Will 'Deaths of Despair' among Whites Change How We Talk about Racial/Ethnic Health Disparities?

Abstract

The recent trend of premature death among Whites in the United States has garnered attention in both the popular and academic literature. This attention has focused on the plight of low socioeconomic status Whites in non-urban areas. The population health literature in general and the health disparities literature more specifically has struggled to describe differences in health when White groups present worse health outcomes or worsening trends compared with racial/ethnic minority groups. There remain many open questions as population health/health disparities research attempts to explain the increasing mortality rates for low socioeconomic status Whites in non-urban areas in relationship to other racial/ethnic groups. As the conversation in the academic and popular literature continues to unfold, a key question for population health research and practice is how will the 'deaths of despair' phenomenon among Whites influence our measuring of, and reporting and intervening on, race/ethnic health disparities?

Does Despair Really Kill? A Roadmap for an Evidence-Based Answer

“…Some economists have interpreted these recent population-level trends to indicate that despair rising from economic stagnation is a shared pathway to suicides, drug poisonings, and death from alcoholic liver disease. Accordingly, they coined the term “deaths of despair” (DoD), 1,3 which quickly captured the attention of scientists, 4–7 policy makers, 8 and popular media, but also drew criticisms from addiction researchers, 9 racial disparities researchers, 10–12 family sociologists, 13 and demographers. 14…”

Rising US Suicides: Achieving Health Equity

“…Despite favorable public health gains in some areas and lower suicide rates versus other groups (Figure 1), NHB have the second highest premature mortality after AIAN, seemingly high rates of adult depression relative to other groups [51] often coupled with significant gaps in access to mental health care, and have seen a recent sharp rise (and reversal of trend) in premature mortality across all age groups in those with less than a high school education (similar to NHW in Particularly against the backdrop of polarizing current events, the topics of race, ethnicity, class, culture, and historical or contemporary discrimination, oppression, or trauma, can be especially sensitive issues that are extraordinarily difficult to adequately and comprehensively address, even in the context of health disparities and when authors have only humanitarian intentions. In this light, the controversy and discussion that emerged from the Case and Deaton papers have been very thoroughly, thoughtfully, and expertly covered in great detail by others, and we refer readers there for those discussions [44] (and see additional relevant discussion in [37]).…”

“…In two papers that generated vigorous discussion and mild controversy (expertly discussed in [44]), Anne Case and Angus Deaton, the 2015 Nobel Laureate for Economics, highlighted the unprecedented rise in midlife mortality among socioeconomically disadvantaged middle-aged NHW Americans [45,46]. These researchers linked rising midlife mortality to a decline in the economic prospects for the NHW working class during an era of rising income inequality in the USA.…”

“…Following from their examination of the NSDUH data which showed that compared to other racial/ethnic groups only NHW experienced a significant increase in depression from 2005-2015, Weinberger et al also presented a thoughtful, comprehensive, and comparative epidemiological discussion of depression risk factors, demographics, and driving forces amongst the racial/ethnic groups surveyed [37] (which closely interrelates with the expert discussion in [44]). (Nonetheless, and particularly in populations or individuals with significant disparities, we cannot discount the possibility that much depression may go undiagnosed, either because it may differ from a classic clinically-diagnosable depression, such as demoralization or disenfranchisement, or it may simply go unsurveyed.)…”

“…Indeed, estimates suggest that 20% of US children have a diagnosable mental health condition, and "[m]ore than half of mental illness emerges before age 14" [81], yet 85% of those needing treatment do not receive it [60,81]. Suicide is the second leading cause of death for 10-34 year olds, fourth leading cause of death for [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] year olds, and 8th leading for ages 55-64 [82].…”