America's Declining Well-Being, Health, and Life Expectancy: Not Just a White Problem

Abstract

Although recent declines in life expectancy among non-Hispanic Whites, coined "deaths of despair," grabbed the headlines of most major media outlets, this is neither a recent problem nor is it confined to Whites. The decline in America's health has been described in the public health literature for decades and has long been hypothesized to be attributable to an array of worsening psychosocial problems that are not specific to Whites. To test some of the dominant hypotheses, we show how various measures of despair have been increasing in the United States since 1980 and how these trends relate to changes in health and longevity. We show that mortality increases among Whites caused by the opioid epidemic come on the heels of the crack and HIV syndemic among Blacks. Both occurred on top of already higher mortality rates among all Americans relative to people in other nations, and both occurred among declines in measures of well-being. We believe that the attention given to Whites is distracting researchers and policymakers from much more serious, longer-term structural problems that affect all Americans.

FIGURE 1—

All-Cause and Cause-Specific Percentage Changes in Mortality Rates Attributable to Drugs, Suicides, or Alcohol Among White 45- to 54-Year-Old (a) Women and (b) Men: United States, 1980–2013 Note. Drug and all-cause series: double line (=) indicates a negative correlation over time; solid line (–) within-man opioid deaths indicates a positive or null correlation over time. Source. Data provided by Ryan Masters.

FIGURE 2—

Black and White Mortality Rates per 100 000 Standard Population: United States, 1970–2015 Note. Mortality disparities by race largely converged until the mid-1980s with the onset of HIV/AIDS. They then widened and narrowed again with the introduction of protease inhibitors. Source. National Center for Health Statistics death rates and life expectancy at birth. Available at: https://data.cdc.gov/NCHS/NCHS-Death-rates-and-life-expectancy-at-birth/w9j2-ggv5. Analyses by author.

FIGURE 3—

Long-Term Trends in Selected Measures of Well-Being in the United States and Australia: 1983–2012. Note. Australia is a world leader in life expectancy gains. All figures are presented as cumulative percentage change in the outcome of interest so that they can be more easily compared and are limited to Whites. The overall trends in the United States for these measures are declining. However, the 2 available comparison trends—happiness and trust in others—are increasing in Australia over time. Source. Analyses by Boshen Jiao using data from the General Social Survey—National Death Index and the National Center for Health Statistics.