The numbers are even starker when stratified by race. In the most recent years studied, a black man in Appalachia could expect to die about three years earlier than a white man in Appalachia and a year younger than a black man elsewhere. A black man living in a high-poverty area in Appalachia could expect to die a full 13 years younger than a typical white woman in a low-poverty area elsewhere in America. That’s roughly the life expectancy difference between the United States and Rwanda.
Most of this gap is attributable to deaths among people younger than 65. Half of the life-expectancy gap is attributable to smoking, and another 6 percent could be explained by drug overdoses. The rest of the gap could be explained, in large part, by ailments like cancer and heart disease—to which poor nutrition and obesity can contribute.
“For all of these things—obesity, smoking, and health-care access—the disparities between Appalachia and the rest of the country have been growing,” Singh said.
To him, the poor health is a symptom of joblessness, social isolation, and the attendant psychological distress. “Calorie-dense foods are much less expensive, and they tend to be less healthy, which then contributes to obesity, which contributes to an increased risk of hypertension,” Kogan said. And that, in turn, increases a pregnant woman’s risk of having her infant die.
This study echoes other recent findings that paint a bleak view of the health of low-income Americans. American life expectancy recently declined for the first time since 1993, the height of the AIDS epidemic. One recent paper showed the eight counties with the largest declines in life expectancy since 1980 are all in the state of Kentucky.
Zeb Hampton, manager at the J.W. Call funeral home in Pikeville, Kentucky, said recently young people have been leaving the region to go to college—and never coming back. Among those who stay, some fall into unhealthy habits, like smoking, a poor diet, and drugs. He’s seen more 30-, 40-, and 50-somethings dying of overdoses in the past five years. Many of the victims lack life insurance, he said, so the families struggle to pay for the funeral—a problem Reger said is common in Huntington, as well.
“It used to be families would all pitch in and help take care of a funeral service,” Reger said. “Their incomes are so limited that they don’t have that ability anymore. They want to take care of their loved ones, so they do the best they can.”