This is a list of some of the easiest public health and public safety policy choices that the U.S. can make to save lives.
There are other common causes of what are sometimes called "preventable deaths" in the U.S. such as high blood pressure and being overweight, but unlike many of the measure discussed below, the solution to these problems are difficult, have causes that are often not well understood, and take a great deal of time to produce results.
In contrast, these proposals address problems whose causes and solutions are better understood, which are likely to produce significant results in a matter of months or a few years if implemented, and do not require epic levels of sustained personal fortitude to accomplish.
1. COVID.
We should focus on vaccinating and providing anti-viral treatment to vulnerable populations.
This is because these populations are the source of almost all COVID deaths, a very large share of COVID hospitalizations, and a disproportionate share of exceptionally severe or long lasting COVID outcomes, which both vaccinations and anti-viral treatments can profoundly mitigate, although even these measures don't eliminate all risk of these outcomes.
If we vaccinate 90% of people in vulnerable populations who haven't had a positive COVID test or a new vaccine dose within the last six months (the approximate duration of the resistance to COVID and mitigation of reinfection severity that appears to be emerging), and promptly provide the most effective anti-viral treatments to members of vulnerable populations who test positive for COVID, we could reduce COVID deaths by about 75,000 per year in the U.S.
For these purposes, vulnerable means age 65 or more, age 50 to 64 with a risk enhancing condition (e.g. obesity, diabetes, asthma), or age 5 to 49 if the person is immunocompromised or has three or more risk enhancing conditions.
2. Motorcycle Accidents.
Motorcycles are, by far, the most dangerous means of transportation.
Mandatory helmet laws reduce deaths in motorcycle accidents by about one-third. While some states have them already, a national helmet law would still save lives.
It would also help to make it harder to get a motorcycle license (e.g. by increasing the minimum age to get such a license and increasing the rigor of practical testing requirements), because young, inexperienced motorcycle riders have the highest death rates.
These measures combined would probably save more than a thousand lives per year in the U.S. out of the roughly 5,000 motorcycle accident deaths per year in the U.S.
3. Organ Donation.
Transplants save about 40,000 lives a year. But about 7,500 people a year die while waiting for an organ transplant. More lives, thousands of them, would be saved if permission to donate organs was conclusively presumed in everyone who doesn't affirmatively opt out of being an organ donor before an incident occurs. This would particularly reduce deaths from kidney disease.
Italy has had great success with this policy, which has grown very popular there in the time since it has been implemented by engendering a sense that its people are supporting each other in ways that matter.
4. Smoking Regulations.
Smoking kills hundreds of thousands of people in the U.S. each year (mostly from heart disease, cancer, and lung disease) despite a greatly reduced rate of smoking from a few decades ago.
Adopting Colorado class secondary smoke exposure rules, and other forms of the most strict regulations of smoking in the U.S., would save thousands of lives a year. When strict secondary smoke exposure rules were first adopted in Colorado, the decline in deaths from conditions which exposure to smoke aggravates almost immediately declined in statistically significant amounts.
Smokers should also routinely be screened for bipolar disorder and schizophrenia (which often lead to premature death in the absence of the most exemplary treatment of it), since people with those conditions have extreme elevated likelihoods of smoking, especially now that smoking has become less common. Ways to provide nicotine without lung and cancer health risks to people with these conditions should get greater attention.
5. Nursing Home Regulation.
Many live would be saved by adopting and enforcing regulations for nursing homes including infectious disease control standards, bed sore prevention measures, measures to prevent falling deaths, and minimum standards for nursing home workers.
COVID alone has killed more than 200,000 nursing home residents and employees since the pandemic began (23% of all U.S. COVID deaths), many preventable, and that is just one of many dimensions of the problems caused by under regulated nursing homes.
Because nursing home residents are so fragile, even modest percentage improvements in health and safety income translate into many fewer nursing home deaths and long lives on average for nursing home residents.
6. Opioid Overdoses.
There are currently more than 100,000 opioid overdose deaths in the U.S. each year, and it has steadily increased year after year for many, many years.
But the experience of places like France, Switzerland, and Portugal, suggests that better policy responses can dramatically reduce opioid deaths.
Tens of thousands of lives per year could be saved by: (1) widely training primary care physicians, physician's assistants, and registered nurses to administer medication based opioid addition treatments and authorizing them to autonomously prescribe such treatments, (2) providing Narcan and basic related first aid training to all first responders, designated libraries, and other people likely to encounter overdoses who may not have medical training, (3) establish new more restrictive standards for prescribing opioids and monitoring efforts to obtain prescriptions from multiple sources, and (4) authorize supervised clean needle situations for addicts to reduce harm (this would also reduce the risk of transmission of HIV, monkeypox, and syphilis).
7. Home Nurse Visits For Newborns Spreading Proven Best Practices
Routinely having nurses visit mothers of newborns spreading best practices like not shaking a baby and putting a baby to sleep on its back and using car seats properly has been proven to greatly reduce infant mortality, especially in demographics with elevated rates of infant mortality.
About 20,000 infants per year die in the U.S. and while some of these deaths are basically inevitable due to birth defects, but some, especially in demographics with higher rates of infant mortality are preventable. Home nurse visits have been show to be capable of making statistically significant reductions in these numbers in the U.S., and this is an area where the U.S. lags other developed nations that often use this approach to limit infant mortality.
8. Comprehensive Support For Recent Widows and Widowers
One of the periods in which people have the highest risk of death in their lives, after infancy (from myriad causes), is in the three to six months after the death of a spouse. There are many thousands of excess deaths in this window of time in a person's life.
This time period should be one in which society pro-actively provides substantial and intrusive mental and physical health support to grieving widows and widowers. As one study in the year 2008 explained:
For both men and women, the death of a predecedent spouse from almost all causes, including various cancers, infections, and cardiovascular diseases, increased the all-cause mortality of the bereaved partner to varying degrees. Moreover, the death of a predecedent spouse from any cause increased the survivor's cause-specific mortality for almost all causes, including cancers, infections, and cardiovascular diseases, to varying degrees. . . . The increased likelihood for a recently widowed person to die—often called the “widowhood effect”—is one of the best documented examples of the effect of social relations on health. The widowhood effect has been found among men and women of all ages throughout the world. Recent longitudinal studies put the excess mortality of widowhood (compared with marriage) among the elderly between 30% and 90% in the first 3 months and around 15% in the months thereafter. These estimates are comparable across various statistical methodologies, including multivariate models that statistically control for a wide range of confounding factors, prompting increasing confidence in a causal basis of the widowhood effect. . . .
[This study found that:] Mortality after widowhood is significantly elevated for husbands and wives. The death of a wife is associated with an 18% increase in all-cause mortality for men (hazard ratio [HR] = 1.18; 95% confidence interval [CI] = 1.16, 1.19), and the death of a husband is associated with a 16% increase in all-cause mortality for women (HR = 1.16; 95% CI = 1.14, 1.17), after adjusting for covariates. . . .
A wife's death exerts statistically significant effects (P < .05) on men's cause-specific hazards of death for 15 out of 17 causes of death. A wife's death increases men's cause-specific hazards of death by more than 20% for 6 causes of death (in decreasing order: chronic obstructive pulmonary disease [COPD], diabetes, accidents or serious fractures, infections or sepsis, all other known causes, and lung cancer) and for unknown causes of death. The effect exceeds 10% for 7 more causes of death (colon cancer, ischemic heart disease, congestive heart failure, nephritis or kidney disease, cerebral vascular accident or stroke, other heart and vascular diseases, and other cancers). The effects of the wife's death on the husband's hazards of death from influenza or pneumonia and Alzheimer's disease or Parkinson's disease are not statistically significant.
A husband's death exerts statistically significant effects on women's cause-specific hazards of death for 15 out of 17 causes of death. The estimated effects exceeded 20% for 4 causes of death (COPD, colon cancer, accidents or serious fractures, and lung cancer) and for unknown causes. The effects exceeded 10% for another 7 causes (other known causes, infections or sepsis, influenza or pneumonia, nephritis or kidney disease, diabetes, other heart or vascular disease, and congestive heart failure). The impact remains statistically significant yet falls below 10% for 3 causes of death (cerebral vascular accident and stroke, ischemic heart disease, and other cancers). We did not find a statistically significant impact of the husband's death on the wife's hazard of death from rapidly fatal cancers or Alzheimer's disease or Parkinson's disease. . . .
The death of a husband or wife is associated with a statistically significant (P < .05) increase in the all-cause mortality of the surviving partner for almost all causes of death of the predecedent spouse.
Men's hazard of death increases by more than 20% if their wives died of lung cancer, infections or sepsis, COPD, other heart or vascular diseases, or diabetes. Men's hazard of death increases by less than 20% if their wives died of any other causes. Only men whose wives died of Alzheimer's disease or Parkinson's disease do not experience a statistically significant increase in mortality.
Women's hazard of death increases by more than 20% after widowhood only for 2 of their predecedent husbands’ causes of death: COPD and influenza or pneumonia. Women's hazard of death increases by less than 20% in response to their husbands’ deaths from all other causes. Only women whose husband died of Alzheimer's disease or Parkinson's disease did not experience a statistically significant increase in their own mortality.
9. Widespread Adoption Of New, Best Practices Sepsis Treatments
A new highly effective treatment regime for sepsis, a type of infection common in hospitals that can be treated with what amounts to an IV flow rich in Vitamin C, can dramatically reduce deaths from complications in hospitals, which kill thousands of people each year.
Wider implementation of this treatment could save 30,000 lives a year in the U.S.
10. Suicide Reduction.
Reduce the percentage of households that own a gun by 20%. The percentage of households that own a gun is already falling anyway, so this would require more of a nudge than more bold measures.
Increase use of fast acting ketamine treatments of severe depression.
Increase the availability of inpatient mental health beds.
These policies combined could reduce suicide rates by 20-25% (i.e. 9,000 to 12,000 lives a year).
11. Housing First.
Homeless people need housing first. Without this, the percentage of the homeless who die is appallingly high.
12. Mentors For LGBT+ children
A supportive adult mentor for an LGBT child greatly reduces bad outcomes for these children including reductions in suicide.
13. Reduce The Share Of Power Generated By Coal.
Air pollution derived from coal fired electric power plants cause many deaths each year that can be reduced by transitioning to any alternative except petroleum fired electricity generation. Coal fired power plant sourced air pollution result in about 3,000 deaths per year in the U.S. (eve when ignoring its global warming impacts).
But, utility level decisions about how to generate electricity are almost invisible in the lives of day-to-day consumers.
