The WaPo has a fascinating dive into the impact of chronic disease on American health. Interestingly, over the past 40 years life expectancy has increased in urban America and collapsed in rural America. I have to wonder if Trump's bullshit "American carnage" is based on the fact that rural communities are seeing early deaths and dysfunction and project that on American cities. Given the population disparity there are always more "stories" from cities, but the statistics tell us that living in small town America is now more dangerous than living in a city. Not because of violence, but because of obesity, heart disease and cancer. In fact, the Post story posits that these deaths outstrip the "deaths of despair" that have been written about at great length.
As Paul Campos notes, the very people who came up with the term "deaths of despair" have a new study out showing that an American with a college degree who turned 25 in 2019 could expect to live to be 84; those without a college degree could only expect to live to 75. That number has actually declined since 1992. Declining numbers...not good. Campos notes that college degrees have become a proxy for class, even if income isn't necessarily all that different.
Back to the Post's story, here's a critical quote:
“The big-ticket items are cardiovascular diseases and cancers,” said Arline T. Geronimus, a University of Michigan professor who studies population health equity. “But people always instead go to homicide, opioid addiction, HIV.”
We naturally are drawn to stories of dramatic death like shootings or overdoses. Those are understandably tragic. The slow motion death caused by poor health is just less narratively compelling. (It's worth noting that Campos himself often pushes back on the idea that obesity causes poor health, which I find odd.)
One theme that emerges in the Post piece is that health and medicine aren't the same thing. America does great things with medicine - if you can pay for it - but we struggle with healthy living. Our food is unhealthy, unless you can take the time and effort to make it healthy - something people working double shifts to make ends meet can't do. There's the lingering impact of smoking, which I have to imagine is much higher among those without college degrees. If I'm being honest, seeing someone smoking under 50 automatically lowers my estimation of the person's critical thinking ability.
The Post story points to policy, not just obesity and cancer:
Instead, experts studying the mortality crisis say any plan to restore American vigor will have to look not merely at the specific things that kill people, but at the causes of the causes of illness and death, including social factors. Poor life expectancy, in this view, is the predictable result of the society we have created and tolerated: one riddled with lethal elements, such as inadequate insurance, minimal preventive care, bad diets and a weak economic safety net.
The Affordable Care Act increased the ability of some to get insurance and made it generally more affordable, but having access to medicine is not the same as being healthy. When I saw my doctor a year or two ago, he noted that my weight might not be ideal, but I've large framed and muscular, and my blood work and vitals were good. He seemed genuinely happy that I was "taking care of myself" in a way that made it clear that this was not typical of his patients. I see him once a year; I see my dentist twice a year; I access physical therapy when I need it. That's having the monetary means to do so with solid insurance, but it's also a mindset about health.
Meanwhile, Red America (rural) thinks vaccines are bad. That's a mindset, too.
There's one obvious solution to this "hidden" mortality: universal health care. That would help a great deal, but that will also need to be combined with things like more primary care doctors and physician assistants to allow people to actually access care. How you get people to stop smoking and super-sizing their meals is another issue.
At any rate, read the piece. It's why good journalism still matters.
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