Rural California

Obesity, Opioids, and Smoking in Rural White America

The trend is unmistakable now. Life expectancy in the U.S. is stalling. A new analysis in Population and Development Review brings a fresh perspective to this troubling trend. The foundations lie in rural white America and the fuels for these trends are obesity, opioids, and smoking.

Poor Prospects for Rural, Non-Hispanic Whites

Irma Elo and colleagues dug deeply into the mortality trends that Anne Case and Angus Deaton famously ascribed to “deaths of despair.” From Case and Deaton in 2017, we had a compelling story of suicides, alcohol, and drugs. It’s great stuff for headlines – especially if you link it up to our president’s inaugural tale of American carnage. It also aligns with a dystopian vision of forgotten rural communities, bereft of hope.

But the reality that Elo et al found didn’t precisely fit with that dark and dramatic picture. They found a more objective story anchored in rural communities for non-Hispanic whites:

In contrast to non-Hispanic whites, mortality has continued to decline among Hispanics and non-Hispanic blacks, although death rates remain substantially higher for blacks than for whites. The underlying mechanisms driving mortality trends for non-Hispanic whites are fundamentally different from those driving trends for other racial/ethnic groups.

Not only did they find diverging trends for non-Hispanic whites, they also found a divergence when they compared metropolitan and rural populations. Metropolitan areas saw a rise in life expectancy between 2009 and 2016. Rural areas saw a decline.

Obesity, Opioids, and Smoking

Drug overdoses did indeed explain part of this divergence. But not all of it. Obesity and smoking complete the story. As we’ve reported before, obesity is becoming a greater problem for rural communities all over the world. These U.S. mortality trends make it real.

And then too, for rural women, smoking is a cause for declining life expectancy. Smoking-related deaths for rural white women are up, while they are down for women in large metro areas.

Obesity, opioids, and smoking don’t have quite the dramatic punch that “deaths of despair” has. But these three factors seem to offer a more objective picture of what’s responsible for stalled life expectancy in America.

Click here for the paper by Elo et al, here for more from CDC, and here for more on obesity and declining life expectancy.

Rural California, photograph © Bob White / flickr

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July 23, 2019