Lesly-Marie Buer
IN 2017, for the second time in recent years, U.S. life expectancy decreased. Headlines blamed the decline on suicides and opioids, and cast impoverished rural whites as the primary victims. A great deal of attention has been focused on Appalachia, whose population is (erroneously) portrayed as uniformly white, poor, and ravaged by drug addiction. White sickness has thus come to stand for what is supposedly wrong with health, health care, and culture in the United States.
The truth is not so simple. Black mortality rates continue to dwarf those of whites—another tragic indication of how our society has normalized racial inequality. In West Virginia, the state with the highest overdose death rate, the rate of overdose among blacks is slightly higher than among whites. In Tennessee, whites fare worse than blacks, but maybe not for long: from 2008 to 2016, the overdose mortality rate more than quadrupled among blacks compared to about a doubling among whites. Moreover, mortality rates increased for seven of the ten leading causes of death, with the highest percentage increase seen in influenza and pneumonia. Drug addiction, then, is not the easy explanation we have made it out to be. Income inequality, loss of social safety net services, and state violence against communities of color are also massive problems, a conclusion borne out by a large body of research. But by only focusing on class—those poor white Appalachians—most media reports ignore the racism, xenophobia, and LGBTQ discrimination found in every aspect of the U.S. health care system, from medical research to bedside care.