By Noreen Goldman, Hughes-Rogers Professor of Demography and Public Affairs, Princeton University, US
Social scientists and the media have devoted considerable attention to two recent interrelated trends among American adults: an increase in substance abuse epitomized by the opioid epidemic and an increase in death rates, particularly for so-called “deaths of despair” – drug- and alcohol-related deaths and suicide. The focus of much of this work has been on the consequences of these trends for socioeconomic disparities in survival among white middle-aged Americans. Yet, although researchers frequently use the term “despair,” they have failed to examine whether the psychological health of Americans has deteriorated as drug use and mortality rates have increased.
Despite lower life expectancy than whites and historically higher rates of drug use, blacks have received little consideration in these studies of middle-aged mortality. Some commentators argue that this is the result of racism, whereas others attribute the focus on whites to differential trends by race. During the past few years, however, certain aspects of poor health among blacks have received increased attention from scholars and the media: extreme rates of maternal morbidity and mortality and high infant mortality. Unfortunately, researchers have had more success at eliminating from consideration potential sources of these racial disparities than in identifying the likely underlying causes.
I address both of these disturbing mortality patterns in my talk. First, I use two waves of a national survey to assess whether recent changes in psychological well-being mirror those of drug use and “deaths of despair” and whether socioeconomic differentials are consistent with patterns of widening social inequality in mortality. Second, I explore some of the reasons that blacks may have been omitted from this narrative. Finally, I use data on births in a 40-year period, with records linked across generations, to examine the change in birth outcomes (e.g., prevalence of low birthweight) between black immigrant women and their US-born daughters. The findings underscore the potential role of lifetime discrimination in producing the black disadvantage in birth outcomes and infant health.
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