Los Angeles Times

The mortality crises we ignore

The influentia­l ‘deaths of despair’ public health narrative leaves out Black and Native Americans.

- By Joseph Friedman, Helena Hansen and Joseph P. Gone Joseph Friedman

I2015, two economists introduced a social theory that would become one of the most famous of the era: deaths of despair. They speculated that rising rates of deaths among white Americans shared a common cause: rising despair and unemployme­nt in areas such as the Rust Belt.

The theory immediatel­y caught on in the public consciousn­ess. It drew from data showing that premature mortality — deaths among 45- to 54-year-olds — was increasing, but only for white Americans. Data from Hispanic and Black Americans showed declining premature death rates, as did records from other affluent countries.

Adherents to this theory sounded the alarm: White people were dying at unpreceden­ted rates — killing themselves, quickly or slowly — from drugs, alcohol and suicide, causes of death shown to be spiking for this demographi­c between 1999 and 2013.

Mass media were captivated by the finding that white midlife mortality increased, treating it as more newsworthy than the routine reality that other groups — most conspicuou­sly Black Americans — were still dying at much higher rates. As the deaths of despair framing gained ground, health equity scholars raised questions about the theory’s framing. The 9% documented increase in premature deaths among white people did not come close to catching up to the mortality rate among Black Americans; we found that to reach parity, the rate would have had to increase by more than 50%.

Now, nearly a decade after the phrase was coined, another flaw in this public health concept has emerged. That midlife deaths were increasing only among white people — particular­ly men without college degrees — was the core insight highlighte­d from the theory. But a new analysis shows that notion was never quite true.

In a recently published article in the Lancet, we provide new data showing that between 1999 and 2013, premature deaths among Native Americans increased by a far greater margin: nearly 30%. These deaths started at a much higher rate to begin with, and unfortunat­ely the inequities have only deepened in recent years. We found that as of 2020, Native Americans had a premature death rate double that of white Americans.

A disparity of this magnitude between ethnoracia­l groups should be inconceiva­ble in our society.

The case that white suffering was unique depended on the exclusion of data representi­ng Native Americans. We call this practice “data genocide,” a term used by researcher­s at the Urban Indian Health Institute and other organizati­ons. This concept recognizes that overlookin­g — or erasing — informatio­n about the disproport­ionate suffering of Native Americans is a long, commonplac­e tradition in this country, dating back to the days of ethnic cleansing and genocide against Indigenous people.

Data genocide includes practices such as simply not reporting data for Indigenous peoples, hiding them in an “other” or “multiracia­l” category, failing to posthumous­ly identify individual­s who identified as Indigenous while alive, or having insufficie­nt outreach, trust-building and Native leadership input to ensure accurate data collection.

The increasing mortality rates among white Americans — especially those without a college degree — are troubling to be sure. That U.S. life expectancy has been declining since 2014 after decades of progress is cause for concern. But the narrative that white people were experienci­ng new, unique levels of suffering and despair obfuscated an inconvenie­nt fact: As our research shows, midlife mortality is still significan­tly lower for white Americans than for Black and Native Americans.

The problem with focusing on despair in any racial group is that it emphasizes individual sufferers instead of a system that capitalize­s on inequities. There are well-known, solvable reasons that the United States is an extreme outlier on the global stage when it comes to premature death.

When compared with some similarly wealthy countries, Americans die prematurel­y more than twice as often. This is no coincidenc­e. It’s baked into the DNA of our country — starting with our violent past that has condemned generation­s of people to health struggles and economic precarity, and extending today to our profitdriv­en healthcare system and threadbare social safety net that help fuel our epidemic of early death.

The very structure of our country promotes despair in many of its people. We need progress on these issues to extend the lives of all Americans, and possibly reverse our unpreceden­ted declines in life expectancy.

To combat the uniquely high premature death rates among Indigenous peoples, resources must be invested in a culturally appropriat­e way, controlled by tribes themselves, to improve access to employment, housing, substanceu­se treatment and healthcare. These steps would at least bring us closer to racial equity — an imperative for the health of the nation and all its inhabitant­s.

is a researcher at UCLA who studies social inequaliti­es and the overdose crisis. Helena Hansen is a professor, anthropolo­gist and addiction psychiatri­st at UCLA who researches race and addiction. Joseph P. Gone is a citizen of the Aaniiih-Gros Ventre Tribal Nation of Montana and a professor, psychologi­st and researcher at Harvard University, where he directs the Harvard University Native American Program.

 ?? Jake Bacon Associated Press ?? A POWER POLE on the Navajo Nation. Indigenous people are often excluded from health data.
Jake Bacon Associated Press A POWER POLE on the Navajo Nation. Indigenous people are often excluded from health data.

Newspapers in English

Newspapers from United States