White Women Are Dying Prematurely

Some of the consequences of white America’s opiate epidemic—a topic that has been widely explored by media outlets and social scientists—are still coming to light. Opioid use and addiction have exploded in predominantly white communities around the country, and 90 percent of new heroin users over the last decade are white. The vast majority of those users—75 percent—first used prescription painkillers, which are prescribed to African-Americans and Hispanics with far less frequency, thanks to racial biases in medicine. Among the overwhelmingly white majority of new heroin users, the number of women doubled. That fact has specific implications for white women, particularly those of the rural working class, that come down to life and death.

According to the Centers for Disease Control, in the single year between 2013 and 2014, the life expectancy of white American women fell approximately one month, from 81.2 to 81.1 years. That decline is better understood not merely as a fraction of a year but as a contributor to almost a decade and a half of truncating white American female lives. A 2015 Urban Institute study found death rates among white women climbed 12 percent between 1999 and 2013; that period saw white American female deaths increase from 126 to 140 out of 100,000. The rise in mortality holds true for white women across a spectrum of ages, with Urban Institute researchers noting that premature death is “especially pronounced among white women of reproductive age.” Though life expectancies for white men have also decreased slightly, no other group’s mortality rose by as great a measure as white women.

White women still have lower death rates than a number of their cohorts. The expected lifespan of white men, as the New York Times points out, fell slightly but stands at 75.6 years—a full 5.5 years less than white women—just as it did in 2013. Despite their rising mortality rates, white women, on average, still outlive both African-American men and women, whose death rates are far higher. That said, the increase in white American female premature deaths has been statistically significant enough to skew interpretations of white mortality overall. Recall the much cited 2015 study by Nobel Prize-winning economist Angus Deaton and Anne Case which indicated rising mortality for middle-aged, working-class whites. A closer look at the numbers by numerous other researchers shows that white female deaths, in particular, have dragged down the mean. And those death counts represent a sharp change in direction for a group whose life expectancies have been on the rise for decades.

The shift comes as mortality rates for blacks and Latinos are moving downward. As the Times notes, between 2013 and 2014, Hispanic life expectancies across the board rose from 81.6 to 81.8 years. During that timeframe, life expectancy for Hispanic women increased from 83.8 to 84 years. African Americans’ life expectancies overall increased by a year, going from 75.5 to 76.5 years. More specifically, for black women, Mother Jones cites a 1999 to 2013 drop in death rates from 262 per 100,000 to 201, a decline of almost 25 percent. Black men were the biggest gainers in a single year, not just among African Americans but out of all groups assessed. From 2013 to 2014, their lifespans increased by .4 years, from 71.8 to 72.2 years.

At least where health outcomes are concerned, we know what’s killing white women, and for the most part, it’s self-harming behaviors. The Washington Post points to a National Center for Health Statistics study that reveals white women’s suicide rates skyrocketed 80 percent between 1999 and 2014, up from 7 per 100,000 to 12.6. In particular, researchers noted—though they struggle to understand why—death by hanging vastly increased as the method of suicide in all populations during this period. Among white women, there was a staggering 157 percent increase in hanging and other forms of suffocation. (Some researchers believe the internet, and the easy access it provides to information about how to carry out suicide, may be a contributing factor.)

Obesity and its correlating illnesses are also a likely factor in premature deaths among white women. As a country, we rank as one of the fattest in the world. Two-thirds of Americans are overweight or obese, as are 63 percent of white women, who are at higher risk for ailments and diseases including hypertension, heart disease and stroke.

Alcohol and tobacco also play a role here, and as the Washington Post notes, white women “are [now] far more likely than their grandmothers to be smokers, suffer from obesity or drink themselves to death.” Studies find women, in general, “progress faster than men, on average, between first getting drunk regularly and first encountering drinking problems.” Women’s bodies process alcohol more slowly than men, and research suggests this difference in metabolism contributes to women’s greater susceptibility to alcohol-related illnesses such as liver disease and alcoholic hepatitis, even “after a shorter period of excessive drinking and at a lower daily alcohol intake” than their male cohorts. Case, the Princeton economist involved in the 2015 study, also notes that despite smoking rates falling among all Americans, the drop-off in women’s smoking rates happened later than men’s. We’re only witnessing the end results now.

“It takes about two to three decades to see lung cancer deaths due to smoking, because lung cancer does take a long time to develop," Lindsey Torre, of the American Cancer Society, told the Chicago Tribune. "The lung cancer deaths we are seeing today really have to do with smoking trends we saw in the 1970s, when women really started to pick up smoking."

From 1999 to 2013, per New York Magazine, “men enjoyed a decline in lung-cancer deaths of almost 9 per 100,000... while rates remained flat for women.” Harold Wimmer, the president and CEO of American Lung Association writes at the Huffington Post that lung cancer is the number-one “cancer killer of women,” taking the lives of “almost twice as many women as any other cancer.”

Any discussion of death rates among white Americans necessarily includes a look at drug overdoses. In particular, young white Americans have experienced the consequences of narcotics abuse. A New York Times investigation released early this year found that between 1999 and 2014, overdose death rates increased fivefold for whites 25 to 34, and threefold for those 35 to 44. “Whites 25 to 34 are the first generation since the Vietnam War years of the mid-1960s to experience higher death rates in early adulthood than the generation that preceded it,” the paper concluded.

Perhaps the greatest factors in white women’s mortality are, unsurprisingly, education, class and geography. As with nearly every societal ill, the highest toll is exacted in poor communities, where concurrent health-damaging issues—obesity, drug use, unemployment, isolation—are most prevalent. A 2012 study concluded that between 1990 and 2008, white women who had attained only a high school education saw their lifespans shrink by five years. Similarly, a Washington Post report found that since the turn of this century, death rates rose from 228 to 296 per 100,000 among rural white women in their late 40s. In 21 counties throughout the South and Midwest, middle-aged white women’s mortality rates have increased by 100 percent or more. “In at least 30 counties in the South, black women in midlife now have a lower mortality rate than middle-aged white women” the Post finds. “That’s up from a single such county in 1999. Among them is Newton County, Georgia, southeast of Atlanta, where the death rate for black women ages 35 to 54 dropped from 472 per 100,000 to 234. The rate for white women went the other way, from 255 to 472.”

If it is easy to deduce many of the behaviors that have led to shortening of rural, undereducated white women’s lives, researchers have suggested that mental and social factors are harder to definitively pin down. The Great Recession and a blue-collar job market that has increasingly been transported overseas are undoubtedly among the root causes of the angst and anxiety that lead to poor life choices with potentially fatal consequences. Researchers have also attributed white women’s increasing mortality to changes in gender roles, with more women laboring outside the home, juggling family and work duties. “The stressors have increased,” Janine Clayton, of the Office of Research on Women’s Health at the National Institutes of Health, told the Post. “If it’s affecting women who previously had better health, how might it even more deleteriously affect women who previously had borderline health?”

While acknowledging those factors, it seems important to reassert that minority communities still face far greater economic instability and other stressors than members of the white working class. Whites without college degrees are still the largest demographic group in the workforce, even with increasing job scarcity. The Great Recession had far more devastating consequences for African Americans than whites across the board, and black and Hispanic employment rates are still struggling to recover. White families at every economic strata live in nicer neighborhoods than black and Hispanic families earning identical incomes, and a 2014 Pew Research Center study found white working-class families are, in terms in assets and wealth, still better off than middle and upper-middle-class black and Hispanic families.

That white women must now contribute to household breadwinning also deserves comparison to the expectations black women have always been saddled with. Going back to 1920, 38.9 percent of black women were active members of the labor force, outpacing women of every other race. (In many cases, they juggled domestic duties not just in their own homes, but for their white employers as well.) Today, in our post-1960s second-wave feminist era, black women aged 16 and older still have “the highest national workforce participation rate” among women, at 59.2 percent, according to the Institute for Women’s Policy Research. More than any of their female cohorts in other racial groups, black women also remain in the labor force even after having children. Despite dealing with racism in addition to sexism in every institution, black women now attend college at higher rates than other racial groups, regardless of sex. Those achievements are hindered by a gender wage gap that is persistently worse for black women—meaning they earn less than whites across gender—even when they possess the same level of education as their white peers.  

For all the troubling issues now afflicting white working-class women, this isn’t just about the impact of struggle or suffering. As Julie A. Phillips, a Rutgers University sociologist told the Post, white working-class women’s premature deaths are tied to the fact that many had “a certain expectation...and the Great Recession and other things have really changed that.” As those ideals have faded, so too has hope. “Things aren’t panning out the way people expect,” says Phillips. “I feel for sure that has had an effect.”

Those expectations—and with their demise, the rise of white rural desperation and disaffectation—have everything to do with race and entitlement. “Whites had a privileged place in the blue-collar economy,” Johns Hopkins University sociologist Andrew Cherlin told the Post. “The idea that today’s generations will do better than their parents’ generation is part of the American Dream. It has always been true until now. It may still be true for college-educated Americans, but not for the high school-educated people we used to call the [white] working class.”

Perhaps the most salient response to the death of white working-class dreams has been white working-class anger. Infused with a heavy dose of blame and fear, it results from the mistaken belief that whiteness rightfully owns all of America: its jobs, its opportunities, its life and liberty and pursuit of happiness. It is not a surprise that the Post found a direct relationship between areas with rising white mortality and support for Donald Trump.

After writing about this at length before, I’m less interested in revisiting the white racism that undergirds white anger. It’s on prominent display at every GOP rally, in a million studies and in the rhetoric coming from those angry white folks themselves. Now that America’s white underclass finds itself coping with many of the problems that have long burdened black America, I suspect it will be far more interesting to watch how the conversation around poverty might change. When white opioid usage and addiction soared, a kinder, gentler attitude toward those addicts emerged, with some of the most hard-on-crime politicians suddenly calling for an end to the war on drugs in favor of more therapeutic, rehabilitative approaches. The same people who couldn’t throw away the key fast enough when drugs were seen as inner city and urban (the loudest of dogwhistles for "black") problems now want to talk about treatment and therapy. That’s obviously a good move, but such a sudden turn in the discussion would not have occurred were white folks not being hardest hit.

What happens now if poor whites continue to die off in ways of their own making? In the sympathetic remarks of researchers and op-ed writers, who talk about white dreams deferred, the resulting white depression and bitterness, and the ultimate and ensuing increase in white self-harm, I hear a tonal shift toward understanding and compassion that was never afforded communities of color. Where white working-class societal breakdown is made relatable and human, the inevitable and heartbreaking reaction to seeing their dreams dashed, black failure is just another symptom of blackness itself. Black despair and sadness, which has been at the core of black American existence in this country due to a very real oppression that white America does not experience, is rarely recognized as the cause of black expressions of pain. Humanity is for white people. Black people are faulty by design.

Princeton professor Martin Gilens, in his book Why Americans Hate Welfare: Race, Media and the Politics of Antipoverty Policy, notes that for much of the country’s history, popular images of the poor were of presumed hardworking whites who simply needed a “hand up.” As a result, there was widespread support for the social safety net. (“White Americans,” Gilens writes, “were profoundly uninformed and unconcerned about black poverty.”) Only in the mid-1960s, as conservatives began to attack LBJ’s War on Poverty, did the media face of poverty (though not the actual proportion of African Americans among the poor) transition from white to black. “It’s really right at that time—and it’s a very dramatic shift in the media portrayal—that the imagery shifts from poor white people, positively portrayed, to poor black people, negatively portrayed,” Gilens explained in an interview with BillMoyers.com.

Alongside this new overrepresentation of African Americans in media stories about the poor, Gilens identifies a simultaneous emergence of the notion of the deserving versus the undeserving poor. White Americans, Gilens explains, had been “viewed as deserving because their circumstances are sort of understood to be a consequence of factors beyond their control.” Contrast this with the undeserving poor, “people who are viewed as undeserving because they're seen as having contributed or even caused their own poverty,” and who therefore don’t merit sympathy, much less aid. “The undeserving poor in particular is associated with blacks in this country,” Gilens says.

On the heels of the Great Recession, and intensified focus on the struggles of the rural white working-class, I can’t help but wonder if politicians, media pundits and others will increasingly paint the impoverished more as what Gilens calls “noble victims,” and less as an undeserving class. “[W]hen times are bad, the public generally becomes more sympathetic to the poor and images in the news tend to be whiter,” Gilens has found in his studies. “During better economic times when there’s less sympathy for the poor, there are more images of African Americans.”

If outcomes for the poorest white Americans continue in their current direction—with increasing deaths among the very worst of those—it's likely that poverty will be equated less with pathology in favor of a more empathic view. There may even be greater attentiveness to issues affecting whites living in poverty, while the struggles of black Americans become (even) less of a priority. That sort of indifference to black poverty, which we already see so often, could lead to reversals of positive trends for African Americans. This country's zero-sum approach to race always results in limited resource expenditure and empathy for the most vulnerable. White supremacy depends on the social construct of an undeserving poor black boogeyman. So do successful political campaigns.

“My concern is that people will think, ‘Oh, it’s whites that need to be helped,’” Bridget Catlin, a University of Wisconsin social scientist told the Post. That’s a valid fear as we continue to watch how the numbers look moving forward. If black lives truly mattered, we’d all have to worry a little less. 


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