photo by Flickr user mtneer_man
While presidential candidates and other politicians promise balm to a vaguely defined middle class that struggles to pay for health care and college education, the American working class is dying. Not rhetorically dying; literally dying.
A new Washington Post series, based on statistical analysis and humanized by on-the-spot reporting from the American heartland, tells the story. Since the start of the 21st century, death rates have soared for middle-aged white women and have stayed stubbornly high for middle-aged white men across a broad swath of rural and small-town America, even as those rates continue to decline in coastal urban areas and among other demographic groups.
The proximate causes of these premature deaths, and of the stunted and compromised lives that precede them, are easy to spot: smoking, poor nutrition, heavy drinking and the abuse of prescription, as well as illegal, drugs. These factors often appear in combination, making one another more deadly.
The underlying reasons for the surge in these problems are more difficult to tease out of the statistics, however. The way we interpret and prioritize those causes is apt to be as much a function of our political and economic philosophies as of the objective data we cite for our conclusions.
Agriculture has been a small and shrinking share of rural employment for decades. According to the Department of Agriculture, today’s farms are bigger but fewer – about 2 million compared to the nation’s peak of 7 million in the 1930s. Meanwhile, manufacturing jobs have mostly disappeared and gone overseas, and many of those that remain require a level of education and training beyond the reach of much of the local population. Older workers have had a particularly hard time finding decently paying jobs to replace those they lost in the Great Recession.
As the Post observed, hospitals are now one of the few major sources of employment in rural communities, but pressures to control health care costs and government spending have shut down many small-town hospitals, not only removing employment opportunities but also making access to care itself more difficult. Declining birth rates have led to school closures. The heartland’s young and educated population has largely migrated away, and those who remain are increasingly concentrated in a few larger urban islands, surrounded by thousands of square miles of spreading rural poverty.
It turns out that if small-town America can’t survive, neither can many of the people who live there.
The Washington Post reported on the death of Anna Marrie Jones, a 54-year-old woman from Oklahoma, as an illustration of the broader statistical trend. Jones died of cirrhosis of the liver, brought on by alcohol abuse; her family and friends speculated but disagreed on the root causes of her behavior. But it was clear that lack of opportunity and economic pressure had at least some role to play.
We can fault policy and ideology in both political parties for contributing to this disaster. Manufacturing has been destroyed by tax and labor policies that make it senseless to produce products in this country, especially if the products’ ultimate buyers live abroad. Immigration restrictions keep out millions of young adults from around the world who would jump at a chance to care for our sick and elderly, create and deliver goods, or build the homes and fill the schools that could revive our smaller communities. We cannot offer an efficient system of primary health care in smaller communities, many of which lack any doctors at all. And many of our rural schools, like many of their inner-city counterparts, are failing to train today’s young people for jobs that require some degree of proficiency in math, physical science and technology.
The Post series tells a story of human tragedy in these stunted lives. But it also tells a story of policy failure on an epic scale, and the human consequences accompanying that failure. While we continue to idealize a mostly mythological vision of small-town culture and values in some hazy long-ago era, today’s real small-town America is dying. The people who live there are dying along with it.