What's Killing Poor White Women?
September 3, 2013 11:28 AM   Subscribe

For most Americans, life expectancy continues to rise—but not for uneducated white women. They have lost five years, and no one knows why.
posted by Pater Aletheias (99 comments total) 17 users marked this as a favorite
 
Yes, I RTFA, but I didn't see - does the study take murder and victim-of-domestic-abuse deaths into account when calculating cause of death?
posted by EmpressCallipygos at 11:35 AM on September 3, 2013 [1 favorite]


Longevity is often associated with social ties - family, community, work. It has been breaking down since, well the 1960s, but the rise of the Internet, more isolated locally, more connected virtually. Only so many hours in the day it's a sum loss every minute on the computer vs live. In total if you have say a 20% reduction in overall live-person social ties across a population, it could result in lower lifespan on average in that population due to whatever factors cause that.
posted by stbalbach at 11:46 AM on September 3, 2013


From the article: "lack of access to education, medical care, good wages, and healthy food".
posted by roomthreeseventeen at 11:47 AM on September 3, 2013 [14 favorites]


I find life expectancy continues to rise—but not for uneducated white women bullshit. It's a study designed to find an answer.

I'm willing to wager that all uneducated humans have the same odds.
posted by Mblue at 11:48 AM on September 3, 2013


Since crime has been falling for a couple decades, I doubt a rise in crime is to blame.
posted by DU at 11:49 AM on September 3, 2013 [3 favorites]


Yes, I RTFA, but I didn't see - does the study take murder and victim-of-domestic-abuse deaths into account when calculating cause of death?

I'd have thought diet more likely.
posted by Artw at 11:50 AM on September 3, 2013


End of the 7th paragraph says it all:
"Lack of access to education, medical care, good wages, and healthy food isn’t just leaving the worst-off Americans behind. It’s killing them."

Any one of those alone is bad. Combine all of them and you have a recipe for a short life. I'd go so far as to make medical care, good wages, and healthy food the trifecta for destroying a persons life expectancy.

I mean, I'm not in that demographic (not a poor white woman), but those 3 things (medical care, wages, and healthy food) have already seriously compromised my life expectancy (2 hospitalizations). And I had health insurance. Just not good enough to allow me to go to a doctor regularly and manage my health problems.

And the part that makes it worse? I'm lucky. If you add anything else to that list (being a minority, having to live in a food desert, not having a cell phone to call for an ambulance), and you end up with a very different outcome (i.e.: end up dead at 30).

I think the framing of the article and the study is attempting to latch on to the media's big "white woman in trouble" myopia. Sadly, I think this will backfire.
posted by daq at 11:51 AM on September 3, 2013 [3 favorites]


Diet is probably a major contributor, but it's a subject few want to discuss: often not people who eat a poor diet, certainly not the food manufacturers who profit from it.
posted by Blazecock Pileon at 11:52 AM on September 3, 2013 [1 favorite]


My guess before I RTFA was going to be prescription drug abuse. It was mentioned though seemingly dismissed as an explanation. The explanations cited: "lack of access to education, medical care, good wages, and healthy food" make a lot of sense, but I still see a lot of people dying from drug abuse and that's something that didn't exist 50 years ago (whereas those other explanations did).

Anecdotal is anecdotal I guess.
posted by NervousVarun at 11:52 AM on September 3, 2013 [3 favorites]


I'm willing to wager that all uneducated humans have the same odds.

They looked at other uneducated groups in their research Mblue, and they did not find what you wager. So give me some money!

A lot of the comments are focusing on Polycystic Ovarian Syndrome as the possible cause of death in the particular case featured in the article, as Crystal specifically displayed a constellation of symptoms associated with the disease and it tends to be under-diagnosed in the US.
posted by saulgoodman at 11:52 AM on September 3, 2013 [9 favorites]


Its not hard to imagine that the chronic stress of simply being poor contributes to this, too.
posted by sandettie light vessel automatic at 11:52 AM on September 3, 2013 [12 favorites]


I'm voting for heartbreak and abandonment! By life, obviously.

It's the same thing that's killing all the unemployable white men. When there's no reason to go on, people don't.
posted by hobo gitano de queretaro at 11:53 AM on September 3, 2013 [9 favorites]


Why didn't they find the same dramatic effect among black women in similar circumstances then?
posted by saulgoodman at 11:53 AM on September 3, 2013


Why didn't they find the same dramatic effect among black women in similar circumstances then?

Because black women (as a group) were ALREADY poor. They are trying to explain a delta, not a state.
posted by DU at 11:55 AM on September 3, 2013 [12 favorites]


but I still see a lot of people dying from drug abuse and that's something that didn't exist 50 years ago

Pretty sure plenty of folks died of alcohol and tobacco related causes in the 60s.
posted by maryr at 11:55 AM on September 3, 2013 [4 favorites]


Alcohol and tobacco are prescription drugs? That's the "drugs" I was referring to in that last sentence. Maybe I should have been more clear. I'm certainly not saying more people are dying now from alcohol/tobacco than 50 years ago.
posted by NervousVarun at 11:55 AM on September 3, 2013


No, they are drugs that are abused.
posted by maryr at 11:57 AM on September 3, 2013 [1 favorite]


One theory is that low-income white women smoke and drink and abuse prescription drugs like OxyContin and street drugs like meth more than black women. Despite Crystal’s weight and diabetes, those problems are more common among black women and usually kill more slowly.
Because black women (as a group) were ALREADY poor. They are trying to explain a delta, not a state.

From the article:
Black women without a high-school diploma are now outliving their white counterparts.
That would suggest that the delta, and the state is different.
posted by cell divide at 11:58 AM on September 3, 2013 [10 favorites]


(But my apologies, my comments were phrased in an unnecessarily fighty way. I don't have any numbers, but I have no reason to believe that abuse of prescribed drugs has not risen.)
posted by maryr at 11:58 AM on September 3, 2013 [1 favorite]


Hey guys I have a great idea what if we all read this really interesting article about some pretty counterintuitive public health research before we insist we have a ready one-line explanation of the entire thing
posted by RogerB at 11:59 AM on September 3, 2013 [63 favorites]


Black women without a high-school diploma are now outliving their white counterparts.

That would suggest that the delta, and the state is different.

It suggests no such thing.

Example: the life expectancy of black women was and is 65, say. If white women used to be 70 but are now 60, then black women are now outliving their white counterparts.
posted by DU at 12:02 PM on September 3, 2013


I was WAY off; my guess was mutant alligators.
posted by infinitywaltz at 12:02 PM on September 3, 2013 [15 favorites]


Because black women (as a group) were ALREADY poor. They are trying to explain a delta, not a state.

That's possible. But I'm actually more inclined to think this is a health care issue and that there's some underlying epidemiological factor at work. At the very least, if it were possible to settle the medical questions first before attributing this to squishier, harder to prove factors, that might be a good place to start.

Among the poor white folks I personally know, there tends to be a lot of resistance to seeking medical care for subtle health issues (because there's a lot of cynicism about physician's motives these days), and this woman wasn't even getting treatment for her diabetes, so it seems likely she wasn't particularly fond of visits to the doctor.

I wonder if there are any measurable differences in medical care utilization rates that might partly explain the phenomenon? Lord knows, I barely even trust the doctor to handle anything more complicated or subtle than my blood pressure prescriptions anymore. The only answer I ever seem to get for any other health complaints is "take more Vitamin B"! My liver almost failed when a dentist kept me on Hydrocodone APAP for six months before an oral surgery they couldn't perform until my blood pressure was under control, so my direct experience with medical science in recent years has even made me a little jaded about the power of the physician's oath to "do no harm," so I can imagine poorer folks are increasingly skeptical. Especially considering the kind of treatment you get at a doctor's office these days if you don't have insurance.
posted by saulgoodman at 12:09 PM on September 3, 2013 [1 favorite]


Is it illegal or something for online articles like this to actually link to the studies they reference? Drives me crazy.

Here is the abstract of the HA piece the author references, and here is a related policy brief on the effects of health disparities. From that brief:

"Race and Gender: Research also shows that health varies depending on individual characteristics, starting with race and gender. For example, the latest research by Kenneth Kochanek and colleagues found that in 2010 the life expectancy for the black population was 3.8 years lower than that of the white population. Gender differences are also very real. Historically, US females enjoyed longer life expectancies than males, but recent research found that the gender gap in longevity has narrowed--unfortunately because female mortality rose in 42 percent of US counties between 1992 and 2006." (emphasis mine)
posted by rtha at 12:11 PM on September 3, 2013 [11 favorites]


no one knows why

This entire thread begs to differ.
posted by rocket88 at 12:13 PM on September 3, 2013 [6 favorites]


I find life expectancy continues to rise—but not for uneducated white women bullshit. It's a study designed to find an answer.

I'm willing to wager that all uneducated humans have the same odds.
White men without high-school diplomas had lost three years of life expectancy, but it was the decline for women like Crystal that made the study news.
I'm willing to wager that they "don't know why" for them either, but the more pronounced change for women was the more arresting part of the story.
posted by Etrigan at 12:18 PM on September 3, 2013


A lot of the comments are focusing on Polycystic Ovarian Syndrome as the possible cause of death in the particular case featured in the article, as Crystal specifically displayed a constellation of symptoms associated with the disease and it tends to be under-diagnosed in the US.

I mean, okay, but I'm not sure that's necessary. She was an untreated, unmanaged diabetic. Complications from untreated, unmanaged diabetes can produce all of the symptoms that she suffered, including death. So she may or may not have had PCOS, but there's no reason to think that such a diagnosis is necessary to explain her case. The diabetes is enough.
posted by valkyryn at 12:19 PM on September 3, 2013 [3 favorites]


Interesting article, but it relied a bit too much on Crystal as an example from whom the entire constellation of the story could be extrapolated. "Smoking kills" but Crystal didn't smoke (her sister did and died young). It was as if Crystal could dismiss arguments.
posted by dances_with_sneetches at 12:21 PM on September 3, 2013 [1 favorite]


I'm willing to wager that all uneducated humans have the same odds.

But you know what? Every society has had "uneducated humans," those who either have no access or no interest. But once upon a time in America, for a brief historical moment anyway, opportunity still existed. You drop out of high school, get a job on the factory line and pay the rent, buy a house, have money left over, put a kid through college, etc. Now globalization and automation/technology that displaces actual human workers has put an end to that era.

And we say - well, this just shows how important education is. Sure. But even then, there will be those who have no access or no interest. A just and stable society ensures that even the uneducated have opportunity.
posted by kgasmart at 12:21 PM on September 3, 2013 [6 favorites]


A just and stable society ensures that even the uneducated have opportunity.

So you'd argue that there hasn't been a "just and stable society" in human history?
posted by valkyryn at 12:22 PM on September 3, 2013


I'd argue that we had it, in this/American society, throughout much of the 20th century. That there was opportunity for the poorest of the poor; but that the policies we've since adopted have eradicated that opportunity, and we've simply expanded the welfare state to fill the gap.
posted by kgasmart at 12:24 PM on September 3, 2013 [1 favorite]


From the article: "lack of access to education, medical care, good wages, and healthy food".

While those are almost certainly the big factors, I'd bet that another thing that's going on is changing correlation patterns such that the same measure -- white woman without HS diploma -- means something different now than it did in 1980 or 1950. Something more rural (or center-city urban), something less prosperous, something more likely to be a single mother or married to another low-education, low-income, low-access-to-health-care person, and so on.

That is, I expect that if instead of analyzing the life expectancies of women without high school diplomas, they'd analyzed the life expectancies of rural women in the bottom X% of educational attainment who were either single mothers or married to men in the bottom X% of educational attainment, and so on, they'd have found less of a change.
posted by ROU_Xenophobe at 12:24 PM on September 3, 2013 [7 favorites]


He'd probably argue once upon a time in America, for a brief historical moment anyway, opportunity still existed. You drop out of high school, get a job on the factory line and pay the rent, buy a house, have money left over, put a kid through college, etc.
posted by NervousVarun at 12:24 PM on September 3, 2013 [2 favorites]


does the study take murder and victim-of-domestic-abuse deaths into account when calculating cause of death?

Past 30 or so, murder drops very quickly as a leading cause of death in white women (source site). It's worth noting, however, that the leading causes of death for young women are accidents, suicide and cancer.

It's a complex problem, affecting white females most strongly, but also everyone in bad socioeconomic shape.
Social and economic factors increase the vulnerability of low socioeconomic communities to risk factors such as smoking, obesity, physical inactivity, hypertension, and HIV infection.[18]–[22] People without health insurance are less likely to receive basic preventive services or standard timely treatment.[23], [24] Those with lower health literacy are less likely to seek medical attention for asymptomatic conditions or to navigate the health care system effectively.[25], [26] The prevalence of most major risk factors remains much higher among persons with lower than high socioeconomic position.[27]–[29] Progress in reducing smoking has been slowest among the least educated.[27], [30] The prevalence of obesity, hypertension, and diabetes has increased in all socioeconomic position groups in recent years.[27], [30]–[33]
--Widening of Socioeconomic Inequalities in U.S. Death Rates, 1993–2001, Ahmedin Jemal et al, PLOS One, 2008.
posted by bonehead at 12:26 PM on September 3, 2013 [1 favorite]


I'm willing to wager that all uneducated humans have the same odds.

See the slide here.
posted by rtha at 12:27 PM on September 3, 2013 [1 favorite]


I suspect -- based on fuck all, mind -- that maybe it's that obesity-related issues are depicted and perceived as primarily affecting men, so women are less likely to think they're having a heart attack when they do?

But it'd be nice to not have to speculate. Seems like this kind of thing would have a "cause of death" column in the spreadsheet or whatever.

Yes, I RTFA, but I didn't see - does the study take murder and victim-of-domestic-abuse deaths into account when calculating cause of death?

Bad as women have it, in the United States, men are more than three times as likely to be the victim of a homicide. (Source.)
posted by Sys Rq at 12:27 PM on September 3, 2013


Interesting article, but it relied a bit too much on Crystal as an example from whom the entire constellation of the story could be extrapolated.

It wasn't a well-written article, as far as researching Crystal's overall health history, let alone the cause of death. An emotional anecdote, but I'm not sure it says anything useful about this phenomenon.
posted by Blazecock Pileon at 12:30 PM on September 3, 2013 [1 favorite]


So you'd argue that there hasn't been a "just and stable society" in human history?

Not only would I argue that, I'd damn well expect you to agree with me. Unless you want to tell me when the Lord came down and established the Kingdom, 'cuz I missed that.
posted by ROU_Xenophobe at 12:30 PM on September 3, 2013 [3 favorites]


I mean, okay, but I'm not sure that's necessary. She was an untreated, unmanaged diabetic. Complications from untreated, unmanaged diabetes can produce all of the symptoms that she suffered, including death.

Well, sure, but PCOS may be a causal factor in diabetes, so it's complicated...

I'm not suggesting it's necessarily that there's been a surge in undiagnosed PCOS, specifically, and even obesity can't be ruled out as the determining factor in this case (since "...the clinical severity of PCOS symptoms appears to be largely determined by factors such as obesity..."), but maybe our health care systems just don't do a very good job with complex medical problems, and maybe poor white women in particular aren't getting enough health care for cultural reasons.

I don't know, obviously. But only more research looking into any common epidemiological patterns among the deaths seems to offer any promise of actually answering the title question by at least ruling out any common pathologies and identifying associated patterns of behavior or circumstance. I suspect cultural attitudes toward health care and access to health care play a part. Possibly also the tendency of white males to dismiss women's medical complaints as "whiny" and "overblown." I've seen a lot of that, too, especially in the South. And it seems to have gotten a lot worse in my lifetime.
posted by saulgoodman at 12:31 PM on September 3, 2013 [1 favorite]


Is it illegal or something for online articles like this to actually link to the studies they reference? Drives me crazy.

I'm so with you there. Here is the county map from the University of Wisconsin research that was mentioned.
posted by 0 at 12:33 PM on September 3, 2013 [2 favorites]


Differences In Life Expectancy Due To Race And Educational Differences Are Widening, And Many May Not Catch Up
It has long been known that despite well-documented improvements in longevity for most Americans, alarming disparities persist among racial groups and between the well-educated and those with less education. In this article we update estimates of the impact of race and education on past and present life expectancy, examine trends in disparities from 1990 through 2008, and place observed disparities in the context of a rapidly aging society that is emerging at a time of optimism about the next revolution in longevity. We found that in 2008 US adult men and women with fewer than twelve years of education had life expectancies not much better than those of all adults in the 1950s and 1960s. When race and education are combined, the disparity is even more striking. In 2008 white US men and women with 16 years or more of schooling had life expectancies far greater than black Americans with fewer than 12 years of education—14.2 years more for white men than black men, and 10.3 years more for white women than black women. These gaps have widened over time and have led to at least two “Americas,” if not multiple others, in terms of life expectancy, demarcated by level of education and racial-group membership. The message for policy makers is clear: implement educational enhancements at young, middle, and older ages for people of all races, to reduce the large gap in health and longevity that persists today.
If anyone here would like a copy of the actual research paper were are discussing third hand please feel free to memail me with an email address I can send a PDF to and a promise not to distribute it further. Furthermore, it would make me unbelievably happy if you were to take me up on this and then comment in the thread with insights or questions from the paper.
posted by Blasdelb at 12:35 PM on September 3, 2013 [14 favorites]


Thank you, 0!
posted by rtha at 12:35 PM on September 3, 2013


So I unexpectedly got the afternoon off and am going to actually read the damn Health Affairs article. By the by, it was not published this August, but in August of 2012. Further, it's examining mortality trends from 1990 to 2008 for all races. I'll check back in once I'm done Ring T Fing A.
posted by The White Hat at 12:36 PM on September 3, 2013 [1 favorite]


In May, Jennifer Karas Montez of the Harvard University Center for Population and Development Studies co-authored the first paper investigating why white women without high-school diplomas might be dying. Most research has looked at which diseases are the cause of death, but Montez and her co-author wanted to tease out quality of life... smoking and employment were the only two factors of any significance.

This seems to be a significant pull from this article, much moreso than any of the anecdotal details of this single patient.
posted by OHenryPacey at 12:36 PM on September 3, 2013 [1 favorite]


"...but Crystal never had regular medical care because she didn’t qualify for Medicaid as Possum did."

Kind of solves a lot of the "mystery" right there, doesn't it?
posted by The Underpants Monster at 12:37 PM on September 3, 2013 [3 favorites]


"lack of access to education, medical care, good wages, and healthy food".

Yes, but TFA also mentions that "Black women without a high-school diploma are now outliving their white counterparts." and that "...the factors that determine well-being—income, education, access to health care—tend to be worse for blacks."

As for diet, the article doesn't go into detail, but I suspect that the differences in diet for poor uneducated white woman isn't that much different than for black women.

Here's a golden nugget for me: The article mentions that "...joblessness hit white women harder than other groups[.] Overall, men lost more jobs during the Great Recession. Why are women losing years at a faster rate?"

While those two datapoints seem comparable, I bet you that the joblessness of women includes a higher portion that never had a (paying) job to begin with compared to men, or in other words, men are more likely to have been employed at one time or another in their lives. That gives them a slightly higher social net to help them along thanks to a network of peers, even if only temporarily.

My hypothesis: poor uneducated men, and poor uneducated black women, are more likely to have a slightly stronger social net, thus offering a slight advantage in hope, which can be enough to reflect in life expectancy. It's really hard to measure hope, especially after the fact.
posted by furtive at 12:42 PM on September 3, 2013


That there was opportunity for the poorest of the poor; but that the policies we've since adopted have eradicated that opportunity, and we've simply expanded the welfare state to fill the gap.

Providing for the general welfare has always been one of the US state's core missions, and one of the first acts our nation took after the Revolutionary War was to start a national central bank and lend ourselves money to throw at people hand over fist to promote economic development, so I think this gets the story fundamentally wrong. It was the fact that America used to be a "welfare state" that made that dream of equality of economic opportunity seem even remotely achievable in the first place, and it wasn't just bad policy, but the machinations of industrial concerns working against the US's regulatory and safety-net protections over many years that got us to this point.
posted by saulgoodman at 12:42 PM on September 3, 2013


Somewhat related. I always find statistical blips interesting. From the CDC website:

Education Level Cigarette Smoking Rate
Less than high school 25.5%
GED 45.3%
High school graduate 23.8%
Some college 22.3%
Associate degree 19.3%
Undergraduate degree 9.3%
Postgraduate degree 5.0%

So having a GED doubles your rate of smoking over dropping out or finishing high school.
posted by dances_with_sneetches at 12:44 PM on September 3, 2013 [2 favorites]


So having a GED doubles your rate of smoking over dropping out or finishing high school.

I wonder whether it's a money problem -- if you have a GED, odds are you have a better job than your neighbor who dropped out at the same time you did but never bothered getting his GED, and you have that skoonch more disposable income that you can spend on cigarettes.

I'd also wonder whether smokeless tobacco takes up some significant portion of that difference.
posted by Etrigan at 12:48 PM on September 3, 2013


From the NYT on September 20, 2012: a graph entitled "A Troubling Trend in Life Expectancy".
posted by vapidave at 12:54 PM on September 3, 2013


Anecdotally, a friend and former bandmate of mine was both a GED kid and an unrepentant smoker. He reputedly had one of the highest IQs among the crowd of smart kids in the gifted programs in our high school, and I think with him at least, both getting the GED and persisting in smoking long after others gave it up despite all the evidence of its harmful effects were both expressions of a strong, stubbornly individualistic streak in his personality. I think he would probably have read Dostoevsky's Notes from Underground and identified completely with the iconoclastic Underground Man.
posted by saulgoodman at 12:57 PM on September 3, 2013


Are you guys sure you aren't all just overthinking this? ...cause I'm pretty sure the answer is cats.
posted by Anoplura at 12:58 PM on September 3, 2013 [1 favorite]


Are you guys sure you aren't all just overthinking this? ...cause I'm pretty sure the answer is cats.

Makes sense. I don't have a cat and I'm still alive.
posted by Pater Aletheias at 1:05 PM on September 3, 2013 [1 favorite]


does the study take murder and victim-of-domestic-abuse deaths into account when calculating cause of death?

Can't imagine what one's world-view could be to come up with such a question. If this was the contributing factor, it would have to be so significant in percentage and scale, that it would be not only the answer to the OP's question, but the biggest headline of all.

Poor white women are not an endangered class.
posted by Kruger5 at 1:06 PM on September 3, 2013 [1 favorite]


Poor white women are not an endangered class.

I'm not saying they're endangered, only positing that they're the most likely class to suffer from domestic abuse and yet stay in the marriage - and also the most likely class for people to overlook or write that kind of thing off rather than making a headline out of it.
posted by EmpressCallipygos at 1:09 PM on September 3, 2013


McNugget shortage.
posted by telstar at 1:09 PM on September 3, 2013 [3 favorites]


I have a cat and I am alive but I went to college. Thank god - it would be a shame to have to quit cat-owning.
posted by maryr at 1:10 PM on September 3, 2013


whats most troubling is that poor people have lost life expectancy compared to poor people years ago.

poor people have always been poor. poor peopled have always smoked. poor people have always had bad diets. poor people have always been more at risk to violence. and yet only now their life expectancy heads in a negative direction? whats been so dramatically different about the last 20 years?
posted by Glibpaxman at 1:10 PM on September 3, 2013 [7 favorites]


I'm not saying they're endangered, only positing that they're the most likely class to suffer from domestic abuse and yet stay in the marriage - and also the most likely class for people to overlook or write that kind of thing off rather than making a headline out of it.

Not according to this study:

Results: Black and Hispanic couples were at approximately three times greater risk of MFPV [male-to-female partner violence] and two times greater risk of FMPV [female-to-male partner violence] at follow-up in comparison to white couples even after controlling for socio-demographic characteristics, alcohol consumption, and psychosocial variables. Extreme specific models indicated that among blacks, MFPV was a significant predictor of MFPV and FMPV at follow-up. In contrast, among Hispanics, FMPV was a significant predictor of FMPV and MFPV at follow-up.
posted by Blazecock Pileon at 1:15 PM on September 3, 2013 [1 favorite]


whats been so dramatically different about the last 20 years?

Obesity rates are much higher.
posted by Blazecock Pileon at 1:19 PM on September 3, 2013 [2 favorites]


i think it's misleading to talk about there being a lot of opportunity way back when for factory jobs and such, as there are areas of the country where there never have been many factory jobs

you can't outsource something that wasn't ever there

my guess as to what has happened in the last 20 years in those areas is that social ties have fractured - the gradual exodus to bigger towns has become much larger and those left behind have less to connect with

although i must admit that population shrinkage in sharp county, where cave city is located, hasn't been much at all lately
posted by pyramid termite at 1:20 PM on September 3, 2013


It's frustrating to observe that whenever an FPP is posted about an issue that has a disproportionately negative effect on women, there's always at least one comment that says something like, "Bullshit, this issue affects men and women equally!" Guess what? It doesn't. That's what the FPP is about.

It's almost like some folks are so uncomfortable with the notion that any woman could possibly have it even marginally worse than a man that they feel the need to loudly deny the existence of gendered phenomena even when presented with clear evidence to the contrary.
In low-income white communities of the South, it is still women who are responsible for the home and for raising children, but increasingly they are also raising their husbands. A husband is a burden and an occasional heartache rather than a helpmate, but one women are told they cannot do without. More and more, data show that poor women are working the hardest and earning the most in their families but can't take the credit for being the breadwinners. Women do the emotional work for their families, while men reap the most benefits from marriage. The rural South is a place that often wants to remain unchanged from the 1950s and 1960s, and its women are now dying as if they lived in that era, too.
This was also my experience growing up poor and white in the rural North, to the extent that it was a bit eerie to read it in an article like this. Especially once we made it to the projects, I heard many women complain a great deal about the amount of thankless work required to "keep" a husband and have/raise kids, but they remained convinced -- even in the face of extreme physical and psychological violence, grinding poverty, and the seeming impossibility of gainful employment -- that they absolutely could not survive without both. No matter how exhausted they were by the ongoing needs of their husband and children, they just kept on keeping on. I'm the oldest of five because my mom didn't know she could just opt out, and once she was burdened with me, well...

This attitude was universalized to the extent that more than a couple of women who clearly hated children decided to have them anyway "because it's what you do." They dropped out of school, married layabouts and/or abusive assholes who screamed at and beat their kids, divorced them and married different layabouts and/or abusive assholes, the results of those couplings went on to have kids of their own, parents were often kept out of the workforce for years at a time because there were kids to raise, and the cycle continued.

I still believe that the only reason I was able to make it on my own is because I've steadfastly refused to get married or have babies since the moment it became clear that it was expected of me as a poor and uneducated woman. Even my goddamn guidance counselor asked me which year of high school I was planning on having my first child. In line with my family before me, I dropped out at 16.

It's interesting to contemplate whether or not I'll have the same drastically shortened life span as my forebears because I'm very different from them in a lot of ways (childless, single, working full-time, longtime/current vegan, never smoked a day in my life), but I still "act poor" even more often than I realize, and just like the folks I know who never made it out of the projects, I wouldn't know how to stop even if you told me.
"If you are a woman, and you are a poorly educated woman, opportunities for you are next to nothing. You get married and you have kids. You can't necessarily provide as well as you'd like to for those kids. Oftentimes, the way things are, you're better off if you’re not working. You get more help. You get better care for your kids if you're not working. It's a horrible cycle.

"You don't even hear about women's lib, because that's come and gone. But you hear about glass ceilings, and I think girls, most especially girls, have to be taught that just because they're girls doesn’t mean they can't do something. That they are just as smart, that they are just as valuable as males. And we have to teach boys that girls can be that way, too. They all need the love, nurturing, and support from somebody from their family or who's not their family. Somebody who's willing to step up. There has to be something to inspire kids to want more, to want better. And they have to realize that they're going to have to work hard to get it. I don't know how you do that..."
posted by divined by radio at 1:22 PM on September 3, 2013 [37 favorites]


Some interesting comments from this fascinating and depressing article, suggesting isolation and lack of employment play a big part:

Researchers have long known that high-school dropouts like Crystal are unlikely to live as long as people who have gone to college. But why would they be slipping behind the generation before them? James Jackson, a public-health researcher at the University of Michigan, believes it’s because life became more difficult for the least-educated in the 1990s and 2000s. Broad-scale shifts in society increasingly isolate those who don’t finish high school from good jobs, marriageable partners, and healthier communities. “Hope is lowered. If you drop out of school, say, in the last 20 years or so, you just had less hope for ever making it and being anything,” Jackson says. “The opportunities available to you are very different than what they were 20 or 30 years ago. What kind of job are you going to get if you drop out at 16? No job.”

and

Julie knows a lot of young women who will never break the cycle. She has her own thoughts about what might be dragging down their life expectancy. “Desperation,” she says. “You look at the poverty level in this county—I love this place. It’s where I’m from. I don’t want you to think I’m being negative about it.” But she gestures toward the highway and notes how little is there: a few convenience stores, a grocery, and a nursing home. You have to drive north to the county seat in Ash Flat for a Walmart, or you can negotiate traffic in Batesville, where you might get a job at the chicken plant or a fast-food restaurant. “If you are a woman, and you are a poorly educated woman, opportunities for you are next to nothing. You get married and you have kids. You can’t necessarily provide as well as you’d like to for those kids. Oftentimes, the way things are, you’re better off if you’re not working."
posted by bearwife at 1:22 PM on September 3, 2013 [1 favorite]


I'm not saying they're endangered, only positing that they're the most likely class to suffer from domestic abuse and yet stay in the marriage - and also the most likely class for people to overlook or write that kind of thing off rather than making a headline out of it.

Numerous studies conclude very differently (black and Hispanic women as Most Likely).
posted by Kruger5 at 1:24 PM on September 3, 2013


No discussion of the Hispanic paradox? This isn't quite the first time that public health researchers have discovered a pair of large U.S. demographics for which one group does better by most economic indicators but the other group has a greater life expectancy.

AFAIK much of the greater Hispanic life expectancy has to do with lower smoking rates, though; I doubt that applies here.
posted by roystgnr at 1:25 PM on September 3, 2013 [1 favorite]


I would hazard the guess that it has a lot more to do with the types of healthcare that used to be available versus what is currently available.

Most of my mother's family is very poor, and until her generation, most of the women died in their 50s. My mother's generation, even the ones who never graduated high school, were able to find jobs in their poverty stricken section of the South that at least had some nominal healthcare. My mother's female cousins are all in less than perfect health, but have some level of healthcare due to previous employment and state assistance. They're all in their late 60s and still trucking on.

Their daughters, on the other hand, have none. Out of 15 grandkids on that side of the family, only two have health insurance of any kind. One is in the military and the other married into the military. Even those on that side of the family who have "made it", i.e. have an associates or bachelors, don't have jobs that grant them full medical insurance. Two of my second cousins have died of diabetic or pregnancy complications before they were 40. Another two are morbidly obese and I can't imagine they have the ability to get the medical care they need to treat it.

My mother and two of her cousins have beaten breast cancer, but as far as I know, I'm the only one in the following generation who has even had a mammogram. I think a combination of rising standard of health for the middle class and a decreasing standard of healthcare for the poor is the major contributing factor.
posted by teleri025 at 1:26 PM on September 3, 2013 [10 favorites]


Hey, everyone here who's not a poorly educated, impoverished white woman, let's all hypothesize about why their life expectancy has declined based upon whatever random thing comes to mind, pulled from our vast experience with the topic from reality television and various stereotypes! It'll be fun!

Also, let's joke about cats being involved, because poor women and cats, haha, amiright?
posted by Ivan Fyodorovich at 1:30 PM on September 3, 2013 [9 favorites]


EmpressCallipygos: I think you're under the impression that the number of domestic violence deaths is a lot higher than it actually is. Something like 1000 women are killed by their partners every year. Every single one of those is a tragedy that should not have happened. But, statistically, even if every one was of a poor white woman (and many of them are not) it is not enough to significantly affect life expectancy given that well over a million women die each year. It doesn't even appear to be in the top fifty causes of death.
posted by Justinian at 1:31 PM on September 3, 2013


Yeah, since we're just pulling random guesses out of thin air I'm gonna go with a couple other people and guess obesity-related issues.
posted by Justinian at 1:33 PM on September 3, 2013


"Bullshit, this issue affects men and women equally!" Guess what? It doesn't. That's what the FPP is about.

It's almost like some folks are so uncomfortable with the notion that any woman could possibly have it even marginally worse than a man that they feel the need to loudly deny the existence of gendered phenomena even when presented with clear evidence to the contrary.
According to the graph in the journal article, the least educated white men saw a 3 year drop in life expectancy while the least educated white women saw a 5 year drop... which left the men's life expectancy at around 67 years, and the women's at around 73.
posted by roystgnr at 1:36 PM on September 3, 2013 [2 favorites]


Hey, everyone here who's not a poorly educated, impoverished white woman, let's all hypothesize about why their life expectancy has declined based upon whatever random thing comes to mind, pulled from our vast experience with the topic from reality television and various stereotypes!

did you know that some of us actually live in towns and small cities where poorly educated, impoverished white women are common?
posted by pyramid termite at 1:37 PM on September 3, 2013 [2 favorites]


Hmm. I would say that the stressors on that particular demographic are even greater than in the past. In North Carolina, the plants and factories that employed these women are disappearing and have been for some time. Health care is becoming more expensive, and harder to access. I don't think it's one big thing, I think it's a lot of little things, coming together.

As to why the African American women are doing better, there may be some cultural issues in play, I don't know.
posted by St. Alia of the Bunnies at 1:38 PM on September 3, 2013


Guess what? It doesn't. That's what the FPP is about.

As roystgnr points out, life expectancy is still significantly lower for least educated white men than for white educated white women. So a lot of these issues affect men more than women. The reasons for that are complicated and difficult.

What this FPP is about is the sudden change in the life expectancy of uneducated white women which is disturbing and needs to be studied more. But it isn't a claim that they are suddenly the demographic with the worst life expectancy.
posted by Justinian at 1:40 PM on September 3, 2013 [2 favorites]


Domestic violence can be an indirect cause of death. Just, y'know, as a college-educated white woman who left her abusive ex, he wasn't what nearly killed me, it was finding myself suddenly homeless (he'd lied about my name being on the lease; it wasn't), and due to several systematic factors that set me in a precarious position where there were no shelters, there was no housing law that would have protected me, I was a freelancer so couldn't easily rent in the then-foreign (now citizenship home) country I was (am) in, I could not return to my similarly-abusive family... it was that homelessness and precarity that very nearly got me. My family had also very nearly done me in through neglect, but I was saved by socialist healthcare in Finland. Healthcare I would not have sought in the US, because I could not have afforded it in the States.

Domestic violence is a very real indirect cause of death as well as a real one. And the effects of systemic denigration of women are across the board. No one taught me that I could get an ovarian cyst in high school health class. Yet a torsioned, burst one was what I nearly died from in Finland. I'd have borne the pain and died in my sleep from hemorrhaging if I'd been in the US.

Also, yeah, count me in as someone who is both friends with and related to women (of many colors, some white) who dropped out of high school. So many of them have been raised to denigrate their needs in favor of others', it's really not a stretch to think it could be a cause. Now, if only domestic violence could be researched as the indirect link it is, that would be helpful...
posted by fraula at 1:41 PM on September 3, 2013 [12 favorites]


Look, domestic violence is a scourge. But it's simply not enough of a cause of death (directly or indirectly) to lead to a significant drop in life expectancy. Cancer, heart disease, and other stuff kills far too many people for that.
posted by Justinian at 1:44 PM on September 3, 2013 [3 favorites]


Yeah, since we're just pulling random guesses out of thin air I'm gonna go with a couple other people and guess obesity-related issues.

Did obesity rates increase dramatically enough among poor white women as a group between 1992 and 2006 to explain the effect though?

This study does bear out the idea that obesity rates among whites have been increasing generally in that time frame, but it's not clear whether or not the increases are enough to account for this effect. And:

Blacks (especially women) had a consistently higher BMI than their white counterparts. Although white women remained the leanest group throughout the study period, their mean BMI was above 26 kg/m2 at the end of the study.

The study definitely seems to suggest obesity rates have been increasing more rapidly among less educated white women in the time period observed (1997--2008).
posted by saulgoodman at 1:45 PM on September 3, 2013


"Disparities in mortality across the eight Americas, each consisting of millions or tens of millions of Americans, are enormous by all international standards. The observed disparities in life expectancy cannot be explained by race, income, or basic health-care access and utilization alone. Because policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the US, health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries."

I'll quote this again for emphasis: The observed disparities in life expectancy cannot be explained by race, income, or basic health-care access and utilization alone.
posted by rtha at 1:53 PM on September 3, 2013 [8 favorites]


For the record, my question was not rhetorical, it was a legitimate question. Which I now considered answered, and I thank you all and please everyone chill because you're scaring me now
posted by EmpressCallipygos at 1:54 PM on September 3, 2013 [1 favorite]


We could talk about cancer and heart disease some more. That will make you feel better!
posted by Justinian at 2:00 PM on September 3, 2013


My gosh--something just occurred to me, guys! This just blew my mind, and it might blow yours, too! What if there's no single cause for the changes in life expectancy, but a constellation of related and unrelated factors that are all converging in a way that has the effect of creating a large, measurable change at the aggregate level? In fact, what if, in general, problems sometimes have multiple contributing causes, none of which can be easily reduced or singled out as the solely most important factor in the observed effects? Like, what if even simple old obesity were that kind of problem?

/robble robble
posted by saulgoodman at 2:06 PM on September 3, 2013 [14 favorites]


That's just crazy talk, saul.
posted by Justinian at 2:19 PM on September 3, 2013 [2 favorites]


The author talks a lot about a 38-year old woman named Crystal who died recently. When statisticians calculate life expectancy, does anyone know how long they wait? Did Crystal's death move any statistic this year, or do we have to wait until everyone born the same year as Crystal dies before we have a reliable number? What if most of Crystal's cohort, who are still alive, live to be 90?

I'm curious, because depending on the answer, the decreased life expectancy number either signals something that happened a long time ago, or something that is happening right now.
posted by Triplanetary at 2:27 PM on September 3, 2013


Ok. So here's a basic synopsis of the 2012 Health Affairs Article, as well as some information on subsequent studies:

Olshansky, S. J., Antonucci, T., Berkman, L., Binstock, R. H., Boersch-Supan, A., Cacioppo, J. T., … Rowe, J. (2012). Differences in life expectancy due to race and educational differences are widening, and many may not catch up. Health affairs (Project Hope), 31(8), 1803–13. doi:10.1377/hlthaff.2011.0746


  • Methods:
  • Results:
    • The Big Points
      • Women live longer than men for all levels of education. Duh. We've known this for some time, but this information bolsters the argument that these methods aren't completely shit from right out the gate.
      • "For those with less than a high school education, white males and white females experienced a consistent pattern of decreasing longevity, while blacks and Hispanics of both sexes exhibited increasing longevity."
        • Between 1990 and 2008, nonhispanic white least-educated female life expectancy at age 25 decreased from 54.5 to 49.2 (additional years, as in 25+54.5), a decrease of 5.3 years. Men of the same demographic group went from 47 to 43.6, a decrease of 3.4 years. Poorly-educated blacks stayed about the same and poorly-educated Hispanics gained about 4.6 years.
        • For the highest-educated strata, white women increased their life expectancy between 1990 and 2008 from 56.4 to 59.7 years (+3.7 years), while white men went from 52.1 to 56.7 (+4.6 years). Black females 51.7→56.6 (+4.9); Black males 46.3→53.2 (+6.9); Hispanic females 58.8→61.3 (+2.5); Hispanic males 52.6→59 (+6.4). There are tons more numbers to crunch in the appendix.
    • Ancillary Stuff
      • Hispanics have the highest life expectancy at birth, though Hispanic immigrant mortality is between 10-20% lower than native-born Hispanics. Take this with a few grains of salt: immigrants tend to be among the healthiest and best-educated members of the populations from which they come.
      • The largest disparities, at 14.2 and 10.3 years respectively for males and females, were observed between the highest-educated whites and the lowest educated blacks.
      • Higher education had a protective effect of between 2.9y and 12.9y, varying by sex and race/ethnicity.
  • Olshansky's discussion:
    • Possible explanations:
      • "The disparities appear to be related to educational attainment and its socio-economic correlates of income and wealth." Olshansky goes on to say that "at least two Americas have formed, with notably different longevity prospects."
      • There may be an additional direct effect of education on health/longevity even after controlling for socioeconomic status, but that's a discussion for a bunch of other papers and not this one.
    • The benefit of a college education over a high school diploma is less than the benefit of a high school diploma over less than 12 years of education.
    • The highest-educated blacks and Hispanics lived upwards of a decade longer than the least-educated whites, but still lag behind highest-educated whites. Because these disparities continue across all age strata, we can't really blame the greater infant mortality rates among minorities. The author suggests that it may have something to do with accumulated life-long stress.
    • Olshansky thinks that a good solution to this disparity is to implement "public policies that encourage life-long learning for people of all races and ages," in an attempt to help catch up those who fell through the cracks.
    Since the publication of this article in 2012, there have been a couple other pubmed-indexed papers that cite Olshansky's work:
    • Begier, Li, and Meduro published a letter in the April issue of Health Affairs challenging Olshansky's findings and suggesting that some of the disparity may have been due to the fact that a higher percentage of people graduated high school in 2008 compared to 1990. As such, Begier points out that "increasing mortality rates among nongraduates may reflext the fact that healthier people are moving into higher educational brackets. They are pointing out what's known as a secular trend. Olshansky himself replied in the most recent edition of Health Affairs, agreeing that "changing characteristics of the least educated population might account for the decline in life expectancy [Olshansky's team] observed," and that "if the higher death rates we observed were caused by the population's becoming smaller and increasingly disadvantaged, this does not change the fact that life expectancy is lower for this population. It merely explains, in part, why this is so." He then goes on to encourage Begier &al to go do their own goddamn study.
    • Antonucci et al (free paper!) focused on the obesity angle and fleshed out an ecological model for a full-court press on obesity and the encouragement of physical activity over the next decade or so.
    • Montez et al wrote a one-page policy brief that recommends focusing on the employment angle through the implementation of work-family policies such as paid parental leave and subsidized child care. Montez also writes that "[c]ontinued policy efforts to reduce smoking may also stem the growing longevity gap. However, these efforts must go beyond conventional tobacco controls oriented at changing individual behavior and instead address the adverse conditions faced by low-educated women that shape smoking behavior."
    • Brown et al (another free paper!) asked whether or not the projected life expectancy at old-age also differed significantly according to educational attainment. This introduces the interesting but ancillary topic of mortality compression, a topic on which Olshansky has written a couple other papers.
    Phew. That's more than I'd originally planned on typing. I'll withhold my own opinions on the matter; there's plenty of data here for you all to go generate your own.

    • posted by The White Hat at 2:44 PM on September 3, 2013 [26 favorites]


    I'll withhold my own opinions on the matter

    THAT'S NOT HOW WE DO IT HERE WHITE HAT
    posted by sandettie light vessel automatic at 2:46 PM on September 3, 2013 [5 favorites]


    From working with adults in crisis I strongly suspect it's what's floated in the article: linked opioid and opiate use. It aligns with race because of the way race influences access to health care, which triggers dependency in adults.

    This sounds weird, right? How can being able to see a doctor be a risk factor? Well, that's what happened during the period when physicians were assured oxycontin was a safe way to treat pain. (And I would not be surprised that oxy prescriptions as an SOP were more prevalent with low income patients.) Beyond the addicts created by people with legitimate prescriptions, this created informal networks of dealing and use that eventually hardened into an aspect of the drug trade, especially when addicts made up for supply shortfalls by self-medicating with traditional drugs.

    Why women? I would say it's because of another ironic factor: Women are more likely to seek out medical care than men. Men fall prey to a whole other host of risk factors because they suck at going to the doctor. Furthermore, women are more likely to be diagnosed for the chronic pain conditions that lead to prescriptions like Oxy. Men are probably still more likely to be addicts, but I suspect these factors have led to a measurable spike in addiction among poor white women. This study predictably reports higher levels of male drug abuse, but interestingly notes women are more likely to report past abuse, and engage in drug hoarding.

    While everybody knows about Oxy now, I think they really, really tend to underestimate how much of a bomb it dropped on communities. If we were to look at it frankly, it represents massive, systemic abuse of the poor by an axis of medical and pharmaceutical interests who didn't look very closely at what they were doing.
    posted by mobunited at 2:49 PM on September 3, 2013 [2 favorites]


    The headline makes it sound like the poorest white women have been losing life expectancy.

    However, the percentage without a high school diploma is not fixed and it wouldn't mean the same thing in a context where it's expected as it does in one where it's an optional extra.
    posted by PJMcPrettypants at 2:55 PM on September 3, 2013 [2 favorites]


    ...and apparently someone called Begier said basically that but better. Thanks The White Hat.
    posted by PJMcPrettypants at 3:01 PM on September 3, 2013


    According to the graph in the journal article, the least educated white men saw a 3 year drop in life expectancy while the least educated white women saw a 5 year drop... which left the men's life expectancy at around 67 years, and the women's at around 73.

    Are there numbers for life expectancy after 40 or the like? Because if you have two groups that, one of which has a higher younger death rate (men in this case I suspect) but both are dying younger if they make it past the dangerous young years the group that had a lower expectancy to begin with would not drop as quickly, because averages work unintuitively.
    posted by aspo at 3:26 PM on September 3, 2013


    My state has a big oxy problem. I don't have the cite handy, but when the causes for oxy addiction were examined, it turned out that a big part of the problem was having to work even while injured; if you don't have sick days, well, you can't take the time off to heal from that separated shoulder or whatever, you just have to keep working. And the way to keep working is to keep taking your oxy. Eventually, you just. . . keep taking the oxy. This is a problem for blue-collar workers, but it's even MORE of a problem for women who are at home taking care of kids. A tilemason might not get paid if he doesn't go to work, but he won't go to jail for child neglect.
    posted by KathrynT at 3:46 PM on September 3, 2013 [10 favorites]


    I was WAY off; my guess was mutant alligators.

    Someone's getting ready for the new Pynchon book.
    posted by ersatz at 3:48 PM on September 3, 2013 [1 favorite]


    apso: male death rates are higher across the board for all ranges. Men are more likely to die than a woman of the same age from the moment of birth onwards. See data from 2005 for example.

    Your theory is a decent one but turns out not to be the case. You are correct that young men have a much higher death rate than young woman but the absolute number of deaths is still too low to have a huge impact on life expectancy; the lower life expectancy isn't a statistical artifact, it really does mean what it implies. Men die younger even once they outlive their foolish risk-taking youth.
    posted by Justinian at 3:49 PM on September 3, 2013 [2 favorites]


    >So you'd argue that there hasn't been a "just and stable society" in human history?

    Not only would I argue that, I'd damn well expect you to agree with me.

    Quite. But he wouldn't: I'd argue that we had it, in this/American society, throughout much of the 20th century.

    My point is that defining "just and stable society" in a way rules out all human societies in history is not really a great basis from which to argue for policy changes. Which is what the linked commenter probably wants to do, but not at all what I want to do.
    posted by valkyryn at 4:12 PM on September 3, 2013 [1 favorite]


    Hunh---ROU_Xenophobe's and valkyryn's comments make for a really interesting political theory contrast. Explains a lot, actually.
    posted by ThatFuzzyBastard at 11:45 PM on September 3, 2013


    Uneducated white women are seeing a slowing in the trend of longer life expectancy which our country has followed in the last 50 years...and the reason in my opinion is that they are still working themselves to death sun up to sundown unlike other groups who have had improvement in that aspect of life...being poor takes its toll on your body. The article does not say that life expectancy is going down for anyone though...does it?
    posted by OhSusannah at 2:59 AM on September 4, 2013


    There is a comment on the Prospect thread that points out that the % of adult white women who never completed HS dropped from 21% to 12% from 1990 to 2008. So the relevant population in 2008 may be quite different from the relevant population in 1990.
    posted by leopard at 6:41 AM on September 4, 2013 [2 favorites]


    The article does not say that life expectancy is going down for anyone though...does it?

    Eh, that's exactly what the article says. Which is why it's good to read the articles!
    posted by Justinian at 9:33 AM on September 4, 2013


    I wonder if there's an underlying current of untreated mental health issues here too. High levels of smoking, painkiller addictions etc... are often symptoms of depression and similar problems.

    If the poor, and poor women in particular, have trouble making use of medical care for obvious and physical issues, how much harder is it to get help for the invisible ones?

    Is untreated mental illness, triggered by increasing economic stress, a significant factor in lowering life expediencies? Women are nearly twice as likely as men to have depression. The circumstantial indicators are suggestive.
    posted by bonehead at 10:04 AM on September 4, 2013


    There is a comment on the Prospect thread that points out that the % of adult white women who never completed HS dropped from 21% to 12% from 1990 to 2008.

    If the drop really was that large, then I'd have to say that probably accounts for the change. That would make this result really look like more of a stastical chimera than anything more substantial.
    posted by saulgoodman at 2:41 PM on September 4, 2013


    Erm... Statistical, of course.
    posted by saulgoodman at 3:55 PM on September 4, 2013


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