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Uninsured and armed to the teeth -- the soaring mortality rate of middle-aged Americans

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Photo: Barbara Krawcowicz/flickr

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As Donald Trump arouses humour, fear, and world skepticism, new reports reveal a new wild card in the political mix. People are dying to get out of middle America. Social supports have been so weak and wages have been so low that mortality rates for midlife rural Americans are increasing, after more than a century of decreasing. Let me say that again: while life expectancy is rising in the developed world and much of the developing world, heartland Americans are dying in their prime years, especially middle-aged white women.

According to the Washington Post:

"The statistics show decaying health for all white women since 2000," says the article by Joel Achenbach and Dan Keating. "The trend was most dramatic for women in the more rural areas. There, for every 100,000 women in their late 40s, 228 died at the turn of this century. Today, 296 are dying. And in rural areas, the uptick in mortality was noticeable even earlier, as far back as 1990. Since then, death rates for rural white women in midlife have risen by nearly 50 per cent..."

A December 2015 report in the National Academy of Sciences in the United States of America compared this contrary trend to the AIDS crisis. Summarized the National Academy of Sciences:

"If [the white mortality rate for ages 45-54] had continued to decline at its previous (1979-1998) rate, half a million deaths would have been avoided in the period 1999-2013, [a number] comparable to lives lost in the U.S. AIDS epidemic through mid-2015."

Worse, health surveys found that fewer U.S. rural folks reported excellent health than previous generations had done. Chronic illnesses were on the rise. As with the military, for every one of those half million avoidable deaths, many live on with their disease or addiction, in pain and limitations.

You may wonder how this could be happening in America. American experts blame bad habits. The NAS report and the extended Washington Post follow-up cited many prevalent health issues, such as obesity, heavy drinking, smoking and opioid addiction.

Certainly some kind of self-destructive behaviour is going on. In 2011, "Poisoning, Drug Poisoning and Drug Poisoning Involving Opiods" overtook lung cancer as the leading cause of death among Americans 45 -54, says the NAS report, with suicide a close third. Then come chronic liver diseases, and way at the bottom, diabetes.

Just as Canada has a fentanyl crisis, the U.S. has a catastrophic opioid crisis -- which many believe was created by doctors dispensing Oxycondin for pain as liberally as they once prescribed Valium for depression. When they stopped, their patients had to find other, riskier, resources. Opioids are cheaper and more available than, say, knee replacement, for folks who live paycheque to paycheque and can't afford health insurance.

Post reporters investigated geographic areas that showed very high-mortality rates. "In Victoria County, Tex.," says the Post article, "a rural area near the Gulf Coast, deaths among women 45 to 54 have climbed by 169 percent [between 1999 and 2013], the sharpest increase in that age group of any U.S. county. The death rate climbed from 216 per 100,000 people to 583.. "

Likewise, "A 2013 study at the University of Wisconsin looked at the geography of death and discovered that mortality for women of all races had risen in 43 per cent of U.S. counties between 1992 and 2006. Men's mortality had risen in only 3 per cent of counties...."

Investigators found that about one-third of Victoria County's population is obese, and one-fifth smoke cigarettes. The article quotes the health department medical director saying that she personally knows many, many white women with cancer. "It's kind of weird," she said.

The Post cited stress caused by women's changing roles as causing obesity, smoking, and of course, heavy alcohol use. The NAS study cites these typical rural women's health issues and allows that the 2008 financial crash might have played a role.

Apart from those mentions, I keep searching the reports in vain for some mention of social, economic and environmental factors. For example, Victoria County, Texas, is a major coastal crossroads that lies on a bay off the Gulf of Mexico, adjacent to a Texas county that received compensation for the BP Horizon underwater oil gusher. A cancer cluster might signal environmental contamination.

Let's suggest a few other reasons that might expose poor women to potentially lethal risk of  poor health:

  • Before the Affordable Care Act, the U.S. was the only world power without universal health care coverage. In fact, if NAS repeats this study in five years, some findings may be different.
  • Contrariwise, the US is the only country with nearly universal access to guns, and one report found that "Someone with access to firearms is three times more likely to commit suicide and nearly twice as likely to be the victim of a homicide as someone who does not have access."
  • The Republican War on Women particularly attacked women's ability to control pregnancy. Multiple pregnancies plus poverty plus insufficient health care equal poor prognoses for mother as well as child. The Post notes that the women who are dying are "of reproductive age," (45 - 54), which is mostly true, although pregnancy and childbirth are riskier for women in their 40s.
  • Blue governments also instituted "workfare" programs that require welfare recipients (a majority of whom are white) to hold jobs or to perform community service -- and that contain lifetime limits on single parents' eligibility for benefits. Trapped in workfare jobs, single mothers had barely time to spend with their children, much less improve their education or prospects. They're the ones who were hurt first by these welfare "reforms."
  • Between the Internet and international trade agreements, whole industries are disappearing from local job markets. People may re-train two or three times as their jobs are outsourced, and still never find a stable career. 

In a sense, America’s insistence that health care is a private matter and not a public responsibility has finally delivered some clear policy results. I believe there’s consensus that when a population’s death rate rises, something is wrong. Here are my conclusions:

1) For-profit medical care fails massively. In other countries, people who get sick, seek out medical help. They present themselves to the doctor, the nurse practitioner, the walk-in clinic, the ER, or the urgent care clinic and they ask for help. There’s no shame and no expense.  When people have to worry about whether they can pay the doctor – especially for intractable chronic conditions like strained backs – they tend to avoid the effort and instead self medicate as they get sicker and sicker. 

2) Separation makes people vulnerable. US policy emphasizes individualism as opposed to community strength.  People are expected to follow their work or their dreams, and not to settle down next to their parents. In countries that stress community rather than individuality, mortality rates are still holding steady or dropping.

3) We urgently need research to count up how many women were pregnant or post-pregnant when they died, in the states that passed regressive anti-abortion measures. Argentina has strict anti-abortion laws, which Human Rights Watch says "are the leading cause of maternal mortality in this country," for as long as they've had statistics.  If women are dying in mid-life because of initiatives supposedly for "the sanctity of all life," voters should know it.   

4) Finally, women cannot carry the extra weight. The perennial policy of relying on women’s unpaid work to make up for scarcer and scarcer resources is totally bankrupt. Weak flesh can only take so much. America would be alarmed if middle-aged women were robbing banks or blowing up legislatures. But women dying? What else is new? With welfare payments restricted, the only safety valve seems to be disability payments, already attracting swelling numbers of people.

America’s heartland is in despair. The people there have been failed by the economy and the medical system. Desperate people will believe anything and do anything – maybe even vote for Donald Trump. They’re living in a tempest. We’re the ones who will reap the whirlwind.

Photo: Barbara Krawcowicz/flickr

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