President Donald Trump recently announced a public health emergency to combat the so-called opioid crisis that last year claimed the lives of more than 59,000 people.
This is not just an opioid crisis, however. The root cause is much more ominous, and this astonishing surge of drug-related deaths is unfortunately only a symptom of a much larger epidemic afflicting mostly rural white Californians.
An in-depth study commissioned by the California Endowment’s Building Healthy Communities found that in some rural counties, death rates for whites ages 25 to 34 have more than doubled because of premature deaths.
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Drug overdoses account for only about a third of these excess deaths, while suicide and alcoholic liver disease each cause almost as many. When witnessing a dramatic spike in self-inflicted deaths, my physician training tells me to look deeper for a diagnosis. Our study suggests that rural white Californians are dying of despair as they watch their hands slip from the ladder of opportunity as the country shifts away from manufacturing and towards an information economy. As this despair takes hold, opiate and alcohol abuse and suicide rise.
We have seen profound despair leading to accelerating death rates before – in Russia after the collapse of the Soviet Union and in America’s poor, minority communities for decades. As a health disparities researcher, I have been saying for many years: “When it comes to your health, your ZIP code matters more than your genetic code.”
Our nation’s sordid history of residential segregation and redlining has created inner cities that are incubators of despair. Many low-income neighborhoods in California have life expectancies 20 years lower than nearby affluent and whiter neighborhoods. Despite all of the attention to increasing white death rates, African Americans and Native Americans still have much higher absolute death rates than whites.
Fundamental to understanding what is happening in rural white America and what has happened for decades in poor communities of color is recognizing that unlike other developed countries, the U.S. lacks universal health care, affordable college, paid sick leave, living wages and effective housing policies. In other words, we lack a meaningful social compact, and this is generating despair, particularly with rapid shifts in the global economy.
People who are socially and economically vulnerable – poor minorities and less educated rural whites – are always the first and hardest hit.
The good news is that California is trying to address this epidemic of despair. We are actively reweaving our social compact. We are pursuing universal health care, college affordability, paid sick leave, livable wages and effective housing policies. We are also dismantling mass incarceration, enhancing civic engagement, supporting and integrating immigrants and increasing equity in school funding. We are restoring the California dream.
Anthony Iton is senior vice president of The California Endowment’s Building Healthy Communities program. He can be contacted at AIton@calendow.org.