Poverty

Poverty Is Deadly

Why is the death rate for young white Americans rising?

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When a Princeton University study released last fall found that the mortality rate for midlife non-Hispanic whites is rising, my thoughts turned immediately to McDowell County, West Virginia. My family hails from that county, which is known for having the lowest male life expectancy in the United States. (Female life expectancy is only the second lowest in the country, at 73 years; the lowest is found in nearby Perry County, Kentucky.) Men in McDowell County live an average of 63.9 years, compared to a national average of 76.3. In Fairfax County, Virginia, the average American male's lifespan is 81.7 years—nearly 18 years more than in McDowell.

During the post-World War II coal boom, the population of McDowell County swelled to nearly 100,000. (My father's family decamped from coal country to dairy farming in Virginia around that time.) The county's population, which is about 90 percent white, has since dropped to just over 20,000 today. Fewer than 6 percent of residents have college degrees, and the annual per capita income is $14,000. By comparison, some 30 percent of Americans over age 25 have bachelor's degrees or above, and per capita annual income stands at $28,000 nationally.

One more pertinent fact: McDowell County is where the first food stamps were distributed. On the occasion, the U.S. Department of Agriculture reported: "Mr. and Mrs. Alderson Muncy…were the first food stamp recipients on May 29, 1961. They bought a can of pork and beans at Henderson's Supermarket."

U.S. mortality rates have been steadily declining and average life expectancy increasing for well over a century. So the discovery that the death rate for middle-aged white Americans began rising around 1999 is alarming. The increase is accounted for entirely by those with a high school degree or less. The 2013 mortality rates for midlife whites with that level of educational attainment was 736 per 100,000; for those with some college education it was 288 per 100,000; for whites with a B.A. or higher their death rate stood at 178 per 100,000. In other words, whites who have only a high school degree or less are four times more likely to die between ages 45 and 54 than are college-educated whites. For comparison, the overall death rate for midlife black non-Hispanics is 582 per 100,000, and for Hispanics, it is 270 per 100,000. In January, Columbia University researchers reported the white midlife death rate increase was actually a bit lower than originally calculated.

Rising death rates among white Americans is not confined to midlife, according to Robert Anderson, chief of the Mortality Statistics Branch at the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics. The mortality rate for the cohort of non-Hispanic white Americans between the ages of 25 and 34 has risen from 90 per 100,000 in 2000 to 115 per 100,000 in 2014. This is a reversal of the trend for that group, which saw its mortality rate fall by 28 per 100,000 from 1980 to 2000.

The CDC has not disaggregated the mortality trends in these younger white cohorts by educational attainment yet. "I know better than to speculate in advance of the data," says Anne Case, who along with Nobel laureate Angus Deaton conducted the Princeton study. Case and her colleagues plan to conduct an analysis of the mortality data from the younger cohorts and publish their findings later this year.

As it happens, McDowell County has a mortality rate of 861 per 100,000 persons. That's higher than every jurisdiction in the U.S. except two counties in South Dakota that lie entirely within Indian reservations (which is in itself a sad and appalling situation). The lowest mortality rate in the country is found in Pitkin County, Colorado, home to Aspen, where it stands at 118 per 100,000. Nearly 57 percent of Pitkin County residents have bachelor's degrees or above, and per capita income there is just shy of $52,000 per year.

Case and Deaton report that nearly two-thirds of the increase in the white midlife death rate is the result of drug overdosing. Most of the rest is attributed to increases in suicide and in chronic liver diseases like alcoholic cirrhosis. The death rates in 2013 for midlife whites with a high school education or less, from drug poisoning, suicide, and cirrhosis, were 58, 39, and 39 per 100,000, respectively. The comparable rates for college-educated whites were 8, 16, and 7 per 100,000, respectively.

CDC data show that mortality rates are higher the farther one gets from a central metropolitan area, and that the gap between urban and rural whites has been widening since 2000. Seventy-eight percent of the 465 counties in which 20 percent or more of the working-age population (adults ages 25 to 64) lacks a high school diploma or equivalent are located in non-metro areas. Only 18 percent of working age adults in rural areas have at least a 4-year college degree, compared to 32 percent in urban areas. The unemployment rate for people with less than a high school education is three times higher than for those with a college education.

"Something profound is going on," says Case, who also found rising reports of ill health, both mental and physical. "We need to focus on what is causing people so much distress."

In 2010, Oregon State University economist Bruce Weber pointed out that "persistent poverty is largely a rural phenomenon." In fact, 95 percent of the nearly 400 counties that have experienced persistent poverty over the past half-century—those that have sustained poverty rates higher than 20 percent—are rural. In their 2006 book The Geography of American Poverty: Is There a Need for Place-Based Policies? economists Mark Partridge and Dan Rickman argue that location-based policies aimed at poor counties, such as providing tax credits for newly created jobs and income subsidies for low-wage workers, could help to revive fading rural communities.

Others counter that if the resources that once sustained a place are no longer valuable, we shouldn't try to keep people and businesses there. In their 2003 paper, "Economic Rationales For and Against Place-Based Policies," Iowa State University economists David Kraybill and Maureen Kilkenny observed, "The provision of subsidies to induce people to stay in that place delays the inevitable. At worst, such subsidies effectively retain the kinds of people who are the least able to adjust, ultimately, to market forces." They add, "It does no good to retain (or attract) people in places that are too costly for most businesses, which cannot sustain economic activity. That turns the place into a poverty trap."

The history of food stamps in McDowell County may provide one clue as to why the death rate for poor rural whites is rising. Perhaps dependence on the paltry alms doled out by the welfare state encourages recipients to stay out in the boondocks where they have few opportunities for improving their lives. Not being as cautious about speculation as Case, I'll guess that lots of poor rural whites have come to believe the modern world is leaving them behind and are seeking solace in mind-numbing substances and suicide. Bribing people to stay poor can kill them.

NEXT: Why a contested Republican convention will not produce a third-party challenge

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  1. I live in a rural area, and people know it’s farther to hospitals and ambulances, but people take that tradeoff to get away from cities. I myself like having mountains around me and fewer city slickers.

    There are a lot of river rats who have enough from social security, food stamps, etc, that they could live in a city. They don’t want to.

    There are also druggies and drunks are bored in the boonies, but they don’t want the crowds and noise of a city.

    I lived in San Francisco near an alley and homeless kitchen, and grew to despise the do-gooders who ran that kitchen. We all figured most of those bums were voluntarily so, too damned lazy to work when there was so much free support, and they were like the tweakers and river rats up here — living that way by choice.

    I despise government “charity” — it prevents any discretion on the part of the charity givers, any strings tied to it like cleanliness or work. People make choices based on incentives, and while I don’t mind the bums and river rats who just can’t stand work or crowds, I want them to make their decision without the benefit of free support for their voluntary decision to not work.

    I suppose this ramble is only tangentially related to mortality rates in poor counties, where people have in effect been painted into the poverty corner and don’t want to uproot and leave family, friends, and location.

  2. AA members have backed off their claim that “AA has saved the lives of millions”. In fact, this kind of abstinence treatment has killed millions, and further restrictions on opiates will kill more. Poorly educated people are more susceptible to the doctrine of the 12 Step religion / suicide cult, thus the higher death rate.

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  3. “U.S. mortality rates have been steadily declining…”

    Pretty sure the mortality rate hasn’t changed, ever. It’s still 100%.

    1. Someone will chime in that correlation ain’t causality, watch…

  4. The US at the federal level long ago moved away from geographic infrastructure towards population-based infrastructure. Geographic infrastructure is a neutral policy when it comes to mobility. It doesn’t matter where you move – you won’t have to create infrastructure from scratch. Population-based infrastructure focuses infrastructure on where people currently live – and thus serves to lock people into their current location. And every infrastructure budget cut or maintenance delay or ‘efficiency consolidation’ ends up eliminating the geogrphic breadth with the effect of pulling people towards cities.

    This ‘political class’ bullshit that ‘food stamps’ are either the problem or the solution is arrogant crap. Govt helped create the geographic dispersion of the population during the 19th century at a very low cost. It spent the 20th century trying to concentrate the population and keep them concentrated at a very high cost.

    1. “This ‘political class’ bullshit that ‘food stamps’ are either the problem or the solution is arrogant crap. Govt helped create the geographic dispersion of the population during the 19th century at a very low cost. It spent the 20th century trying to concentrate the population and keep them concentrated at a very high cost.”

      Maybe the gummint ought to get out of the social-engineering business altogether; its ‘success’ rate is such that if it were a private operation, it’d be bankrupt.

      1. In theory that’s nice. In practice, doing nothing is doing something too.

        1. No it isn’t. Not forcing people =/= forcing people

          1. OK. Then you explain how the early US govt policy to distribute land patents/title (also the source of prob 70% of govt revenue before the Civil War) can be resolved. You can either a)distribute it in huge swathes in exchange for a big chunk of gold/capital/debt (favored by slaveowners/banks/speculators) or b)distribute it small pieces in exchange for less gold but more labor to acquire title (favored by ‘yeoman farmer’ ideal – and ultimately Free Soil and GOP). Those two are incompatible and can’t be mixed (as history proved). Each provides dramatically different tax bases, views about inflation/debasement of money, trade/tariffs, competition in the market, views about property/liberty, opportunities/incentives for cronyism/corruption, and pretty much every other economic policy going forward. It DEFINES how the market actually works. Changing from one to the other was the cause of the Civil War – but staying with the former would have also led to the same bloodshed. And the only other alternative is to not distribute and keep the land federal – which creates an entirely different dynamic.

            Theories are so nice – and so useless.

            1. There is nothing to resolve, and none of this makes much difference in the long run. In a free society and free market, property gets redistributed through normal market forces within a few generations.

              1. It made a difference from day one and the difference can persist to this day. In areas with small-acreage distribution, one of the first public service buildings in the nearby towns was a small private college – usually started by one church denomination but open to everyone. The farms were too small to split among all the kids – so the college was there to provide some future for the 2nd/3rd/4th kid. Many hundreds of those still exist – many still private, some taken over by the state/county. If future infrastructure (electrification, non-mortgage credit/money, interstate access) ever made it there, those economies were able to diversify into manufacturing/etc. If it didn’t (as it increasingly hasn’t), then at least the kids could get a degree before they leave to go elsewhere. Today, those areas are now in a brain drain. The college grads have to leave. The non-grads can’t afford to leave but there’s nothing there for them either.

    2. What claptrap. Spending money on where people are is the only remotely sane way to go about it. That’s where they are, so that’s where the infrastructure should be. The centralization of population is not some government conspiracy it’s a result of economic forces that are far more powerful.

      1. So you are basically saying that the non-urban parts of the US should be a giant nature preserve for urban dwellers to visit – but not live.

        By the way – that decision is also why the federal government still owns 33% of the West and will never distribute it. Which mostly rewards incumbent politicians since there is less population mobility resulting in less redistricting. And once ‘gummint infrastructure’ is something that goes to voters – it becomes an engine for the growth of things that government can do to expand itself. Which means the Constitution needs to ‘come alive’ in order to enable all the new infrastructure that voters can be convinced that they need.

        1. Grover Cleveland is probably the last President who really understood where this notion you advocate would lead

          I can find no warrant for such an appropriation in the Constitution; and I do not believe that the power and duty of the General Government ought to be extended to the relief of individual suffering which is in no manner properly related to the public service or benefit. A prevalent tendency to disregard the limited mission of this power and duty should, I think, be steadfastly resisted, to the end that the lesson should be constantly enforced that, though the people support the Government, the Government should not support the people.

          Even though his example related to a relief bill for a drought, the same can be argued for interstate highway appropriations that are geared mostly to, say, suburban commuters. That is not infrastructure and it is not general welfare. It is individual/regional welfare which ultimately creates special interests and rewards cronyism.

          1. I’m stealin’ that quote.

      2. And the way to spend money where the people are is to have people spend it themselves, instead of redistributing it via the federal government

        1. Exactly. Geographic-based infrastructure is cheap precisely because:

          1. It can be expensive if the goal (eg every inhabitable place in America will be within pick-your-number miles of interstate system – and that is the ENTIRETY of the federal ‘post roads and highways’ commitment) is too extensive. And the benefits are too truly ‘general’ to be ‘porky’. So people are willing to identify what is basic infrastructure and what is personal benefit. And areas that need denser infrastructure – that basic level is what state/local/private can build on.

          2. And once areas are part of the basic American economy, they can and will find ways to take care of themselves. So there is less of a poverty trap and less demand for individual welfare and MUCH less demand for such welfare as is needed to become a federal responsibility.

          1. As an aside, had the federal-level persisted with geographic-based infrastructure, there would have been no individual income tax needed. The federal govt would have instead gone with some level of a Georgist land value tax – imposed on the states themselves based on their territory and the federal infrastructure funded on it. Lower than his ‘Single Tax’ (since that was intended for all levels of govt revenue) – but that tax on states also means states would have kept their control of Senate appointments.

  5. Mortality rates for whites are rising to meet minority mortality rates? Progress.

    /BLM crowd

  6. I’d look up electric power use per capita. That figure tracked life expectancy at birth for most geographic areas in the 1980s

  7. chronic liver diseases like alcoholic cirrhosis.

    If only we could switch them to pot.

  8. All this analysis over mortality rates in populations is pointless. Populations don’t get sick, individuals do.

    1. understanding demographic trends provides insight into possible causes of illness. once you find a cause you can investigate cures/treatment/prevention. making the sick well isnt pointless.

  9. But Bernie said white people don’t know what it’s like to be poor. These white people are obviously just lazy, racist, drug addicted miscreants who shun education and have no respect for authority. And they all vote for one party year after year, against their best interests. Always amazes me how the left’s opinions on rural white culture are nearly identical to the “racists'” opinions on urban black culture.

    1. Agreed. Sanders is way off on another measure: many economists remind us that by simply residing in the USA, one is already in the top 1% globally. True poverty is found outside of the USA and not in the black inner city neighborhoods. Obviously, if obesity is a public health problem here while starvation is a bigger problem elsewhere, we Americans already have it good. “First World Problems,” so to speak.

      1. Poverty is the most deadly when it is relative poverty. And do not assume that just because someone has a tv or cell phone that they can afford decent quality food or a place to live. Obesity is not a sign of affluence.

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  11. Every newspaper and TV station in my area(Philly suburbs) says that the young, white mortality rate is rising due to heroin overdoses in people who just had to switch to heroin after they ran out pain pills. Total BS.

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  16. Author writes, “Bribing people to stay poor can kill them.” So paltry food stamps actually bribe people to stay poor? What an utter load.

    Neoliberalism, also known as Economic Darwinism, or “Free markets,” is destined to kill people off. That it is what it is best at, the culling of the herd. You libertarians should be happy. This is what you wanted, after all.

    In the past few decades, the poorer whites of this nation are competing against a huge influx of illegal immigrants, out-sourcing, and trade agreements like NAFTA that result in manufacturing jobs leaving the U.S. Libertarians want a global free market. Now you have it. You want Jim-Bob in West Virginia pitted against Jorge in Mexico.

    So rejoice and be glad. People are dying so that the top 1% can get richer. Just be honest and do not act like you care, because you don’t.

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