Thanks to decades of scientific advances, we have the ability to save the lives of infants born months prematurely, prevent infectious diseases and effectively treat previously fatal conditions such as diabetes, leukemia and HIV/AIDS.
We lay infants to sleep safely on their backs, buckle children into crash-tested carseats and make them wear helmets when they ride their bikes. We have the knowledge, the technology and the resources in this country to protect kids better than ever before. A graph of child mortality in the U.S. should show a line steadily approaching zero.
But it doesn’t. Instead, that line ticks up. A recent analysis published in the Journal of the American Medical Association (JAMA) of all-cause child mortality data from 1999 to 2021 reveals that deaths in the 1-19 age group rose 10.7% from 2019 to 2020, and again by 8.3% from 2020 to 2021. These increases are the largest in decades, and they reverse what was previously a downward trend.
“Our stance, based on archival data, is that the last time an increase occurred of this magnitude for two consecutive years might have been as long ago as the 1918 Spanish flu pandemic,” Dr. Steven H. Woolf of Virginia Commonwealth University, one of the authors of the JAMA paper, told HuffPost.
There was also a surge in the death rate of older adults in 2020, caused by the coronavirus pandemic. But COVID-19 does not account for the rise in pediatric deaths.
The number of children who died of COVID was very low, and though the pandemic was global, the rise in child mortality was not.
“Rising death rates in children and teens is not happening in other countries. This is all an American phenomenon,” Woolf said.
What are we doing differently here? And, more critically, what can we do to reverse course?
What are the primary causes of death in children and adolescents?
Of the “hundreds and hundreds of causes of death that we study in children and adolescents,” Woolf said, “we’ve made tremendous progress for most of those major conditions.”
Injury, not disease, is behind the recent rise in deaths.
“We identified four causes of death that seemed to be the main drivers of this trend: suicide, homicide, drug overdoses and car accidents,” Woolf said.
None of these is a natural cause, meaning that each one of those deaths could have been prevented.
Which children are most at risk?
Not all children in this country face the same risk of death from the four causes named above. Boys and older children and teens (ages 10 to 19) are more likely to die overall.
There are also significant differences in the death rates of different racial groups from each of the major causes.
“Drug overdose deaths are highest in white children, generally speaking; car crash accidents [are] highest in Native American young people; and the homicide rates [are] markedly higher in African American youth,” Woolf said.
These racial disparities predate the uptick in child mortality, but most have held strong in recent years. One exception is deaths from drug overdoses, which have historically been higher among white children. Woolf and his co-authors found that, in 2020, overdose deaths among non-Hispanic Black and Hispanic youth reached equivalency with those among their white peers.
The difference in homicide deaths is stark. Non-Hispanic Black youth accounted for 62.9% of homicide victims ages 10 to 19 years, although they comprise 14% of the population of this age group.
When compounded by gender, the difference in risk is even more astonishing. Woolf and his co-authors found that a 10- to 19-year-old Black male is 61 times as likely to be killed in a homicide than a non-Hispanic white female in the same age category.
“The reasons why gun violence is more concentrated in low-income communities and communities of color is not an accident,” Woolf said. There is not always “recognition of the role that society has played in choking off economic resources and segregating these communities and creating very difficult conditions that foster hopelessness in young people, and that’s a fuel that feeds these kinds of problems.”
Woolf said that some have criticized the paper for grouping 19-year-olds with young children in this analysis. He pointed out that these are the standard age categories that demographers use when analyzing deaths.
What role do firearms play?
In these rising homicide deaths, the weapon is almost always a gun. Guns are also the cause of almost half of suicide deaths in young people ages 10 to 19.
Of youth gun deaths, about two-thirds are homicides and one-third are suicides, Sarah Burd Sharps, senior director of research at Everytown for Gun Safety, told HuffPost.
In 2020, shootings overtook car accidents as the number one cause of death for U.S. children and teens.
“Only in the U.S. are guns the leading killer of children because only in the U.S. do we allow such easy access for children and teens to guns,” Burd Sharps said.
When it comes to suicide attempts, those involving guns are “uniquely lethal,” she added. According to Everytown, 90% of suicide attempts with guns are fatal. Of those not involving guns, only 4% are fatal. This means that if the rate of attempted suicides didn’t change but access to guns did, the number of suicide deaths would plummet.
But gun ownership and gun suicides are both going up dramatically. Everytown reports that the firearm suicide rate for kids ages 10 to 14 in 2020 rose 31% from 2019. This rate has increased 146% from 2011 to 2020.
Gun sales spiked during the early months of the pandemic, with 1 in 5 American households purchasing a firearm from March 2020 to March 2022. Five percent of U.S. adults became gun owners during this time.
Though there is a dire need for greater access to culturally competent mental health care, Burd Sharps said, what makes most of these deaths immediately preventable is “ensuring that children can’t access firearms in the first place.”
Where does mental health fit into the picture?
Americans of all ages have been struggling more with mental health issues in recent years, and the stress of the coronavirus pandemic has exacerbated issues such as depression and opioid addiction.
Suicides in youth ages 10 to 19 have been going up since 2007, Woolf pointed out, a “reflection of a much larger mental health crisis,” as suicide deaths represent a relatively small number of those suffering emotionally.
The increase in youth deaths correlates with an overall increase in deaths in adults ages 25 to 64, which Woolf says has been happening since 2010.
Again, he added, “that’s not happening in other countries. But it’s happening here.”
Though we can’t isolate which of many potential factors are causing this mental health crisis, we can see the enormity of its effect.
Woolf thinks the data offers another reminder, to parents, families, schools and communities, to “give more attention to the mental health of our children... to be more tuned in to how our children are coping with these challenges.”
Our mental health care system, he says, was declining before the pandemic began and has taken a hit over the last several years. The situation is particularly dire in rural areas. A related problem, the opioid epidemic, is also causing huge numbers of American deaths, and ingestions of opioids such as fentanyl are responsible for many of the pediatric deaths categorized as poisonings.
Woolf also noted that politicians who are quick to blame an individual shooter’s mental illness for an incidence of violence often aren’t the ones asking for more spending on mental health care. “It’s a talking point but not necessarily a policy,” he said.
“Politicians often create this sort of false dichotomy,” he added. “It’s clearly both. I think the policy strategy has to be multifaceted.”
What policies could reverse this trend?
“There are some simple things that can be done to protect children from guns that I think most gun owners would find reasonable,” Woolf said.
Burd Sharps mentioned child access prevention laws, which can vary in the level of protection they offer. Oregon, for example, has a safe storage law that requires gun owners to secure firearms so that they cannot be accessed by minors.
Gun dealers in Oregon must prominently place the following warning where customers can see: “The purchaser of a firearm has an obligation to store firearms in a safe manner and to prevent unsupervised access to a firearm by a minor. If a minor or unauthorized person obtains access to a firearm and the owner failed to store the firearm in a safe manner, the owner may be in violation of the law.”
Burd Sharps said that such laws have been shown to reduce youth suicides, school shootings and unintentional shootings by children. The unintentional shootings, she explained, “happen in this country nearly once every day. Nearly one time every day, a child somewhere in the United States, under 17 but often 2, 3, 4 and 5 years old, gets their hands on a gun and unintentionally shoots themselves or someone else.”
Locking a gun securely and separately from ammunition prevents these tragedies, she added.
Other policies that would reduce gun deaths among children include, among many others, bans on high-capacity magazines, tighter age restrictions on gun purchases and anything that would reduce the number of firearms in circulation.
In addition, Burd Sharps suggested that parents ask about the presence of firearms and their proper storage in any home their children spend time in, before visits with relatives or playdates.
Finally, she emphasized that it is on us as the adults to keep our children safe from firearms.
“It’s not the child’s responsibility,” she said, noting that studies have shown that even when taught not to touch firearms, children will do so anyway.
“Incidents of gun violence have reverberations far beyond the kid struck by a bullet. It’s shaping the lives of the kids who witnessed that shot, who live in fear of the next shooting,” Burd Sharps said.