The mortality crises we ignore; The influential 'deaths of despair' public health narrative leaves out Black and Native Americans.
S E E D E D C O N T E N T
In 2015, two economists introduced a social theory that would become one of the most famous of the era: deaths of despair. They speculated that rising rates of deaths among white Americans shared a common cause: rising despair and unemployment in areas such as the Rust Belt.
The theory immediately caught on in the public consciousness. It drew from data showing that premature mortality -- deaths among 45- to 54-year-olds -- was increasing, but only for white Americans. Data from Hispanic and Black Americans showed declining premature death rates, as did records from other affluent countries.
Adherents to this theory sounded the alarm: White people were dying at unprecedented rates -- killing themselves, quickly or slowly -- from drugs, alcohol and suicide, causes of death shown to be spiking for this demographic between 1999 and 2013.
Mass media were captivated by the finding that white midlife mortality increased, treating it as more newsworthy than the routine reality that other groups -- most conspicuously Black Americans -- were still dying at much higher rates. As the deaths of despair framing gained ground, health equity scholars raised questions about the theory's framing. The 9% documented increase in premature deaths among white people did not come close to catching up to the mortality rate among Black Americans; we found that to reach parity, the rate would have had to increase by more than 50%.
Now, nearly a decade after the phrase was coined, another flaw in this public health concept has emerged. That midlife deaths were increasing only among white people -- particularly men without college degrees -- was the core insight highlighted from the theory. But a new analysis shows that notion was never quite true.
In a recently published article in the Lancet, we provide new data showing that between 1999 and 2013, premature deaths among Native Americans increased by a far greater margin: nearly 30%. These deaths started at a much higher rate to begin with, and unfortunately the inequities have only deepened in recent years. We found that as of 2020, Native Americans had a premature death rate double that of white Americans.
A disparity of this magnitude between ethnoracial groups should be inconceivable in our society.
The case that white suffering was unique depended on the exclusion of data representing Native Americans. We call this practice "data genocide," a term used by researchers at the Urban Indian Health Institute and other organizations. This concept recognizes that overlooking -- or erasing -- information about the disproportionate suffering of Native Americans is a long, commonplace tradition in this country, dating back to the days of ethnic cleansing and genocide against Indigenous people.
Data genocide includes practices such as simply not reporting data for Indigenous peoples, hiding them in an "other" or "multiracial" category, failing to posthumously identify individuals who identified as Indigenous while alive, or having insufficient outreach, trust-building and Native leadership input to ensure accurate data collection.
The increasing mortality rates among white Americans -- especially those without a college degree -- are troubling to be sure. That U.S. life expectancy has been declining since 2014 after decades of progress is cause for concern. But the narrative that white people were experiencing new, unique levels of suffering and despair obfuscated an inconvenient fact: As our research shows, midlife mortality is still significantly lower for white Americans than for Black and Native Americans.
The problem with focusing on despair in any racial group is that it emphasizes individual sufferers instead of a system that capitalizes on inequities. There are well-known, solvable reasons that the United States is an extreme outlier on the global stage when it comes to premature death.
When compared with some similarly wealthy countries, Americans die prematurely more than twice as often. This is no coincidence. It's baked into the DNA of our country -- starting with our violent past that has condemned generations of people to health struggles and economic precarity, and extending today to our profit-driven healthcare system and threadbare social safety net that help fuel our epidemic of early death.
The very structure of our country promotes despair in many of its people. We need progress on these issues to extend the lives of all Americans, and possibly reverse our unprecedented declines in life expectancy.
To combat the uniquely high premature death rates among Indigenous peoples, resources must be invested in a culturally appropriate way, controlled by tribes themselves, to improve access to employment, housing, substance-use treatment and healthcare. These steps would at least bring us closer to racial equity -- an imperative for the health of the nation and all its inhabitants.
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Countries don’t have DNA, individuals do.
Which countries don’t have violence in their past?
We need to federalize all healthcare workers and end this MIC (Medical Industrial Complex).
There are a number of areas that affect NAs and their health care. IHS (Indian Health Services) is run by the US Government for medical care for NAs. This was based upon treaties where the government promised certain benefits in return for us signing over millions of acres of land along with the mineral rights that went with them.
As with many of the government promises IHS suffers from lack of funding and facilities. There is no fixed funding and it's at the discretion of congress and has been badly underfunded for generations. L ack of access to medical care is and has been devastating to NAs.
Poverty is another which has the same effect on many minority groups.
There are chronic diseases that affect us with deadly results. Diabetes is one and like many Indians I am a borderline diabetic. I don't drink and have always been careful of what I eat yet my whole life I've been along with many family members who either have diabetes or are borderline. It seems that if NA like many other indigenous people, Samoans for one when eating processed foods as a part of their diet all have diabetes. The rate in Samoa is 50% of the population same with Hawaiians and many PI people.
As mentioned NA are rarely addressed in studies of any kind it's why we are referred to as the ''Invisible People''.
There have been strides forward in combating diabetes, which is a good sign. COVID was devestating to NAs yet we had the highest vaccine rate of any group.
Unfortunately, NA's have been a part of the "invisible" culture since 1492 - unless - the dominant society needed/wanted something, so they just "took" if from the NA's.
Crime? 4 times higher than any other ethnicity. Rape/abuse - 4 times the national average - TB - 6 times the national average.
No one wants to produce/show the records because they know and realize that dominant society will not live up to their treaties - 'The law of the land" as stated in the U.S. Constitution.
Until the rest of "dominant society" FINALLY decides to abide by the law and by humanity, nothing's gonna change. Let'm all die - then we can have the other 56 million acres of land we've are slowly but surely taking from them 'cause "they don't deserve it and they don't use it" "Never saw a Red man I liked - better dead than Red. "
"(Gen Sherman in 1868)
The general is best known for his for his bloody march across Georgia, stealing livestock and intimidating civilians in one of the most famous campaigns of the Civil War. But after the war, he didn’t retire. Instead, he took his scorched-earth tactics to another war—one against Native Americans. Sherman’s leadership led not just to the extermination and relocation of thousands of indigenous people, but the annihilation of nearly all of the United States’ wild buffalo.
Like Tecumseh, Sherman was a savvy leader—but unlike the chief, he fought not to preserve Native American culture, but to destroy it.
Such has been/is the attitude of today's dominant society - get rid of them 'cause they bring up too many bad memories of our totally pizz poor "human dignity" and show of "caring" for our people.