In the last few decades, rates of premature death have been decreasing throughout the industrialized world largely because of improvements in public health. But there’s a striking exception.
Young adult and middle-aged non-Hispanic whites in the rural United States have been dying in increasing numbers since 2000.
The trend drew headlines in 2015 when Princeton economists Anne Case and Angus Deaton released an eye-opening report finding that increases in suicides and drug overdoses had driven up midlife mortality among middle-aged white non-Hispanics.
Now a new report, “Why Are Death Rates Rising Among Whites In Missouri?” takes a look at the trend as it has played out in Missouri.
The report, prepared by researchers at Virginia Commonwealth University and the University of Pittsburgh and released by the Missouri Foundation for Health, observes that since 2000, 79 of Missouri’s 114 counties have seen increases in white mortality rates for people ages 25 to 59.
For the period from 2010 to 2014, rates of premature deaths among white Missourians related to drugs, alcohol and suicide rose to more than 66 per 100,000 people. That compares with 34 per 100,000 in the mid- and late 1990s.
Steven Woolf, director of Virginia Commonwealth University Center on Society and Health, spoke about the report’s findings with KCUR’s Alex Smith.
Where are the biggest increases in premature death happening in Missouri?
The increases were most dramatic in areas like the Ozarks, the Bootheel region and other rural areas where the relative increase in death rates in this age group was quite striking. Whereas the St. Louis and Kansas City regions and much of the I-70 corridor between those two cities seemed to be spared.
This raised the question that we then turned to, which is: What is it about those rural areas of the state that might be responsible for this?
What do these rural areas have in common that you don’t see as much in urban or suburban areas?
What stands out won’t be any surprise to your listeners, which is that the Ozarks and other areas like this have been struggling with economic challenges for generations. High poverty rates, stagnant wages, unemployment, challenges with young people getting an adequate education are known characteristics of these places. And there’s a whole history about how conditions in that area led to this. And in fact, when you look historically over a period of years – we went back to the 1960s – and look at these counties that have experienced the biggest increase in death rates among whites, we see that since those early statistics in the ’60s, these counties have consistently had populations with lower incomes, higher poverty rates, higher unemployment rates than the counties that have been less severely impacted.
One of the things that the report highlights is how the recession and the recovery really affected these areas differently. Can you explain that?
Whenever we look at these time trends over this many years, you see the impact of the 2007 recession. Everybody was thrown back by that, but the recovery for it differed for the counties that have been more severely impacted. The counties where mortality actually has decreased and have had the healthiest trends bounced back right away after the recession. The counties that were more modestly impacted by this rise in death rates were somewhere in the middling area, and then the folks who had this very dramatic increase in death rates have really not fully recovered at all from that setback in the recession.
So the death rate among these white Missourians is going up and it’s going down in other groups. How do the rates compare?
One point that I think it’s important to emphasize is that all this talk is about white people. And when this conversation is had in populations of color, it actually is a pretty delicate topic. So I think it’s important to emphasize that, even with this rise in mortality rates, the death rates among these middle-aged whites are still much lower that the death rates of African Americans of the same age. And the policy solutions that we’re talking about that would be helpful in places like the Ozarks or the Bootheel region require parallel policy strategies that can help disadvantaged populations and communities in inner cities, be they in Kansas City, St. Louis or other cities around the country.
What can be done to help improve the situation?
The first thing is for people to realize that this is a bigger problem than opioids. Our understandable alarm about the opioid epidemic has focused a lot of attention among the media and among policymakers on specific solutions for that problem, such as cracking down on the drug industry that manufactures these opioid products, dealing with illicit drug traffic and the criminal activity that’s bringing in heroin and fentanyl and other kinds of opioids, and providing addiction services for drug addicts. All that’s really necessary and essential, but what we’re hoping people realize from research like ours is that we’re really talking about a bigger problem here.
When you think about alcoholism and the suicide data that I’ve described, it’s clear that just changing the supply of opioids that pour into communities or changing doctors’ prescribing habits is not really going to fully address this problem when we understand that it involves other behaviors and other behaviors of despair, if you will. And so we really need to step back and look at the root causes of what’s driving people to these unhealthy behaviors or else we’re going to continue to be barking up the same tree.
Alex Smith is a health reporter for KCUR. You can reach him on Twitter @AlexSmithKCUR