Sunday, April 10, 2016

Now a systemic, quantitative analysis of the early deaths and high morbidity of poorly educated white women--as a rural phenomenon

My post on Friday discussed the Washington Post's feature (by Eli Saslow) about the life and early death of Anna Marrie Jones of Tecumseh, Oklahoma.  I pondered there the extent to which these early deaths of poor and/or poorly educated whites is disproportionately a rural phenomenon.  Now the Washington Post is running a related story that seems to help answer that question--and the answer is "yes."  Here's a summary:
Among African Americans, Hispanics and even the oldest white Americans, death rates have continued to fall. But for white women in what should be the prime of their lives, death rates have spiked upward. In one of the hardest-hit groups — rural white women in their late 40s — the death rate has risen by 30 percent. 
The Post’s analysis, which builds on academic research published last year, shows a clear divide in the health of urban and rural Americans, with the gap widening most dramatically among whites. The statistics reveal two Americas diverging, neither as healthy as it should be but one much sicker than the other.
* * *  
But progress for middle-aged white Americans is lagging in many places — and has stopped entirely in smaller cities and towns and the vast open reaches of the country. The things that reduce the risk of death are now being overwhelmed by things that elevate it, including opioid abuse, heavy drinking, smoking and other self-destructive behaviors.
Maps that accompany the story show that the worst losses in life expectancy for poorly-educated white women are in rural parts of states you would expect:  Arkansas (including my home county, Newton County), Alabama, West Virginia, Kentucky, Louisiana, and Oklahoma.  But the rural parts of some other states that you might not immediately expect to show such decline are also faring badly:  Utah, (parts of) Nevada, Oregon (including Harney County) and much of nonmetropolitan Kansas.  Places like the Carolinas, Missouri and New Mexico look spotty--which is to say, pretty bad.    California is interesting in that the highest mortality rates for white women are not in the great Central Valley, which attracts so much media attention in relation to environmental and health challenges, but in the Sierra Nevada Mountain counties (Mono, Inyo, Plumas, Lassen) and counties like Modoc, Trinity, and Siskiyou in the far northern part of the state.  On the other hand, San Bernardino and Riverside Counties, part of the state's "Inland Empire," fared especially well.

Ground zero, based on the percentage of counties where the mortality rate for white women rose 40% or more during the 1990-2014 period:  Nebraska.  (This shows up on the Washington Post map as lots of red!) I find that surprising based on my perception of the state as an essentially wholesome place with middle-of-the-road social policies and safety net.  Further, neighboring Iowa and South Dakota are two of the healthiest places for low-income white women, the latter no doubt less so for American Indian women.

On the other hand, states with particularly low (or no) rise in the death rates of poorly educated, middle-aged white women included New York (including upstate), Vermont, the Dakotas, Wisconsin, Minnesota (mostly) and Iowa.  Several Nevada counties showed particularly healthy results/outcomes (in contrast to others, with particularly poor outcomes--Nevada is clearly a study in contrasts).  Surprisingly, Aroostook County in far northern Maine, a notoriously poor county frequently stereotypes as backward, also showed good outcomes on this particular metric.

The Post story goes on to link all of this mortality (and morbidity) news to 2016 Presidential politics:   
This reversal may be fueling anger among white voters: The Post last month found a correlation between places with high white death rates and support for GOP presidential candidate Donald Trump.
On the latter issue, read some of my musings here and here, and the musings of another (among many) here.

This Washington Post piece is apparently the first part of a series coming from the Post under the broad heading:  "Unnatural Causes:  Sick and Dying in Small-Town America."  I look forward to the subsequent installments, albeit with some dread for what they will reveal. 

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