The new face of suburbia: Economic woes and early death

Getting lost in suburbia is taking on a grim new meaning in the U.S.

The nation’s suburbs, once the wellspring of the American Dream, now has the highest rate of premature deaths from drug overdoses, according to a new findings from the County Health Rankings, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Just a decade ago, America’s suburbs had the lowest rate of premature death from ODs. 

The spike in drug-related deaths is contributing to what County Rankings’ Marjory Givens said is setting off “alarm bells” among public health experts: More younger Americans are dying prematurely, especially those aged 15 to 44. The drug overdose epidemic is the top cause of early death among 25- to 44-year-olds, an age many people in this group traditionally buy their first homes and embark on careers. 

Yet for many adults, such achievements appear unobtainable, leading to what experts call “deaths of despair.”

The data on drug-related deaths in suburbia “is absolutely an interesting and troubling finding,” Givens, the deputy director of data and science for County Health Rankings, said. “Access to affordable health care is important, but we know it’s so much more than that. Social and economic factors are so important -- the ability to have a good job, having social and family supports.”

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Good jobs and the kind of social structure that propped up generations of Americans are fading in many areas of the country. Workers without college degrees have found themselves especially vulnerable to changes in the labor market. In the 1970s, Americans with only high school degrees could look forward to earning a steady, livable wage with benefits, but those days are long gone. 

White Americans without college degrees are suffering from “deaths of despair” after years of weak demand for their skills and stagnant wages, according to research from Princeton economists Anne Case and Nobel Prize winner Angus Deaton. Earlier this month, they noted the phenomenon had spread across the country, touching both rural areas and cities.

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The impact of globalization, intensified by trade policy that effectively pits American workers against their lower-wage peers around the world, isn’t limited to suburbia. 

Economists Peter Schott of the Yale School of Management and Justin Pierce of the Federal Reserve have found that mortality rates spiked in counties around the U.S. that suffered the greatest economic disruption after trade policy was changed to make it easier for manufacturers to ship jobs to China or for Chinese companies to do business in the U.S.

“What you see is that mortality rates rise and stay high in the most exposed counties,” Schott said, noting the spike in unemployment in those regions after the U.S. liberalized trade with China in 2000. The sharpest increase in death rates were found in communities in the Southeast and in New England where manufacturing jobs have evaporated.

“Trade policy is sometimes sold as everyone wins -- that’s clearly too simple a way of picturing it,” he said.

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Economic distress is prompting some Americans to look for relief in the form of drugs, alcohol and other unhealthy behaviors. The opioid crisis appears to be exacerbating these problems. 

“There’s a desire to escape from stress and anxiety and hopelessness and shame,” said Shannon Monnat, a sociologist at Pennsylvania State University. She noted that deaths from drug overdoses are highest among white men but are rising fastest among women. “Swaths of the country are doing pretty badly.” 

She added, “The evidence is growing stronger every day that income inequality is bad for health.”

The problems go far beyond white adults, the County Health Rankings found. While premature deaths due to drug overdose were highest among whites and Native Americans in 2015, the overall premature mortality rate -- including those due to suicide and homicide -- are highest among American Indians, Alaskan natives and blacks. 

The study also looked at people between 16 to 24, or what Givens calls an “invisible population.” One out of eight of this age group are considered disconnected from either the labor market or education market. Neither working nor in school, these young Americans are at higher risk for suffering from poverty and teen births, all of which can hurt their ability to become successful adults. More than one in five young adults in rural counties are considered disconnected, compared with slightly more than one in eight in the cities. 

“There is some sense of urgency here,” Givens said. “The communities with higher rates of youth disconnection are those those that have struggled with economic growth.”