Experts who attribute a rise in the deaths of white people in recent years to economic “despair” might be missing the forest for the trees, according to Dornsife School of Public Health Dean Ana Diez Roux, MD, PhD.
Diez Roux recently wrote a commentary in the American Journal of Public Health discussing a study that examined a 4 to 6 percent increase in white mortality rates between 1999 and 2015. Since mortality rates had been steadily falling until this 15-year-period, the study looked to explain why there was a reversal and settled on this: increased drug overdoses, suicide and alcohol-related liver diseases due to hopelessness from weak job and lifestyle prospects compared to past generations.
It might not be that simple, Diez Roux wrote. She believes such changes need to be seen in the context of what is happening in other population groups in order to fully understand why they’re happening.
So why are white people dying more frequently as of late? And why are mortality rates still going down for minorities?
“Why is it that black people and Hispanics are somehow protected from the adverse health effects of the adverse economic trends creating despair in whites?” she questioned. “Have they not experienced similar adversity and frustrated expectations? Is frustrated expectation really the driving factor, and is it so differentially distributed by race that recent economic circumstances would cause increases in death rates in whites but not in other groups?”
What is especially stark is the fact that, although mortality rates are improving for minorities, they are still dying at much higher rates than white people. For instance, the study on white “deaths of despair” still found that black people are 20 to 40 percent more likely to die in an untimely way than white people, depending on where they live.
When looking on a population level, black people experienced 521 and 574 untimely deaths per 100,000 in small/medium sized metro and rural areas, respectively, in 2015. Those numbers were down by 160 and 163 deaths over the study’s time period, 1999–2015.
And while white people’s deaths increased by 15 and 25 people (in small/medium sized metro and rural areas, respectively) during the same time period, their deaths per 100,000 were still significantly lower: 358 and 414, respectively.
“The important reductions in death rates in black people are a welcome development, but rates still remain unacceptably high” Diez Roux said. “We should guard against the unintended consequence that the focus on the increase in death rates in some whites — significant as they are — detract attention from the persistent health inequities by race and social class, which are so large that they dwarf the size of what is a very troubling increase in some whites.”
One explanation for increases in mortality rates could be that doctors are more willing to prescribe opioids to white people than minorities.
“Previous research has shown that white people are more likely to be prescribed opioids than are black people,” Diez Roux explained. “Could this put them on a path to dependence and overdose regardless of whether they experience despair (although, undoubtedly, the experience of despair could enhance these effects)?”
The real culprits behind the recent increase in white mortality rates — as well as generally higher rates of mortality in minorities — is likely “upstream causes,” according to Diez Roux.
Examples of these include adverse neighborhood environments and poverty. These are more acutely experienced by minorities, but carry ill effects no matter what racial group might experience them.
“The next step is to determine what can be done, not only to reverse the worrisome increase in death rates among whites, but also to eliminate the profound health inequities by race, social class and geography that have characterized our society for so long,” Diez Roux concluded.
Any media interested in speaking to Diez Roux can contact Frank Otto at 215.571.4244 or fmo26@drexel.edu.
