What’s Killing Poor White Women?

Monica Potts, The American Prospect, September 3, 2013


Everything about Crystal’s life was ordinary, except for her death. She is one of a demographic—white women who don’t graduate from high school—whose life expectancy has declined dramatically over the past 18 years. These women can now expect to die five years earlier than the generation before them. It is an unheard-of drop for a wealthy country in the age of modern medicine. Throughout history, technological and scientific innovation have put death off longer and longer, but the benefits of those advances have not been shared equally, especially across the race and class divides that characterize 21st–century America. 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.

The journal Health Affairs reported the five-year drop in August. The article’s lead author, Jay Olshansky, who studies human longevity at the University of Illinois at Chicago, with a team of researchers looked at death rates for different groups from 1990 to 2008. 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. Previous studies had shown that the least-educated whites began dying younger in the 2000s, but only by about a year. Olshansky and his colleagues did something the other studies hadn’t: They isolated high-school dropouts and measured their outcomes instead of lumping them in with high-school graduates who did not go to college.

The last time researchers found a change of this magnitude, Russian men had lost seven years after the fall of the Soviet Union, when they began drinking more and taking on other risky behaviors. Although women generally outlive men in the U.S., such a large decline in the average age of death, from almost 79 to a little more than 73, suggests that an increasing number of women are dying in their twenties, thirties, and forties. “We actually don’t know the exact reasons why it’s happened,” Olshansky says. “I wish we did.”

Most Americans, including high-school dropouts of other races, are gaining life expectancy, just at different speeds. Absent a war, genocide, pandemic, or massive governmental collapse, drops in life expectancy are rare. “If you look at the history of longevity in the United States, there have been no dramatic negative or positive shocks,” Olshansky says. “With the exception of the 1918 influenza pandemic, everything has been relatively steady, slow changes. This is a five-year drop in an 18-year time period. That’s dramatic.”


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.”

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: economic indicators like employment and income, whether women were married and how educated their spouses were, and health behaviors like smoking and alcohol abuse. It is well known that smoking shortens life; in fact, smoking led to the early deaths of both of Crystal’s parents and her sister and brother. Crystal, though, never smoke or drank. But the researchers discovered something else that was driving women like her to early graves: Whether the women had a job mattered, and it mattered more than income or other signs of financial stability, like homeownership. In fact, smoking and employment were the only two factors of any significance.

At first, Montez and her co-author suspected that women who are already unhealthy are less able to work and so are already more likely to die. When they investigated that hypothesis, however, it didn’t hold up. Jobs themselves contributed something to health. But what? It could be, the authors suggested, that work connects women to friends and other social networks they otherwise wouldn’t have. Even more squishy sounding, Montez wrote that jobs might give women a “sense of purpose.”

Better-educated women are the most likely to work and to achieve parity with men: Seventy–two percent are in the workforce, compared with 81 percent of their male counter-parts. Women without high-school diplomas are the least likely to work. Only about a third are in the workforce, compared to about half of their male counterparts. If they do find work, women are more likely than men to have minimum-wage jobs. They account for most workers in the largest low-paying occupations—child-care providers, housecleaners, food servers. Even if they do have minimum-wage jobs, this group of women is more likely to leave the labor force to take care of young children because child care is prohibitively expensive.


Another mystery emerged from the lifespan study: Black women without a high-school diploma are now outliving their white counterparts.

As a group, blacks are more likely to die young, because the factors that determine well-being—income, education, access to health care—tend to be worse for blacks. Yet blacks on the whole are closing the life-expectancy gap with whites. In a country where racism still plays a significant role in all that contributes to a healthier, longer life, what could be affecting whites more than blacks?

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. Meth and alcohol kill quickly. It could be that white women, as a group, are better at killing themselves.

Still, why would white women be more likely to engage in risky behaviors? Another theory is that the kind of place people live in, who is around them, and what those neighbors are doing play a central role. Health is also a matter of place and time.

In March, two researchers from the University of Wisconsin reported that women in nearly half of 3,140 counties in the United States saw their death rates rise during the same time period that Olshansky studied. The researchers colored the counties with an increase in female mortality a bright red, and the red splashed over Appalachia, down through Kentucky and Tennessee, north of the Cotton Belt, and across the Ozarks—the parts of the South where poor white people live. Location seemed to matter more than other indicators, like drug use, which has been waning. The Wisconsin researchers recommended more studies examining “cultural, political, or religious factors.”

Something less tangible, it seems, is shaping the lives of white women in the South, beyond what science can measure. Surely these forces weigh on black women, too, but perhaps they are more likely to have stronger networks of other women. Perhaps after centuries of slavery and Jim Crow, black women are more likely to feel like they’re on an upward trajectory. Perhaps they have more control relative to the men in their communities. 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.


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