America’s Declining Well-Being, Health, and Life Expectancy: Not Just a White Problem

Abstract

Although recent declines in life expectancy among non-Hispanic Whites, coined “deaths of despair,” grabbed the headlines of most major media outlets, this is neither a recent problem nor is it confined to Whites. The decline in America’s health has been described in the public health literature for decades and has long been hypothesized to be attributable to an array of worsening psychosocial problems that are not specific to Whites. To test some of the dominant hypotheses, we show how various measures of despair have been increasing in the United States since 1980 and how these trends relate to changes in health and longevity. We show that mortality increases among Whites caused by the opioid epidemic come on the heels of the crack and HIV syndemic among Blacks. Both occurred on top of already higher mortality rates among all Americans relative to people in other nations, and both occurred among declines in measures of well-being. We believe that the attention given to Whites is distracting researchers and policymakers from much more serious, longer-term structural problems that affect all Americans. (Am J Public Health. Published online ahead of print September 25, 2018: e1–e6. doi:10.2105/AJPH. 2018.304585)

Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC)

“…[4] This term provides a useful contextual framework for studying socioeconomic risk factors of opioid overdoses and interventions to prevent associated fatalities. Nationwide, the rising rate of fatal opioid overdoses has disproportionately [5] but not exclusively [6] affected Whites, men and middle-aged individuals. The highest opioid overdose death rates are reported in Mountain, Rust Belt, and New England states as well as the South.…”

Rise in mortality involving poisoning by medicaments other than narcotics, including poisoning by psychotropic drugs in different age/racial groups in the US

“…[1]). In absolute terms, life expectancy in whites has been declining starting 2014 [1,3], together with the overall decline in life expectancy in the US starting 2015 [4] amid an ongoing epidemic of drug overdose deaths [5,6].…”

“…Several factors behind the relative decline in life expectancy in white Americans have been proposed, [4,7]. In particular, as suggested by a study that compared midlife mortality for the 2013-2015 period vs. the 1999-2001 period [8], increases in mortality by poisoning, suicide, and liver disease in nonelderly white Americans were notably higher compared to Hispanics and blacks.…”

Housing, housing policy, and deaths of despair

“…The United States is in the midst of a multifaceted public health crisis, marked by increasing midlife mortality rates among nearly all racial and ethnic groups . The burden of this crisis has fallen most heavily among vulnerable populations, particularly individuals with lower levels of income and education . Patterns of rising mortality—which vary across time, space, and causes of death—suggest a complex set of underlying causes, many of which may have been operative for decades …”

“…Stratified analyses—by age, gender, and race/ethnic group—may provide interesting insights into the differential dynamics of rising drug overdose mortality across demographic groups. Such an analysis may also shed light on drivers of emerging population health among women and nonwhites, populations who are also experiencing rising mortality rates but for whom the evidence base on underlying drivers of these trends remains relatively underdeveloped …”