow for flexibility in relationships when dealing with grief and loss. People may not be able to provide the same level of support they once did or may need more support than they did before. Being open to changes in roles and responsibilities can help to reduce strain on relationships.

5. Find Meaning

Finding meaning in the loss can be a powerful way to cope with grief and loss. This can involve creating a memorial, participating in a support group, or volunteering for a cause that is meaningful to you.

The impact of loss is not limited to the individual who experiences it but extends to those around them as well. Relationships can be greatly impacted by the death of a loved one, and it is important to be aware of the changes that may occur. Coping with loss and its impact on relationships involves effective communication, seeking support, self-care, flexibility, and finding meaning.

What Lies Beyond Reflections on the Mystery of Death

Death is an inevitable part of life, and yet it remains one of the greatest mysteries that we face as humans. What happens when we die? Is there an afterlife? These are questions that have puzzled us for centuries, and they continue to do so today. In this article, we will explore the various perspectives on death and what lies beyond.

Understanding Death

Before we can delve into what lies beyond, we must first understand what death is. Death is defined as the permanent cessation of all biological functions that sustain a living organism. This can occur as a result of illness, injury, or simply old age. Death is a natural process that occurs to all living things, but it is also a process that is often accompanied by fear and uncertainty.

The Physical Process of Death

When a person dies, their body undergoes several physical changes. The heart stops beating, and the body begins to cool and stiffen. This is known as rigor mortis, and it typically sets in within 2-6 hours after death. The body also begins to break down, and this can lead to a release of gases that cause bloating and discoloration.

The Psychological Experience of Death

In addition to the physical changes that occur during and after death, there is also a psychological experience that accompanies it. Many people report feeling a sense of detachment from their physical body, as well as a sense of peace and calm. Others report seeing bright lights or visions of loved ones who have already passed on.

Perspectives on What Lies Beyond

There are many different perspectives on what lies beyond death. Some people believe in an afterlife, while others believe in reincarnation or simply that death is the end of consciousness. Let's explore some of these perspectives in more detail.

One of the most common beliefs about what lies beyond death is the idea of an afterlife. This can take many forms, depending on one's religious or spiritual beliefs. For example, many Christians believe in heaven and hell, where people go after they die depending on their actions during life. Muslims believe in paradise and hellfire, while Hindus believe in reincarnation.

Reincarnation

Reincarnation is the belief that after we die, our consciousness is reborn into a new body. This can be based on karma, meaning that the quality of one's past actions will determine the quality of their next life. Some people believe that we can choose the circumstances of our next life based on our desires and attachments in this life.

End of Consciousness

The idea that death is simply the end of consciousness is a common belief among atheists and materialists. This view holds that the brain is responsible for creating consciousness, and when the brain dies, consciousness ceases to exist. While this view may be comforting to some, others find it unsettling.

Death is a complex and mysterious phenomenon that continues to fascinate us. While we may never fully understand what lies beyond death, it's important to remember that everyone has their own beliefs and perspectives on the matter. Whether you believe in an afterlife, reincarnation, or simply the end of consciousness, it's important to find ways to cope with the loss of a loved one and to find peace with your mortality.

Final Words

In conclusion, these powerful essays on death offer inspiring perspectives and deep insights into the human experience of coping with mortality, grief, and loss. From personal accounts to philosophical reflections, these essays provide a diverse range of perspectives that encourage readers to contemplate their mortality and the meaning of life.

By reading and reflecting on these essays, readers can gain a better understanding of how death shapes our lives and relationships, and how we can learn to accept and cope with this inevitable part of the human experience.

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Reflections on Death in Philosophical/Existential Context

• Symposium: Reflections Before, During, and Beyond COVID-19
• Published: 27 July 2020
• Volume 57 , pages 402–409, ( 2020 )

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• Nikos Kokosalakis 1  

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Is death larger than life and does it annihilate life altogether? This is the basic question discussed in this essay, within a philosophical/existential context. The central argument is that the concept of death is problematic and, following Levinas, the author holds that death cannot lead to nothingness. This accords with the teaching of all religious traditions, which hold that there is life beyond death, and Plato’s and Aristotle’s theories about the immortality of the soul. In modernity, since the Enlightenment, God and religion have been placed in the margin or rejected in rational discourse. Consequently, the anthropocentric promethean view of man has been stressed and the reality of the limits placed on humans by death deemphasised or ignored. Yet, death remains at the centre of nature and human life, and its reality and threat become evident in the spread of a single virus. So, death always remains a mystery, relating to life and morality.

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What a piece of work is a man! how noble in reason! how infinite in faculty! In form and moving, how express and admirable! In action, how like an angel! in apprehension, how like a god! the beauty of the world! the paragon of animals! And yet, to me, what is this quintessence of dust? William Shakespeare ( 1890 : 132), Hamlet, Act 2, scene 2, 303–312.

In mid-2019, the death of Sophia Kokosalakis, my niece and Goddaughter, at the age of 46, came like a thunderbolt to strike the whole family. She was a world-famous fashion designer who combined, in a unique way, the beauty and superb aesthetics of ancient and classical Greek sculptures and paintings with fashion production of clothes and jewellery. She took the aesthetics and values of ancient and classical Greek civilization out of the museums to the contemporary art of fashion design. A few months earlier she was full of life, beautiful, active, sociable and altruistic, and highly creative. All that was swept away quickly by an aggressive murderous cancer. The funeral ( κηδεία ) – a magnificent ritual event in the church of Panaghia Eleftherotria in Politeia Athens – accorded with the highly significant moving symbolism of the rite of the Orthodox Church. Her parents, her husband with their 7-year-old daughter, the wider family, relatives and friends, and hundreds of people were present, as well as eminent representatives of the arts. The Greek Prime Minister and other dignitaries sent wreaths and messages of condolences, and flowers were sent from around the world. After the burial in the family grave in the cemetery of Chalandri, some gathered for a memorial meal. This was a high profile, emotional final goodbye to a beloved famous person for her last irreversible Journey.

Sophia’s death was circumscribed by social and religious rituals that help to chart a path through the transition from life to death. Yet, the pain and sorrow for Sophia’s family has been very deep. For her parents, especially, it has been indescribable, indeed, unbearable. The existential reality of death is something different. It raises philosophical questions about what death really means in a human existential context. How do humans cope with it? What light do religious explanations of death shed on the existential experience of death and what do philosophical traditions have to say on this matter?

In broad terms religions see human life as larger than death, so that life’s substance meaning and values for each person are not exhausted with biological termination. Life goes on. For most religions and cultures there is some notion of immortality of the soul and there is highly significant ritual and symbolism for the dead, in all cultures, that relates to their memory and offers some notion of life beyond the grave. In Christianity, for example, life beyond death and the eternity and salvation of the soul constitutes the core of its teaching, immediately related to the incarnation, death, and resurrection of Christ. Theologically, Christ’s death and resurrection, declare the defeat of death by the death and the resurrection of the son of God, who was, both, God and perfectly human (theanthropos). This teaching signifies the triumph of life over death, which also means, eschatologically, the salvation and liberation of humankind from evil and the injustice and imperfection of the world. It refers to another dimension beyond the human condition, a paradisiac state beyond the time/space configuration, a state of immortality, eternity and infinity; it points to the sublimation of nature itself. So, according to Christian faith, the death of a human being is a painful boundary of transition, and there is hope that human life is not perishable at death. There is a paradox here that through death one enters real life in union with God. But this is not knowledge. It is faith and must be understood theologically and eschatologically.

While the deeply faithful, may accept and understand death as passage to their union with God, Sophia’s death shows that, for ordinary people, the fear of death and the desperation caused by the permanent absence of a beloved person is hard to bear – even with the help of strong religious faith. For those with lukewarm religious faith or no faith at all, religious discourse and ritual seems irrelevant or even annoying and irrational. However, nobody escapes the reality of death. It is at the heart of nature and the human condition and it is deeply ingrained in the consciousness of adult human beings. Indeed, of all animals it is only humans who know that they will die and according to Heidegger ( 1967 :274) “death is something distinctively impending”. The fear of death, consciously or subconsciously, is instilled in humans early in life and, as the ancients said, when death is near no one wants to die. ( Ην εγγύς έλθει θάνατος ουδείς βούλεται θνήσκειν. [Aesopus Fables]). In Christianity even Christ, the son of God, prayed to his father to remove the bitter cup of death before his crucifixion (Math. 26, 38–39; Luke, 22, 41–42).

The natural sciences say nothing much about the existential content and conditions of human death beyond the biological laws of human existence and human evolution. According to these laws, all forms of life have a beginning a duration and an end. In any case, from a philosophical point of view, it is considered a category mistake, i.e. epistemologically and methodologically wrong, to apply purely naturalistic categories and quantitative experimental methods for the study, explanation and interpretation of human social phenomena, especially cultural phenomena such as the meaning of human death and religion at large. As no enlightenment on such issues emerges from the natural sciences, maybe insights can be teased out from philosophical anthropological thinking.

Philosophical anthropology is concerned with questions of human nature and life and death in deeper intellectual, philosophical, dramaturgical context. Religion and the sacred are inevitably involved in such discourse. For example, the verses from Shakespeare’s Hamlet about the nature of man, at the preamble of this essay, put the matter in a nutshell. What is this being who acts like an angel, apprehends and creates like a god, and yet, it is limited as the quintessence of dust? It is within this discourse that I seek to draw insights concerning human death. I will argue that, although in formal logical/scientific terms, we do not know and cannot know anything about life after/beyond death, there is, and always has been, a legitimate philosophical discourse about being and the dialectic of life/death. We cannot prove or disprove the existence and content of life beyond death in scientific or logical terms any more than we can prove or disprove the existence of God scientifically. Footnote 1

Such discourse inevitably takes place within the framework of transcendence, and transcendence is present within life and beyond death. Indeed, transcendence is at the core of human consciousness as humans are the only beings (species) who have culture that transcends their biological organism. Footnote 2 According to Martin ( 1980 :4) “the main issue is… man’s ability to transcend and transform his situation”. So human death can be described and understood as a cultural fact immediately related to transcendence, and as a limit to human transcendental ability and potential. But it is important, from an epistemological methodological point of view, not to preconceive this fact in reductionist positivistic or closed ideological terms. It is essential that the discourse about death takes place within an open dialectic, not excluding transcendence and God a priori, stressing the value of life, and understanding the limits of the human potential.

The Problem of Meaning in Human Death

Biologically and medically the meaning and reality of human death, as that of all animals, is clear: the cessation of all the functions and faculties of the organs of the body, especially the heart and the brain. This entails, of course, the cessation of consciousness. Yet, this definition tells us nothing about why only the human species, latecomers in the universe, have always worshiped their gods, buried their dead with elaborate ritual, and held various beliefs about immortality. Harari ( 2017 :428–439) claims that, in the not too distant future, sapiens could aim at, and is likely to achieve, immortality and the status of Homo Deus through biotechnology, information science, artificial intelligence and what he calls the data religion . I shall leave aside what I consider farfetched utopian fictional futurology and reflect a little on the problem of meaning of human death and immortality philosophically.

We are not dealing here with the complex question of biological life. This is the purview of the science of biology and biotechnology within the laws of nature. Rather, we are within the framework of human existence, consciousness and transcendence and the question of being and time in a philosophical sense. According to Heidegger ( 1967 :290) “Death, in the widest sense, is a phenomenon of life. Life must be understood as a kind of Being to which there belongs a Being-in-the-world”. He also argues (bid: 291) that: “The existential interpretation of death takes precedence over any biology and ontology of life. But it is also the foundation for any investigation of death which is biographical or historiological, ethnological or psychological”. So, the focus is sharply on the issue of life/death in the specifically human existential context of being/life/death . Human life is an (the) ultimate value, (people everywhere raise their glass to life and good health), and in the midst of it there is death as an ultimate threatening eliminating force. But is death larger than life, and can death eliminate life altogether? That’s the question. Whereas all beings from plants to animals, including man, are born live and die, in the case of human persons this cycle carries with it deep and wide meaning embodied within specific empirical, historical, cultural phenomena. In this context death, like birth and marriage, is a carrier of specific cultural significance and deeper meaning. It has always been accompanied by what anthropologists refer to as rites of passage, (Van Gennep, 1960 [1909]; Turner, 1967; Garces-Foley, 2006 ). These refer to transition events from one state of life to another. All such acts and rites, and religion generally, should be understood analysed and interpreted within the framework of symbolic language. (Kokosalakis, 2001 , 2020 ). In this sense the meaning of death is open and we get a glimpse of it through symbols.

Death, thus, is an existential tragic/dramatic phenomenon, which has preoccupied philosophy and the arts from the beginning and has been always treated as problematic. According to Heidegger ( 1967 : 295), the human being Dasein (being-there) has not explicit or even theoretical knowledge of death, hence the anxiety in the face of it. Also, Dasein has its death, “not in isolation, but as codetermined by its primordial kind of Being” (ibid: 291). He further argues that in the context of being/time/death, death is understood as being-towards-death ( Sein zum Tode ). Levinas Footnote 3 ( 2000 :8), although indebted to Heidegger, disagrees radically with him on this point because it posits being-towards death ( Sein zum Tode) “as equivalent to being in regard to nothingness”. Leaving aside that, phenomenologically the concept of nothingness itself is problematic (Sartre: 3–67), Levinas ( 2000 :8) asks: “is that which opens with death nothingness or the unknown? Can being at the point of death be reduced to the ontological dilemma of being or nothingness? That is the question that is posed here.” In other words, Levinas considers this issue problematic and wants to keep the question of being/life/death open. Logically and philosophically the concept of nothingness is absolute, definitive and closed whereas the concept of the unknown is open and problematic. In any case both concepts are ultimately based on belief, but nothingness implies knowledge which we cannot have in the context of death.

Levinas (ibid: 8–9) argues that any knowledge we have of death comes to us “second hand” and that “It is in relation with the other that we think of death in its negativity” (emphasis mine). Indeed, the ultimate objective of hate is the death of the other , the annihilation of the hated person. Also death “[is] a departure: it is a decease [deces]”. It is a permanent separation of them from us which is felt and experienced foremost and deeply for the departure of the beloved. This is because death is “A departure towards the unknown, a departure without return, a departure with no forward address”. Thus, the emotion and the sorrow associated with it and the pain and sadness caused to those remaining. Deep-down, existentially and philosophically, death is a mystery. It involves “an ambiguity that perhaps indicates another dimension of meaning than that in which death is thought within the alternative to be/not- to- be. The ambiguity: an enigma” (ibid: 14). Although, as Heidegger ( 1967 :298–311) argues, death is the only absolute certainty we have and it is the origin of certitude itself, I agree with Levinas (ibid: 10–27) that this certitude cannot be forthcoming from the experience of our own death alone, which is impossible anyway. Death entails the cessation of the consciousness of the subject and without consciousness there is no experience. We experience the process of our dying but not our own death itself. So, our experience of death is primarily that of the death of others. It is our observation of the cessation of the movement, of the life of the other .

Furthermore, Levinas (Ibid: 10–13) argues that “it is not certain that death has the meaning of annihilation” because if death is understood as annihilation in time, “Here, we are looking for other dimension of meaning, both for the meaning of time Footnote 4 and for the meaning of death”. Footnote 5 So death is a phenomenon with dimensions of meaning beyond the historical space/time configuration. Levinas dealt with such dimensions extensively not only in his God, Death and Time (2000) but also in his: Totality and Infinity (1969); Otherwise than Being, or Beyond Essence (1991); and, Of God Who comes to mind (1998). So, existentially/phenomenologically such dimensions inevitably involve the concept of transcendence, the divine, and some kind of faith. Indeed, the question of human death has always involved the question of the soul. Humans have been generally understood to be composite beings of body/soul or spirit and the latter has also been associated with transcendence and the divine. In general the body has been understood and experienced as perishable with death, whereas the soul/spirit has been understood (believed) to be indestructible. Thus beyond or surviving after/beyond death. Certainly this has been the assumption and general belief of major religions and cultures, Footnote 6 and philosophy itself, until modernity and up to the eighteenth century.

Ancient and classical Greek philosophy preoccupied itself with the question of the soul. Footnote 7 Homer, both in the Iliad and the Odyssey, has several reference on the soul in hades (the underworld) and Pythagoras of Samos (580–496 b.c.) dealt with immortality and metempsychosis (reincarnation). Footnote 8 In all the tragedies by Sophocles (496–406 b,c,), Aeschylus (523–456 b. c.), and Euripides (480–406 b.c.), death is a central theme but it was Plato Footnote 9 (428?-347 b.c.) and Aristotle Footnote 10 (384–322 b.c.) – widely acknowledged as the greatest philosophers of all times – who wrote specific treatises on the soul. Let us look at their positions very briefly.

Plato on the Soul

Plato was deeply concerned with the nature of the soul and the problem of immortality because such questions were foundational to his theory of the forms (ideas), his understanding of ethics, and his philosophy at large. So, apart from the dialogue Phaedo , in which the soul and its immortality is the central subject, he also referred to it extensively in the Republic , the Symposium and the Apology as well in the dialogues: Timaeus , Gorgias, Phaedrus, Crito, Euthyfron and Laches .

The dialogue Phaedo Footnote 11 is a discussion on the soul and immortality between Socrates (470–399 b.c.) and his interlocutors Cebes and Simias. They were Pythagorians from Thebes, who went to see Socrates in prison just before he was about to be given the hemlock (the liquid poison: means by which the death penalty was carried out at the time in Athens). Phaedo, his disciple, who was also present, is the narrator. The visitors found Socrates very serene and in pleasant mood and wondered how he did not seem to be afraid of death just before his execution. Upon this Socrates replies that it would be unreasonable to be afraid of death since he was about to join company with the Gods (of which he was certain) and, perhaps, with good and beloved departed persons. In any case, he argued, the true philosopher cannot be afraid of death as his whole life, indeed, is a practice and a preparation for it. So for this, and other philosophical reasons, death for Socrates is not to be feared. ( Phaedo; 64a–68b).

Socrates defines death as the separation of the soul from the body (64c), which he describes as prison of the former while joined in life. The body, which is material and prone to earthly materialistic pleasures, is an obstacle for the soul to pursue and acquire true knowledge, virtue, moderation and higher spiritual achievements generally (64d–66e). So, for the true philosopher, whose raison-d’être is to pursue knowledge truth and virtue, the liberation of the soul from bodily things, and death itself when it comes, is welcome because life, for him, was a training for death anyway. For these reasons, Socrates says is “glad to go to hades ” (the underworld) (68b).

Following various questions of Cebes and Simias about the soul, and its surviving death, Socrates proceeds to provide some logical philosophical arguments for its immortality. The main ones only can be mentioned here. In the so called cyclical argument, Socrates holds that the immortality of the soul follows logically from the relation of opposites (binaries) and comparatives: Big, small; good, bad; just, unjust; beautiful, ugly; good, better; bad; worse, etc. As these imply each other so life/death/life are mutually inter-connected, (70e–71d). The second main argument is that of recollection. Socrates holds that learning, in general, is recollection of things and ideas by the soul which always existed and the soul itself pre-existed before it took the human shape. (73a–77a). Socrates also advises Cebes and Simias to look into themselves, into their own psych e and their own consciousness in order to understand what makes them alive and makes them speak and move, and that is proof for the immortality of the soul (78ab). These arguments are disputed and are considered inadequate and anachronistic by many philosophers today (Steadman, 2015 ; Shagulta and Hammad, 2018 ; and others) but the importance of Phaedo lies in the theory of ideas and values and the concept of ethics imbedded in it.

Plato’s theory of forms (ideas) is the basis of philosophical idealism to the present day and also poses the question of the human autonomy and free will. Phaedo attracts the attention of modern and contemporary philosophers from Kant (1724–1804) and Hegel (1770–1831) onwards, because it poses the existential problems of life, death, the soul, consciousness, movement and causality as well as morality, which have preoccupied philosophy and the human sciences diachronically. In this dialogue a central issue is the philosophy of ethics and values at large as related to the problem of death. Aristotle, who was critical of Plato’s idealism, also uses the concept of forms and poses the question of the soul as a substantive first principle of life and movement although he does not deal with death and immortality as Plato does.

Aristotle on the Soul

Aristotle’s conception of the soul is close to contemporary biology and psychology because his whole philosophy is near to modern science. Unlike many scholars, however, who tend to be reductionist, limiting the soul to naturalistic/positivistic explanations, (as Isherwood, 2016 , for instance, does, unlike Charlier, 2018 , who finds relevance in religious and metaphysical connections), Aristotle’s treatment of it, as an essential irreducible principle of life, leaves room for its metaphysical substance and character. So his treatise on the soul , (known now to scholars as De Anima, Shields, 2016 ), is closely related to both his physics and his metaphysics.

Aristotle sees all living beings (plants, animals, humans) as composite and indivisible of body, soul or form (Charlton, 1980 ). The body is material and the soul is immaterial but none can be expressed, comprehended or perceived apart from matter ( ύλη ). Shields ( 2016 ) has described this understanding and use of the concepts of matter and form in Aristotle’s philosophy as hylomorphism [ hyle and morphe, (matter and form)]. The soul ( psyche ) is a principle, arche (αρχή) associated with cause (αιτία) and motion ( kinesis ) but it is inseparable from matter. In plants its basic function and characteristic is nutrition. In animals, in addition to nutrition it has the function and characteristic of sensing. In humans apart from nutrition and sensing, which they share with all animals, in addition it has the unique faculty of noesis and logos. ( De Anima ch. 2). Following this, Heidegger ( 1967 :47) sees humans as: “Dasein, man’s Being is ‘defined’ as the ζωον λόγον έχον – as that living thing whose Being is essentially determined by the potentiality for discourse”. (So, only human beings talk, other beings do not and cannot).

In Chapter Five, Aristotle concentrates on this unique property of the human soul, the logos or nous, known in English as mind . The nous (mind) is both: passive and active. The former, the passive mind, although necessary for noesis and knowledge, is perishable and mortal (φθαρτός). The latter, the poetic mind is higher, it is a principle of causality and creativity, it is energy, aitia . So this, the poetic the creative mind is higher. It is the most important property of the soul and it is immaterial, immortal and eternal. Here Aristotle considers the poetic mind as separate from organic life, as substance entering the human body from outside, as it were. Noetic mind is the divine property in humans and expresses itself in their pursuit to imitate the prime mover, God that is.

So, Aristotle arrives here at the problem of immortality of the soul by another root than Plato but, unlike him, he does not elaborate on the metaphysics of this question beyond the properties of the poetic mind and he focuses on life in the world. King ( 2001 :214) argues that Aristotle is not so much concerned to establish the immortality of the human individual as that of the human species as an eidos. Here, however, I would like to stress that we should not confuse Aristotle’s understanding with contemporary biological theories about the dominance and survival of the human species. But whatever the case may be, both Aristotle’s and Plato’s treatises on the soul continue to be inspiring sources of debate by philosophers and others on these issues to the present day.

Death in Modernity

By modernity here is meant the general changes which occurred in western society and culture with the growth of science and technology and the economy, especially after the Enlightenment, and the French and the Industrial Revolutions, which have their cultural roots in the Renaissance, the Reformation and Protestantism.

It is banal to say that life beyond death does not preoccupy people in modernity as it did before and that, perhaps, now most people do not believe in the immortality of the soul. In what Charles Taylor ( 2007 ) has extensively described as A SECULAR AGE he frames the question of change in religious beliefs in the west as follows: “why was it virtually impossible not to believe in God in, say, 1500 in our western society, while in 2000 many of us find this not only easy, but even inescapable?” (p. 25). The answer to this question is loaded with controversy and is given variously by different scholars. Footnote 13 Taylor (ibid: 65–75, 720–726) shows how and why beliefs have changed radically in modernity. Metaphysical transcendent beliefs on life and death have shrunk into this-worldly secular conceptions in what he calls, “the immanent frame”. As a consequence, transcendence and the sacred were exiled from the world or reduced to “closed world structures”. Footnote 14 In this context many scholars spoke of “the death of God” (ibid: 564–575).

In criticizing postmodern relativism, which brings various vague conceptions of God and transcendence back in play, Gellner ( 1992 :80–83) praises what he calls Enlightenment Rationalist fundamentalism, which “at one fell swoop eliminates the sacred from the world”. Although he acknowledges that Kant, the deepest thinker of the Enlightenment, left morality reason and knowledge outside the purview of the laws of nature, thus leaving the question of transcendence open, he still claims that Enlightenment rationalism is the only positive scientific way to study religious phenomena and death rituals. This position seems to be epistemologically flawed, because it pre-empts what concerns us here, namely, the assumptions of modernity for the nature of man and its implications for the meaning and reality of death.

In rejecting religion and traditional conceptions of death, Enlightenment rationalism put forward an overoptimistic, promethean view of man. What Vereker ( 1967 ) described as the “God of Reason” was the foundation of eighteenth century optimism. The idea was that enlightened rationalism, based on the benevolent orderly laws of nature, would bring about the redeemed society. Enlightened, rational leaders and the gradual disappearance of traditional religious beliefs, obscurantism and superstitions, which were sustained by the ancient regime, would eventually transform society and would abolish all human evil and social and political injustice. Science was supportive of this view because it showed that natural and social phenomena, traditionally attributed to divine agencies and metaphysical forces, have a clear natural causation. These ideas, developed by European philosophers (Voltaire 1694–1778; Rousseau, 1712–1778; Kant, 1724–1804; Hume, 1711–1776; and many others), were foundational to social and political reform, and the basis of the French Revolution (1789–1799). However, the underlying optimism of such philosophical ideas about the benevolence of nature appeared incompatible with natural phenomena such as the great earthquake in Lisbon in 1755, which flattened the city and killed over 100,000 people. Enlightenment rationalism overemphasised a promethean, anthropocentric view of man without God, and ignored the limits of man and the moral and existential significance of death.

In his critique of capitalism, in the nineteenth century, Marx (1818–1883), promoted further the promethean view of man by elevating him as the author of his destiny and banishing God and religion as “the opium of the people”. In his O rigin of the Species (1859), Charles Darwin also showed man’s biological connections with primates, thereby challenging biblical texts about the specific divine origin of the human species. He confirmed human dominance in nature. Important figures in literature, however, such as Dostoevsky (1821–1881) and Tolstoy (1828–1910), pointed out and criticised the conceit and arrogance of an inflated humanism without God, promoted by the promethean man of modernity.

By the end of the twentieth century the triumph of science, biotechnology, information technology, and international capitalist monetary economics, all of them consequences of modernity, had turned the planet into a global village with improved living standards for the majority. Medical science also has doubled average life expectancy from what it was in nineteenth century and information technology has made, almost every adult, owner of a mobile smart phone. Moreover, visiting the moon has inflated man’s sense of mastery over nature, and all these achievements, although embodying Taylor’s ( 1992 ) malaise of modernity at the expense of the environment, have strengthen the promethean view and, somehow, ignored human limits. As a consequence, the reality of death was treated as a kind of taboo, tucked under the carpet.

This seems a paradox because, apart from the normal death of individuals, massive collective deaths, caused by nature and by hate and barbarity from man to man, were present in the twentieth century more than any other in history. The pandemic of Spanish flue 1917–1919 killed 39 million of the world’s population according to estimates by Baro et al. (2020). In the First World War deaths, military and civilians combined, were estimated at 20.5 million (Wikipedia). In the Second World War an estimated total of 70–85 million people perished, (Wikipedia). This did not include estimates of more than seven million people who died in the gulags of Siberia and elsewhere under Stalin. But Auschwitz is indicative of the unlimited limits, which human barbarity and cruelty of man to man, can reach. Bauman ( 1989 :x), an eminent sociologist, saw the Holocaust as a moral horror related to modernity and wrote: “ The Holocaust was born and executed in modern rational society, at the high stage of our civilization and at the peak of human cultural achievement, and for this reason it is a problem of that society, civilization and culture. ”

Questions associated with the mass death are now magnified by the spread of the coronavirus (Covid-19). This has caused global panic and created unpredictability at all levels of society and culture. This sudden global threat of death makes it timely to re-examine our values, our beliefs (secular or religious), and the meaning of life. Max Weber (1948: 182), who died a hundred years ago in the pandemic of great influenza, was sceptical and pessimistic about modernity, and argued that it was leading to a cage with “ specialists without spirit, sensualists without heart; this nullity imagines that it had attained a level of civilization never before achieved. ”

So, what does this examination of philosophical anthropology illuminate in terms of questions of human nature and life and death in deeper intellectual, philosophical, dramaturgical context? Now, we are well into the twenty-first century, and with the revolution in information science, the internet, biotechnology and data religion , the promethean view of man seems to have reached new heights. Yet, massive death, by a single virus this time, threatens again humanity; are there any lessons to be learned? Will this threat, apart from the negativity of death, bring back the wisdom, which T. S. Elliot said we have lost in modern times? Will it show us our limits? Will it reduce our conceit and arrogance? Will it make us more humble, moderate, prudent, and more humane for this and future generations, and for the sake of life in this planet at large? These are the questions arising now amongst many circles, and it is likely that old religious and philosophical ideas about virtuous life and the hope of immortality (eschatologically) may revive again as we are well within late modernity (I do not like the term postmodernity, which has been widely used in sociology since the 1980s).

The central argument of this essay has been that death has always been and remains at the centre of life. Philosophically and existentially the meaning of death is problematic, and the natural sciences cannot produce knowledge on this problem. Religious traditions always beheld the immortality of the soul and so argued great philosophers like Plato and Aristotle. Modernity, since the Enlightenment, rejected such views as anachronistic and advanced an anthropocentric promethean, view of man, at the expense of the sacred and transcendence at large. Instead, within what Taylor (1967: 537–193) has described as the immanent frame, it developed “closed world structures,” which are at the expense of human nature and human freedom. One consequence of this has been massive death during the twentieth century.

Following Levinas ( 2000 ), I argued that death should not be understood to lead to nothingness because nothingness means certitude and positive knowledge, which we cannot have existentially in the case of death. In this sense the reality of death should not be understood to lead to annihilation of life and remains a mystery. Moreover, the presence and the reality of death as a limit and a boundary should serve as educative lesson for both the autonomy and creativity of man and against an overinflated promethean view of her/his nature.

David Martin ( 1980 :16) puts the matter about human and divine autonomy as follows: “Indeed, it is all too easy to phrase the problem so that the autonomy of God and the autonomy of man are rival claimants for what science leaves over”. This concurs with his, ( 1978 :12), understanding of religion, (which I share), as “acceptance of a level of reality beyond the observable world known to science, to which we ascribe meanings and purposes completing and transcending those of the purely human realm”.

We do not know how and when human beings acquired this capacity during the evolutionary process of the species. It characterises however a radical shift from nature to culture as the latter is defined by Clifford Geertz (1973:68): “an ordered system of meanings and symbols …in terms of which individuals define their world, express their feelings and make their judgements”.

For a comprehensive extensive and impressive account and discussion of Levinas’ philosophy and work, and relevant bibliography, see Bergo ( 2019 ).

Perhaps it is worth mentioning here that the meaning of the concept of time, as it was in Cartesian Philosophy and Newtonian physics, has changed radically with Einstein’s theories of relativity and contemporary quantum physics (Heisenberg 1959 ). Heisenberg’s uncertainty principle (Hilgervood and Uffink, 2016 ) is very relevant to non- deterministic conceptions of time/space and scientific and philosophical discourse generally.

Various religions articulate the structure of these meanings in different cultural contexts symbolically and all of them involve the divine and an eschatological metaphysical dimension beyond history, beyond our experience of time and space.

Ancient Egyptian culture is well known for its preoccupation with life after death, the immortality of the soul and the elaborate ritual involved in the mummification of the Pharaohs. See: anen.wikipedia.org/wiki/Ancient_ Egyptian_ funerary_ practices). Also the findings of archaeological excavations of tombs of kings in all ancient cultures constitute invaluable sources of knowledge not only about the meaning of death and the beliefs and rituals associated with it in these cultures but also of life and religion and politics and society at large.

For an extensive account of general theories of the soul in Greek antiquity see: Lorenz ( 2009 ).

For a good account on Pythagoras’ views on the transmigration of the souls see: Huffman ( 2018 ).

For a recent good account on the diachronic importance of Plato’s philosophy see: Kraut ( 2017 ).

For a very extensive analytical account and discussion of Aristotle’s philosophy and work with recent bibliography see: Shields ( 2016 ).

For an overview of Phaedo in English with commentary and the original Greek text see: Steadman ( 2015 ).

See, for instance, Wilson ( 1969 ) and Martin ( 1978 ) for radically different analyses and interpretations of secularization.

Marxism is a good example. God, the sacred and tradition generally are rejected but the proletariat and the Party acquire a sacred significance. The notion of salvation is enclosed as potentiality within history in a closed system of the class struggle. This, however, has direct political consequences because, along with the sacred, democracy is exiled and turned into a totalitarian system. The same is true, of course, at the other end of the spectrum with fascism.

Further Reading

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Charlton, W, 1980, Aristotle’s definition of the soul. Phonesis, vol. 25, no. 2, pp. 170–186.

Garsey-Foley, K. 2006. Death and Religion in a Changing World . MC Sharpe.

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Huffman, C. 2018. Pythagoras. Stanford Encyclopedia of Philosophy (winter 2018 edition) Edward Zalta (ed.). https://plato.stanford.edu/entries/pythagoras/ .

Isherwood, D. 2016. Science at last explains our soul: exploring the human condition with clues from science. https://www.zmescience.com/science/science-explains-our-soul/ .

King, R. 2001. Aristotle on Life and Death. London: Duckworth.

Kokosalakis, N. 2001. Symbolism (religious)) and Icon. International Encyclopedia of Social and Behavioural Science . Amsterdam: Elsevier.

Kokosalakis, N. 2020. Symbolism and Power in David Martin’s Sociology of Religion. Society. vol. 57, pp. 173–179. https://doi.org/10.1007/s12115-020-00462-x .

Kraut, R. 2017. Plato. The Stanford Encyclopaedia of Philosophy (Fall 2017 edition) Edward N. Zaltman (ed.) https://plato.stanford.edu/archives/fall2017/entries/plato/ .

Levinas, E. 1969. Totality and Infinity: An Essay on Exteriority . (Trans. A. Lingis). Pittsburgh: Duquesne University Press.

Levinas, E, 1991 . Otherwise than Being or Beyond Essence . (trans. A. Lingis). Dordrecht: Kluwer Academic.

Levinas, E. 1998. Of God Who Comes to Mind . (trans, Betina Bergo). Stanford CA: Stanford University Press.

Levinas, E. 2000. God, Death and Time . (tr. Betina Bergo) Stanford Calif: Stanford University Press.

Lorenz, H. 2009. Ancient Theories of the Soul. The Stanford Encyclopaedia of Philosophy . (Summer 2009 edition), Edward N. Zalta (ed.) https://plato.stanford.edu/archives/sum2009/entries/ancient-soul/ . Accessed 22 Apr 2009.

Martin, D. 1978. A General Theory of Secularization . Oxford: Basil Blackwell.

Martin, D. 1980. The Breaking of the Image. Oxford: Basil Blackwell

Sartre, Jean-Paul. 1969. Being and Nothingness: An Essay on Phenomenological Ontology. London: Methuen.

Shagufta, B. and M. Hamad. 2018. Concept of immortality in Platos’s Phaedo. Al-Hikmat , Vol. 36, pp. 1–12.

Shakespeare, W. 1890, Charles Knight (ed.) The Works of William Shakespeare. London: Routledge. Vol V, p. 132.

Shields, C. 2015. De Anima. (tr. with an introduction and commentary). Oxford: Oxford University Press.

Shields, C. 2016. Aristotle. The Stanford Encyclopaedia of Philosophy (winter 2016 edition) Edward N. Zalta (ed.). https://plato.stanford.edu/entries/aristotle/ . Accessed 29 Jul 2015.

Steadman, G. 2015. Plato’s Phaedo , 1 edition. https://geoffreysteadman.files.wordpress.com.....PDF. Accessed 15 Jun 2015.

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Essays About Death: Top 5 Examples and 9 Essay Prompts

Death includes mixed emotions and endless possibilities. If you are writing essays about death, see our examples and prompts in this article.

Over 50 million people die yearly from different causes worldwide. It’s a fact we must face when the time comes. Although the subject has plenty of dire connotations, many are still fascinated by death, enough so that literary pieces about it never cease. Every author has a reason why they want to talk about death. Most use it to put their grievances on paper to help them heal from losing a loved one. Some find writing and reading about death moving, transformative, or cathartic.

To help you write a compelling essay about death, we prepared five examples to spark your imagination:

1. Essay on Death Penalty by Aliva Manjari

2. coping with death essay by writer cameron, 3. long essay on death by prasanna, 4. because i could not stop for death argumentative essay by writer annie, 5. an unforgettable experience in my life by anonymous on gradesfixer.com, 1. life after death, 2. death rituals and ceremonies, 3. smoking: just for fun or a shortcut to the grave, 4. the end is near, 5. how do people grieve, 6. mental disorders and death, 7. are you afraid of death, 8. death and incurable diseases, 9. if i can pick how i die.

“The death penalty is no doubt unconstitutional if imposed arbitrarily, capriciously, unreasonably, discriminatorily, freakishly or wantonly, but if it is administered rationally, objectively and judiciously, it will enhance people’s confidence in criminal justice system.”

Manjari’s essay considers the death penalty as against the modern process of treating lawbreakers, where offenders have the chance to reform or defend themselves. Although the author is against the death penalty, she explains it’s not the right time to abolish it. Doing so will jeopardize social security. The essay also incorporates other relevant information, such as the countries that still have the death penalty and how they are gradually revising and looking for alternatives.

You might also be interested in our list of the best war books .

“How a person copes with grief is affected by the person’s cultural and religious background, coping skills, mental history, support systems, and the person’s social and financial status.”

Cameron defines coping and grief through sharing his personal experience. He remembers how their family and close friends went through various stages of coping when his Aunt Ann died during heart surgery. Later in his story, he mentions Ann’s last note, which she wrote before her surgery, in case something terrible happens. This note brought their family together again through shared tears and laughter. You can also check out these articles about cancer .

“Luckily or tragically, we are completely sentenced to death. But there is an interesting thing; we don’t have the knowledge of how the inevitable will strike to have a conversation.”

Prasanna states the obvious – all people die, but no one knows when. She also discusses the five stages of grief: denial, anger, bargaining, depression, and acceptance. Research also shows that when people die, the brain either shows a flashback of life or sees a ray of light.

Even if someone can predict the day of their death, it won’t change how the people who love them will react. Some will cry or be numb, but in the end, everyone will have to accept the inevitable. The essay ends with the philosophical belief that the soul never dies and is reborn in a new identity and body. You can also check out these elegy examples .

“People have busy lives, and don’t think of their own death, however, the speaker admits that she was willing to put aside her distractions and go with death. She seemed to find it pretty charming.”

The author focuses on how Emily Dickinson ’s “ Because I Could Not Stop for Death ” describes death. In the poem, the author portrays death as a gentle, handsome, and neat man who picks up a woman with a carriage to take her to the grave. The essay expounds on how Dickinson uses personification and imagery to illustrate death.

“The death of a loved one is one of the hardest things an individual can bring themselves to talk about; however, I will never forget that day in the chapter of my life, as while one story continued another’s ended.”

The essay delve’s into the author’s recollection of their grandmother’s passing. They recount the things engrained in their mind from that day –  their sister’s loud cries, the pounding and sinking of their heart, and the first time they saw their father cry. 

Looking for more? Check out these essays about losing a loved one .

9 Easy Writing Prompts on Essays About Death

Are you still struggling to choose a topic for your essay? Here are prompts you can use for your paper:

Your imagination is the limit when you pick this prompt for your essay. Because no one can confirm what happens to people after death, you can create an essay describing what kind of world exists after death. For instance, you can imagine yourself as a ghost that lingers on the Earth for a bit. Then, you can go to whichever place you desire and visit anyone you wish to say proper goodbyes to first before crossing to the afterlife.

Every country, religion, and culture has ways of honoring the dead. Choose a tribe, religion, or place, and discuss their death rituals and traditions regarding wakes and funerals. Include the reasons behind these activities. Conclude your essay with an opinion on these rituals and ceremonies but don’t forget to be respectful of everyone’s beliefs. 

Smoking is still one of the most prevalent bad habits since tobacco’s creation in 1531 . Discuss your thoughts on individuals who believe there’s nothing wrong with this habit and inadvertently pass secondhand smoke to others. Include how to avoid chain-smokers and if we should let people kill themselves through excessive smoking. Add statistics and research to support your claims.

Collate people’s comments when they find out their death is near. Do this through interviews, and let your respondents list down what they’ll do first after hearing the simulated news. Then, add their reactions to your essay.

There is no proper way of grieving. People grieve in their way. Briefly discuss death and grieving at the start of your essay. Then, narrate a personal experience you’ve had with grieving to make your essay more relatable. Or you can compare how different people grieve. To give you an idea, you can mention that your father’s way of grieving is drowning himself in work while your mom openly cries and talk about her memories of the loved one who just passed away. 

Explain how people suffering from mental illnesses view death. Then, measure it against how ordinary people see the end. Include research showing death rates caused by mental illnesses to prove your point. To make organizing information about the topic more manageable, you can also focus on one mental illness and relate it to death.

Check out our guide on  how to write essays about depression .

Sometimes, seriously ill people say they are no longer afraid of death. For others, losing a loved one is even more terrifying than death itself. Share what you think of death and include factors that affected your perception of it.

People with incurable diseases are often ready to face death. For this prompt, write about individuals who faced their terminal illnesses head-on and didn’t let it define how they lived their lives. You can also review literary pieces that show these brave souls’ struggle and triumph. A great series to watch is “ My Last Days .”

You might also be interested in these epitaph examples .

No one knows how they’ll leave this world, but if you have the chance to choose how you part with your loved ones, what will it be? Probe into this imagined situation. For example, you can write: “I want to die at an old age, surrounded by family and friends who love me. I hope it’ll be a peaceful death after I’ve done everything I wanted in life.”

To make your essay more intriguing, put unexpected events in it. Check out these plot twist ideas .

Maria Caballero is a freelance writer who has been writing since high school. She believes that to be a writer doesn't only refer to excellent syntax and semantics but also knowing how to weave words together to communicate to any reader effectively.

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5 moving, beautiful essays about death and dying

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It is never easy to contemplate the end-of-life, whether its own our experience or that of a loved one.

This has made a recent swath of beautiful essays a surprise. In different publications over the past few weeks,  I've stumbled upon writers who were  contemplating final days. These are, no doubt, hard stories to read. I had to take breaks as I read about Paul Kalanithi's experience facing metastatic lung cancer while parenting a toddler, and was devastated as I followed Liz Lopatto's contemplations on how to give her ailing cat the best death possible. But I also learned so much from reading these essays, too, about what it means to have a good death versus a difficult end from those forced to grapple with the issue. These are four stories that have stood out to me recently, alongside one essay from a few years ago that sticks with me today.

My Own Life | Oliver Sacks

As recently as last month, popular author and neurologist Oliver Sacks was in great health, even swimming a mile every day. Then, everything changed: the 81-year-old was diagnosed with terminal liver cancer. In a beautiful op-ed , published in late February in the New York Times, he describes his state of mind and how he'll face his final moments. What I liked about this essay is how Sacks describes how his world view shifts as he sees his time on earth getting shorter, and how he thinks about the value of his time.

Before I go | Paul Kalanithi

Kalanthi began noticing symptoms — "weight loss, fevers, night sweats, unremitting back pain, cough" — during his sixth year of residency as a neurologist at Stanford. A CT scan revealed metastatic lung cancer. Kalanthi writes about his daughter, Cady and how he "probably won't live long enough for her to have a memory of me." Much of his essay focuses on an interesting discussion of time, how it's become a double-edged sword. Each day, he sees his daughter grow older, a joy. But every day is also one that brings him closer to his likely death from cancer.

As I lay dying | Laurie Becklund

Becklund's essay was published posthumonously after her death on February 8 of this year. One of the unique issues she grapples with is how to discuss her terminal diagnosis with others and the challenge of not becoming defined by a disease. "Who would ever sign another book contract with a dying woman?" she writes. "Or remember Laurie Becklund, valedictorian, Fulbright scholar, former Times staff writer who exposed the Salvadoran death squads and helped The Times win a Pulitzer Prize for coverage of the 1992 L.A. riots? More important, and more honest, who would ever again look at me just as Laurie?"

Everything I know about a good death I learned from my cat | Liz Lopatto

Dorothy Parker was Lopatto's cat, a stray adopted from a local vet. And Dorothy Parker, known mostly as Dottie, died peacefully when she passed away earlier this month. Lopatto's essay is, in part, about what she learned about end-of-life care for humans from her cat. But perhaps more than that, it's also about the limitations of how much her experience caring for a pet can transfer to caring for another person.

Yes, Lopatto's essay is about a cat rather than a human being. No, it does not make it any easier to read. She describes in searing detail about the experience of caring for another being at the end of life. "Dottie used to weigh almost 20 pounds; she now weighs six," Lopatto writes. "My vet is right about Dottie being close to death, that it’s probably a matter of weeks rather than months."

Letting Go | Atul Gawande

"Letting Go" is a beautiful, difficult true story of death. You know from the very first sentence — "Sara Thomas Monopoli was pregnant with her first child when her doctors learned that she was going to die" — that it is going to be tragic. This story has long been one of my favorite pieces of health care journalism because it grapples so starkly with the difficult realities of end-of-life care.

In the story, Monopoli is diagnosed with stage four lung cancer, a surprise for a non-smoking young woman. It's a devastating death sentence: doctors know that lung cancer that advanced is terminal. Gawande knew this too — Monpoli was his patient. But actually discussing this fact with a young patient with a newborn baby seemed impossible.

"Having any sort of discussion where you begin to say, 'look you probably only have a few months to live. How do we make the best of that time without giving up on the options that you have?' That was a conversation I wasn't ready to have," Gawande recounts of the case in a new Frontline documentary .

What's tragic about Monopoli's case was, of course, her death at an early age, in her 30s. But the tragedy that Gawande hones in on — the type of tragedy we talk about much less — is how terribly Monopoli's last days played out.

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Economic Synopses

Mortality and economic growth.

This essay explores the relationship between economic growth and the evolution of mortality across countries between 1960 and 2019. The data are from the World Bank's World Development Indicators and Health Nutrition and Population Statistics; they are for a group of 86 countries for which there exist annual data on real gross domestic product (GDP) per capita and two measures of mortality—the crude death rate and life expectancy at birth. 1

I excluded China from the sample as its demography during this period is abnormal for at least two reasons. First, during the Great Leap Forward (1958-62) and the ensuing famine, China's mortality increased by 150% in a span of a few years. 2 Second, the one-child policy is largely documented to have had negative consequences on births, the male-to-female ratio, and infant mortality—particularly that of girls. 3 The sample, excluding China, covers 74% of the population, 78% of deaths, and 79% of GDP in 1960. In 2019, these numbers are 78%, 76%, and 81%, respectively.

In Figure 1, the horizontal axis indicates the annual growth rate of GDP between 1960 and 2019. Most growth rates are positive because most—but not all—countries experienced economic growth during this period. The following six countries experienced a reduction in their GDP between 1960 and 2019: Burundi, the Central African Republic, Congo (Kinshasa), Haiti, Madagascar, and Niger. The vertical axis measures annual growth of the crude death rate (CDR). Most countries experienced a negative change; that is, their CDR was lower in 2019 than in 1960. The following observations can be made about this figure:

• Most countries had an increasing GDP and a decreasing CDR: lower-right quadrant, 86% of the world population in 1960.
• The six countries that had a decreasing GDP also had a decreasing CDR: lower-left quadrant, 2% of the world population in 1960.
• Finland, Greece, Italy, Japan, the Netherlands, Portugal, Puerto Rico, and Spain had both an increasing GDP and an increasing CDR: upper-right quadrant, 12% of the world population in 1960.
• No countries had a decreasing GDP and a simultaneously increasing CDR: upper-left quadrant.
• The correlation between the growth of CDR and GDP is 0.31 (not indicated in Figure 1). Thus, countries with higher economic growth had, on average, higher CDR growth; that is, their CDR tended to decrease slowly compared with countries with lower economic growth. 

Put together, observations (1)-(5) are somewhat surprising because they appear at odds with the (possibly widely held) notion that economic prosperity is a first-order determinant of low mortality. 4 If that were the case, wouldn't faster increases in economic prosperity (i.e., high GDP growth rates) be associated with faster decreases in mortality (i.e., low CDR growth)? But what of points (2) and (3) above, then? Countries with decreasing prosperity should have experienced increasing mortality, but they did not [point (2)]; and countries with increasing mortality should have exhibited decreasing prosperity, but they did not [point (3)]. Finally, the overall correlation between GDP and CDR growth should have been negative instead of positive [point (5)].

I discuss possible reasons for the disconnect between mortality and income in a June 2022 Regional Economist article . In a nutshell, there exist practices that can reduce mortality from diseases—by reducing either the risk of being sick or the risk of death once sick—and can be both cheap and learned quickly from observation. These include personal hygiene, household cleanliness, safe food handling, breastfeeding practices, safe sexual behavior, and the understanding of vaccines, among other practices. 

For instance, oral rehydration therapy (drinking water mixed with salt and sugar) prevents dehydration from diarrheal disease, a leading cause of child mortality in the world. 5 Oral rehydration therapy is cheap and can be administered without doctors or nurses present. It is possible, therefore, that countries in the lower-left quadrant experienced decreasing CDRs despite their poor economic performances because they adopted such practices over time.

Figure 2 presents complementary information on the relationship between mortality and economic growth. The horizontal axis measures the growth rate of GDP as in Figure 1. The vertical axis measures the growth rate of life expectancy at birth (LEB) between 1960 and 2019 for each country. The following two points are worth making:

• LEB increased for all countries in the sample, including those with increasing CDR. How is this possible? Recall that the CDR is the number of deaths per population. Thus, it can vary for reasons unrelated to individuals' risk of death. When births decrease, for example, the proportion of elderly people eventually increases, leading to a higher CDR even though the risk of death for an elderly person may not have changed.
• The correlation between the growth of CDR and LEB is –0.25 (not indicated in Figure 2). Thus, countries with higher economic growth had, on average, lower LEB growth rates. This confirms the point made earlier: Faster increases in economic prosperity do not imply faster decreases in mortality, which, in the case of Figure 2, would have meant faster increases in LEB. 

In conclusion, the notion that mortality is determined largely by economic prosperity is not a good description of the world after 1960: Reductions in mortality, measured by either decreasing CDR or increasing LEB, are not easily explained as resulting from economic growth.

1 The crude death rate (CDR) is the number of deaths per population in a given year. Life expectancy at birth (LEB) is the expected years of life for a newborn. 

2 World Bank.

3 See https://www.medrxiv.org/content/10.1101/2022.03.09.22272156v1 . 

4 It is possible that people in high-income countries have access to better medical care while living unhealthy (e.g., sedentary) lives. If the second effect dominated the first, observations (1)-(5) would not be surprising. It would become difficult, however, to make sense of the mortality reduction experienced by the world at large, since 1800 at least, as it grew richer.

5 See https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease .

© 2022, Federal Reserve Bank of St. Louis. The views expressed are those of the author(s) and do not necessarily reflect official positions of the Federal Reserve Bank of St. Louis or the Federal Reserve System.

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Essay Samples on Death Rates

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2. Statistics on Death Associated with Alcohol and How to Recover from Alcohol Abuse

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5. Death By Prescription: Doctors’ Handwriting Causes 7,000 Deaths A Year

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Home / Essay Samples / Science / Anthropology / Death Rates

Death Rates Essay Examples

Death related encounters and rates in the united states in the 21st century.

The experience of death in the United States as a rule incorporates three segments. First is the experience with the demise (it is the means by which individuals experience passing in their lives). Also is the mentalities toward the demise (it is the manner by...

The Need for Policies Changes to Decrease African-americans Infant Mortality Rates

Imagine, that you are a pregnant African American women and the year is 2002. The media are filled with talk of a new movement that screams equality and equity in a new world that would rather forget the oppressive, separated ways of the past than...

Innovation and Advance in Health and Social Care: Reducing Death Rates and Preventing People to Quit Smoking

In this report study I will debate and explain the principal of National Initiative that promotes lifestyle change for young people with cardiovascular disease (CVD), lung cancer, cerebrovascular disease, diabetes, chronic obstructive pulmonary disease, asthma, infant death syndrome. The main idea I’m about to debate...

Analysis of the Article "I’m on Death Row for Punching a Man" by Maurice Chammah

This article is a solid example of how and why the criminal justice system is how it is today. In this article, J. T. , the inmate who told this story, is serving a life sentence for punching a man in the head. The man...

Firearm Death Rates in the United States

States that have more firearms per capita, have more injuries and deaths due to firearms. Deaths by firearm are rapidly increasing every year. According to the “The hill news” an American based news company owned by capitol hill states that “The 39,773 recorded deaths from...

The Factors of Gender Differences in Suicide Related Death Rates in America

Suicide can be viewed as a response to extreme stress and buildup of different emotions over a certain period of time. The levels of tolerance for emotions such as sadness vary from one individual to another, and being overwhelmed or overpowered by these emotions can...

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