Suicide, alcohol, and opioids are three players in this health crisis.
For decades, life expectancy in the United States went up, up, and up. Improved medical treatments and better understanding of health and disease has allowed most generations to live a little longer than their parents before them.
However, a recent crisis—dubbed the “deaths of despair” by those who study it—has caused the U.S. life expectancy to dwindle down. These early deaths get their name because they’re linked to economic adversity, resulting in psychological stress and health problems.
The “deaths of despair” are linked to three main health issues:
Alcohol-related cirrhosis (liver disease)
And opioid-related overdose.
This trend of “despair” isn’t new: It has actually been increasing since the 1980s, according to a 2018 article from the American Journal of Public Health. The country is unaffected by famine or war on its own soil, so this crisis is troubling and unexpected—but that doesn’t mean experts don’t have an explanation.
Who Is Affected?
The stereotypical notion of the “deaths of despair” is that they only affect rural, low-income, white Americans. The most affected regions are certainly rural and low-income (such as people in the Appalachian region), but it’s not just white Americans who are struggling with these issues.
In particular, Hispanic Americans, Native Americans, and African Americans in rural areas are also experiencing deaths caused by economic despair. For example, Native Americans have long endured high rates of death by suicide and alcohol-related liver disease, according to the U.S. Department of Health and Human Services. That said, statistically, the deaths of despair are primarily hitting rural, white Americans the hardest.
Behind the Stats
Although unemployment rates are low in the U.S., rural America is facing unique economic setbacks. Many rural hubs have traditionally relied on industries that are no longer booming, or even obsolete, such as coal and steel. When these industries struggle, the entire community can suffer.
Additionally, rural communities tend to have less access to welfare programs, including Medicare (the federal health insurance program). They may also have to drive long distances to see doctors, particularly specialists. This is particularly troubling since chronic diseases are starting younger and younger in these populations. (Here are diseases that are on the rise in young adults.)
Finally, despite being in agricultural communities, rural areas ironically tend to lack access to nutritious foods. Instead of growing fresh fruits and vegetables for human consumption, many farms are growing corn and soy for animal feed.
These chronic stressors create a stressful environment, and some people may feel helpless and hopeless. As a result, more and more Americans are turning to harmful coping mechanisms, such as drugs and alcohol.
Of course, improving treatments for various physical and mental ailments may help, but to truly address the “deaths of despair,” it may require taking a deeper look at society and alleviating the despair that’s fueling the problem.
Case A, Deaton A. Mortality and morbidity in the 21st century. Brookings Pap on Econ Act. 2017 Spring;2017:397-476.
Creating a culture of health in Appalachia: disparities and bright spots. Appalachian Regional Commission. (Accessed on July 8, 2019 at https://www.arc.gov/assets/research_reports/Health_Disparities_in_Appalachia_Mortality_Domain.pdf.)
Disparities. Indian Health Services. (Accessed on July 8, 2019 at https://www.ihs.gov/newsroom/factsheets/disparities/.)
Gaydosh L, Hummer RA, Hargrove TW, Halpern CT, Hussey JM, Whitsel EA, Dole N, et al. The deaths of despair among US adults entering midlife. AJPH. 2019 May.
Muennig PA, Reynolds M, Fink DS, Zafari Z, Geronimus AT. America’s declining well-being, health, and life expectancy: not just a white problem. Am J Public Health. 2018 Dec;108(12):1626-31.
Symptoms & causes of cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases. (Accessed on July 8, 2019 at https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis/symptoms-causes.)