Peter A. Muennig is with the Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY. Peter A. Muennig and Zafar Zafari are with the Global Research Analytics for Population Health Center, Mailman School of Public Health. Megan Reynolds is with the Department of Sociology, University of Utah, Salt Lake City. David S. Fink is with the Department of Epidemiology, Mailman School of Public Health. Arline T. Geronimus is with Health Behavior and Health Education, School of Public Health and the Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor.
Am J Public Health. 2018 Dec;108(12):1626-1631. doi: 10.2105/AJPH.2018.304585. Epub 2018 Sep 25.
Although recent declines in life expectancy among non-Hispanic Whites, coined "deaths of despair," grabbed the headlines of most major media outlets, this is neither a recent problem nor is it confined to Whites. The decline in America's health has been described in the public health literature for decades and has long been hypothesized to be attributable to an array of worsening psychosocial problems that are not specific to Whites. To test some of the dominant hypotheses, we show how various measures of despair have been increasing in the United States since 1980 and how these trends relate to changes in health and longevity. We show that mortality increases among Whites caused by the opioid epidemic come on the heels of the crack and HIV syndemic among Blacks. Both occurred on top of already higher mortality rates among all Americans relative to people in other nations, and both occurred among declines in measures of well-being. We believe that the attention given to Whites is distracting researchers and policymakers from much more serious, longer-term structural problems that affect all Americans.
虽然最近非西班牙裔白人的预期寿命下降,被称为“绝望之死”,这在大多数主要媒体上都占据了头条,但这既不是最近才出现的问题,也不仅限于白人。几十年来,美国的健康状况下降一直在公共卫生文献中有所描述,长期以来一直假设这归因于一系列恶化的社会心理问题,而这些问题并非白人所特有。为了检验一些主流假设,我们展示了自 1980 年以来,美国各种绝望指标是如何增加的,以及这些趋势与健康和寿命的变化有何关系。我们表明,由于阿片类药物泛滥,白人的死亡率增加,紧随其后的是黑人的可卡因和艾滋病毒流行。这两个现象都发生在所有美国人的死亡率已经高于其他国家的人群的基础上,也都发生在幸福感指标下降的情况下。我们认为,对白人的关注使研究人员和政策制定者忽视了对所有美国人都有更严重、更长期影响的结构性问题。