Medicine’s march of forward progress seems hard to deny. In the past century alone, the US has seen the elimination or eradication of smallpox, malaria, and polio. And the rush of medical miracles doesn’t seem to be slowing, either, with new cures and treatments regularly making headlines. But the big question behind a dropping mortality rate is, “For whom?” How you slice your demographics is going to have a huge impact on your headlines. This week’s demographic shocker comes from Nobel laureate Angus Deaton and Anne Case, who released a report showing that middle-aged white Americans are facing rising death rates.
The New York Times article covering the report seemed to bury some important information. Of course it’s interesting that middle-aged white people are dying in increasing rates. Deaton pointed out that, shockingly, “Only H.I.V./AIDS in contemporary times has done anything like this.” But missing from the headline were some major determinants. After all, it’s not that all middle aged whites are seeing rising mortality rates – just those with less than a college education. In fact, white people with college degrees have seen their mortality rates – along with every other demographic surveyed – fall. Also curiously missing from the headline was the causes contributing to the rising death rate: substance abuse and suicide.
Deaton’s comparison to AIDS is an interesting one, in that AIDS was a major epidemic initially blamed on social factors, whereas Deaton and Case’s study highlights social determinants of health that have only gradually entered medical models. As is often the case with demographic studies, the rabbit hole goes deeper. Suicide follows other trends as well, with the Times focusing on rural versus urban suicide rates. And heroin addiction, too, has been highlighted as a rising problem in white communities. Ninety percent of first-time heroin users in America over the past ten years have been white.
The report is fascinating, and shocking. As is often the case when we start realizing that social determinants have massive impact on health outcomes, we are faced with some counterintuitive questions. Would sending more people to college prevent deaths? Can moving to the city stop a cycle of mental health abuse? Of course, one has to dig deeper. What’s interesting about broad demographic surveys is not only the histories they write, but the responses they provoke. With drug addiction turning its evil eye towards white families, the Times points out, the war on drugs is getting seriously questioned. Towns like Gloucester, Massachusetts are turning away from criminalizing addiction.
Of course it’s big news when death rates rise, no matter the demographic. But there was one more buried bit in the Times article that bears highlighting. Despite the skyrocketing death rate for middle-aged whites, middle-aged black people still have a higher death rate than their white counterparts. A renewed look at social determinants of health outcomes requires challenging the status quo, even when it doesn’t make headlines.