Why Are We So Intent on Killing Ourselves?

As time goes on you might assume that as medical knowledge and treatments progress over time, generally, we would live longer, healthier lives. That’s a false assumption for too many Americans according to two stories in the media based on two different medical studies. For large chunks of White America, especially women, life expectancies are declining.

The main divides that seem to make a difference are between men and women, whether they live in rural or urban areas and how much money they have. The Washington Post reports White women have been dying far earlier than expected since the turn of this century, dying in their 30’s, 40’s and 50’s in a slow-motion crisis caused by declining health in rural America. Among African Americans, Hispanics and even the oldest White Americans, death rates continue to fall but for White women death rates have spiked upward. For rural White women in their late 40’s the death rate has risen by 30%.

  • The health of all White women has generally declined since 2000 most dramatically for women in more rural areas.
  • In rural America for every 100,000 women in their late 40’s, 228 died at the turn of this century while now 296 are dying.
  • Since 1990 death rates for White women in midlife have risen by nearly 50%.
  • In the areas with the highest death rates, 21 counties across the South and Midwest, the death rate has doubled, or worse, since the turn of the century for White women in midlife.

Health care and more available treatments and medications are being overwhelmed by destructive (and in many cases cancer causing) behaviors such as opioid abuse, heavy drinking, smoking and obesity. Their White male counterparts are also dying in midlife at unexpectedly high rates but the worst increases in mortality have occurred among White women, who are far more likely than their grandmothers to be smokers, suffer from obesity or drink themselves to death.

The Post cites Victoria County, Texas, a rural area near the Gulf Coast, as one of the most impacted areas in the country.

  • Since the turn of the century deaths among women 45 to 54 went up 169%, the highest increase in that age group of any U.S. county.
  • The death rate climbed from 216 per 100,000 people to 583.
  • About a third of adults are obese (about the same as the national average) and about 20% of the population smokes (compared to 16.8% of the nation as a whole, but that number varies widely depending on racial and ethnic groups).

Lisa Campbell, medical director for the Victoria County health department, told the Post she has been struck by how many White women she knows have some kind of cancer. “It’s kind of weird, actually,” she said. Actually, it’s not weird at all if there are high levels of smoking and obesity. Maybe the county might make some progress with a new medical director.

The Post’s story is based on an article published in September 2015 in the Proceedings of the National Academy of Sciences.

NPR has a story that states that wealth generally has a major impact on life expectancy but that can vary widely depending on location. It also states much of the health damage is self-inflicted. Poor people living in some areas are living much longer than poor people in other areas, almost as long as their richer neighbors, according to a study published in the Journal of the American Medical Association. The study’s results are that poor people in affluent cities such as San Francisco and New York tend to live longer than people of similar income levels in rust belt cities such as Detroit.

Some of the “key messages” of the article are,

  • Life expectancy increases with income. By the age of 40, the difference in life expectancy between Americans in the top and bottom 1% of the income distribution in the U.S. is fifteen years for men and ten years for women. American men in the bottom 1% of income earners have a life expectancy comparable to the average life expectancy of someone living in Pakistan or Sudan.
  • For lower income Americans life expectancy by the age of 40 differs by about 4.5 years between areas with the highest and lowest life expectancies. Adjusting for race and ethnicity, life expectancy for those of low income is the worst in Nevada, Indiana and Oklahoma and the highest in California, New York and Vermont.
  • Traditional explanations for these differences aren’t supported by the data found by researchers, including differences in access to medical care, environmental differences, adverse effects of inequality and labor market conditions. Most of the variation in life expectancy across geographic areas was related to differences in behaviors including smoking, obesity and exercise. Those with the lowest incomes have more healthful behaviors and live longer in areas where there are more immigrants, higher home prices and more college graduates.

The bad news is self-destructive behavior kills so many Americans. The good news is the cause is behavior, which we might be able to change. There are many reasons why drug use, smoking, alcohol abuse and obesity happen and there is no magic wand to make them go away but I can only hope changing behavior will be easier than finding a medical “cure for cancer” which despite decades and billions of dollars spent it just seems the closer we get the farther away a cure ends up being. Will we be able to change our habits faster than researchers can develop that mystical cure?

Disclaimer: Views expressed are those of the author or other attributed individual and do not necessarily represent the official opinion of the OncoLink Staff, University of Pennsylvania Health System (Penn Medicine), or the University of Pennsylvania, unless explicitly stated with the authority to do so.

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