White women in the United States are dying too soon.
That is the simplest way of stating a problem that has become apparent over the past year through statistical analysis. Studies of death rates around the country carried out by the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics show that life expectancy for every demographic group has either gone up or remained stable — except for that of white women, for whom life expectancy has gone down.
The decrease is not very large: The mortality rate for white women in 2013 was 81.2 years and the rate for that same group in 2014 was 81.1 years, a decrease of one-tenth of a percentage point. Health care researchers, like Jarron Saint Onge at the University of Kansas, however, are concerned.
“As things get better, in a sense, as our life gets easier, our jobs become less dangerous, we would expect that life expectancy continues to go up,” said Saint Onge. “When you see life expectancy all of a sudden flatline or not increasing, especially as we see a decline in our smoking rate, it is cause for alarm.”
The other problem is that if the trend continues, it could produce an even wider gap between white women and other demographic groups. For example, life expectancy among black people, while still lower than that of whites overall by a few percentage points, is higher than it was several years ago, and it continues to rise.
Hispanics have higher life expectancies than blacks or whites, even though a large percentage of that group earn low incomes and lack health insurance. Researchers think that may be due to strong community support, close families and a much lower rate of smoking among Hispanics.
Saint Onge found that the rise in premature deaths is more pronounced among white women in rural areas, and smaller cities and towns in southern states. Mental illness, alcohol abuse and drug addiction all have increased in those areas, as well, and many specific deaths can be linked to these problems.
“We need to back up a little more and look at why we are seeing these upticks in substance abuse,” said Saint Onge. “Is it a lack of mental health services? Or is it a lack of economic opportunities or educational opportunities?”
Substance abuse problem
There also has been a slight increase in suicides in some of these areas, along with deaths from such things as heart disease and liver failure. John O’Neill, director of Addiction Services at the world-renowned Menninger Clinic in Houston, said drug and alcohol abuse could be the underlying problem.
“We know that people who struggle with substance use are going to have more medical problems, we know that there are more motor vehicle accidents, we know that there is more crime, there is more domestic violence, more sexual assaults,” he said.
While many small cities and towns may have clinics or hospitals to treat physical ailments, though, they may lack mental health or substance abuse programs.
“In a smaller community, that may be a service that is not available, so it goes untreated and thus it can certainly contribute to long-term heart disease, strokes, various physical problems,” O’Neill said.
Sociologists also are examining such factors as the impact of economic downturns, the fracturing of families, and the ramifications of having physically and/or emotionally disabled military veterans return to smaller communities.
Saint Onge says there is a particular focus now on a segment within the category of white women linked to economic distress.
“Even within that category of white women, what you are really seeing is that it is really divided between the haves and have-nots, and that most of those deaths are concentrated among those women who have lower levels of education and higher levels of poverty,” he said.
O’Neill observed that people who are overwhelmed by grief, stress and loss of purpose often lose hope, fall into depression and seek relief from drugs or alcohol.
“When we have a number of psycho-social stressors, whether it is family members who are fighting for our country or loss of a job, loss of a relationship, financial problems, there is an abundance of evidence that says those are stressors that lead people to look for new ways to manage their emotions, new ways to cope,” he said.
Alcoholic beverages are readily available in many communities and addiction specialists say many doctors routinely prescribe addictive pain killers without adequately exploring the risks. Authorities have arrested many doctors and health care providers for running so-called “pill mills” through which addicted patients can buy opioids even if their original prescription has expired.
Heroin, which once was a problem mainly confined to big cities, is now available all over the country, according to law enforcement officials, and generally cheaper and more readily obtained than the prescription pain killers that may have been the initial cause of an addiction.
Addressing the problem
President Barack Obama unveiled an initiative in March that would provide more than $90 million to community health centers for substance abuse treatment.
News media attention to the growing problem of pain-killing opioid addiction also has helped warn people of the risks involved in taking such medications, and it has led to discussion in the medical community about possible alternatives for pain treatment.
In addition, O’Neill sees another societal problem that could affect women in small towns: the shame factor.
While U.S. society is slowly moving toward greater understanding of mental health disorders like depression, and acceptance of the idea that alcoholism and drug addiction are diseases, not moral failings, O’Neill said people in small communities still may find it hard to open up to anyone about their problems.
He said, “Making it OK to talk about substance use, making it OK to talk about depression, anxiety, all those mental health problems, that to me would be, fundamentally, the most important aspect of changing anything in small communities, rural communities.”
O’Neill emphasizes that various types of treatment have shown success, but having family and community support often is the key to helping people escape addiction. He suggests that at least some of the money currently being spent to fight drug trafficking might be put to better use helping people quit the habits that often end up killing them.
