Those of us who grew up in small rural communities in the 1950s and 60s expected to have longer life spans than our parents.
The trends were in our favor. White women born in 1900 could expect to live, on average, just shy of 49 years; white men 46.6 years. Those were our grandparents and our neighbors.
By 1950, life expectancy had climbed to 72 years for white women born that year and 66.5 for white men. By 2000, life expectancy was still increasing, with female babies expected to live to nearly 80 and males to almost 75. America was on the rise, jobs were plentiful, antibiotics kept us from dying of strep throat and the polio vaccine kept us out of the iron lung. We thought things would only keep getting better.
So I was dismayed to read a story in the Washington Post in April that blew holes in those childhood expectations. The Post found “white women have been dying prematurely at higher rates since the turn of this century, passing away in their 30s, 40s, and 50s in a slow-motion crisis driven by decaying health in small town-America.”
That “small town-America” was where I grew up. I contrasted the Post’s findings to the claims made by all those politicians who have told us we have the best healthcare in the world and who point to gobs of money lavished on the National Institutes of Health to find new cures and to hospitals promoting their latest imaging machines. The Post found that since 2000, the health of all white women has declined, but the trend is most pronounced in rural areas. In 2000, for every 100,000 women in their late 40s living in rural areas, 228 died. Today it’s 296.
If the U.S. really has the best healthcare, why are women dying in their prime, reversing the gains we’ve made since I was a kid? After all, mortality rates are a key measure of the health of a nation’s population.
Post reporters found, however, that those dismal stats probably have less to do with healthcare — which we like to define today as the latest and greatest technology and insurance coverage albeit with high deductibles — and more to do with what health experts call “the social determinants of health,” such basics as food, housing, employment, air quality and education.
Landmark studies examining the health of British civil servants who all had access to health insurance under Britain’s National Health Service have found over the years that those at the lowest job levels had worse health outcomes. Some of those outcomes were related to things like work climate and social influences outside work, like stress and job uncertainty.
In its analysis, the Post found that the benefits of health interventions that increase longevity, things like taking drugs to lower cholesterol and the risk of heart disease, are being overwhelmed by increased opioid use, heavy drinking, smoking and obesity. Some researchers have speculated that such destructive health behaviors may stem from people’s struggles to find jobs in small communities and the “dashed expectations” hypothesis. White people today are more pessimistic about their opportunities to advance in life than their parents and grandparents were. They are also more pessimistic than their black and Hispanic contemporaries.
A 42-year-old Bakersfield, California, woman who was addicted to painkillers for a decade explained it this way: “This can be a very stifling place. It’s culturally barren,” she said. There is no place where children can go and see what it’s like to be somewhere else, to be someone else. At first, the drugs are an escape from your problems, from this place, and then you’re trapped,” she told Post reporters.
I recently heard the U.S. Surgeon General Dr. Vivek Murthy talk about his upcoming report on substance use. About 2.2 million people need help, he said, but only about one million are actually getting it. Murthy wants his report to have consequences as far reaching as the 1964 surgeon general’s report linking tobacco use to lung cancer. In 1964, Murthy noted, 42 percent of Americans smoked; today fewer than 17 percent do.
The Post story concludes that the lethal habits responsible for the increasing mortality rates is cresting in small cities where the biggest manufacturer has moved overseas or in families broken by divorce or substance abuse or in the mind and body of someone doing poorly and just barely hanging on.
The Surgeon General has taken on an enormous task, but his efforts just might help the nation move its life expectancy trends back in the right direction.
Trudy Lieberman, a journalist for more than 40 years, is a contributing editor to the Columbia Journalism Review, where she blogs about health care and retirement at cjr.org. She can be reached at email@example.com. This column was distributed by The Rural Health News Service.