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Life expectancy is declining for uneducated white women; reasons are complex

cave city
Cave City, Ark., resident Crystal Wilson died at age 38 of ‘natural causes.’

Monica Potts, a senior writer at the American Prospect, has written a powerful article about a troubling U.S. demographic trend: the dramatic decline in life expectancy over the past two decades for white women who are high-school dropouts.

A study published earlier this year found that the death rate in 2003-2006 for white women aged 45 to 84 without a high school diploma was 4.7 times larger than for college-educated women. In 1986-1994, it had been only 3.4 times larger.

Potts centers her article around the story of Crystal Wilson, who died in her bed during the early morning hours of May 24, 2012. She was 38 years old.

Wilson lived in Cave City, a small town in rural Sharp County, Arkansas. Most (96 percent) of the county’s 17,000 residents are white, and about one quarter live in poverty. (The mean household income in the county is $29,590.)

Wilson was both white and poor. She was also a high-school dropout, leaving in the 10th grade to get married. Unlike many teenage brides, however, Wilson hadn’t been pregnant at the time. Indeed, she didn’t have her first and only child, a girl, until a few years later.

‘An unheard-of drop’

Potts tells Crystal’s story movingly, using it to try to understand why poor white women who drop out of high school are dying significantly earlier than in previous generations.

“Everything about Crystal’s life was ordinary, except for her death,” writes Potts.

“She is one of a demographic — white women who don’t graduate from high school — whose life expectancy has declined dramatically over the past 18 years. These women can now expect to die five years earlier than the generation before them. It is an unheard-of drop for a wealthy country in the age of modern medicine. Throughout history, technological and scientific innovation have put death off longer and longer, but the benefits of those advances have not been shared equally, especially across the race and class divides that characterize 21st-century America. Lack of access to education, medical care, good wages, and healthy food isn’t just leaving the worst-off Americans behind. It’s killing them.”

“Most Americans, including high-school dropouts of other races, are gaining life expectancy, just at different speeds,” she adds. “Absent a war, genocide, pandemic, or massive governmental collapse, drops in life expectancy are rare.”

As Potts points out, although blacks are more likely than whites in the United States to die young due to factors like income, education and access to health care, they have begun to close that life-expectancy gap. Indeed, black women without a high-school degree now outlive their white counterparts.

No clear answers

Researchers are trying to determine exactly why white women who drop out of high school are dying earlier than a generation ago. What they’re finding is both nuanced and complex. Writes Potts:

In May, Jennifer Karas Montez of the Harvard University Center for Population and Development Studies co-authored the first paper investigating why white women without high-school diplomas might be dying. Most research has looked at which diseases are the cause of death, but Montez and her co-author wanted to tease out quality of life: economic indicators like employment and income, whether women were married and how educated their spouses were, and health behaviors like smoking and alcohol abuse. It is well known that smoking shortens life; in fact, smoking led to the early deaths of both of Crystal’s parents and her sister and brother. Crystal, though, never smoke or drank. But the researchers discovered something else that was driving women like her to early graves: Whether the women had a job mattered, and it mattered more than income or other signs of financial stability, like homeownership. In fact, smoking and employment were the only two factors of any significance.

At first, Montez and her co-author suspected that women who are already unhealthy are less able to work and so are already more likely to die. When they investigated that hypothesis, however, it didn’t hold up. Jobs themselves contributed something to health. But what? It could be, the authors suggested, that work connects women to friends and other social networks they otherwise wouldn’t have. Even more squishy sounding, Montez wrote that jobs might give women a “sense of purpose.”

Researchers also point out, writes Potts, that “health is a matter of time and place.”

In March, two researchers from the University of Wisconsin reported that women in nearly half of 3,140 counties in the United States saw their death rates rise during the same time period that Olshansky studied. The researchers colored the counties with an increase in female mortality a bright red, and the red splashed over Appalachia, down through Kentucky and Tennessee, north of the Cotton Belt, and across the Ozarks — the parts of the South where poor white people live. Location seemed to matter more than other indicators, like drug use, which has been waning. The Wisconsin researchers recommended more studies examining “cultural, political, or religious factors.”

Death by ‘natural causes’

Wilson certainly had considerable health problems for a 38-year-old woman. She was obese and had diabetes, for which she apparently did not receive regular medical care. (She did not qualify for Medicaid.) She had undergone two relatively recent operations, one to remove a cystic ovary and a second to have a hysterectomy after a miscarriage caused her to hemorrhage. 

Most ominously, perhaps, Wilson had complained of chest pains in the days before her death. The emergency room doctors at her local hospital told her she wasn’t having a heart attack and sent her home.

No official cause of death was listed on Wilson’s death certificate. The medical examiner simply said she died of natural causes.

This is not an article to read if you’re looking for easy explanations for this particular alarming U.S. health trend. But it’s one all of us should read if we want to truly understand how “the desperation of the times,” as aptly described by one of Potts’ interviewees, is killing people, particularly poor, uneducated women.

Potts’ article can be read in full on the American Prospect’s website.

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