It’s long been accepted fact that people are living longer in this modern era, and that’s true, except in one area: middle-aged white women, and the spike in deaths is particularly acute among rural women.
Among African Americans, Hispanics and even the oldest white Americans, death rates have continued to fall, but death rates have increased noticeably for white women in their 30s, 40s, and 50s, according to a recent study by The Washington Post. For example, the death rate has climbed by 30 percent for rural white women in their late 40s.
“The most extreme changes in mortality have occurred among white women, who are far more likely than their grandmothers to be smokers, suffer from obesity or drink themselves to death,” The Post noted. Though the statistics show decaying health for all white women since 2000, the trend was most dramatic for women in the more rural areas.
Individuals resorting to such “self-destructive” behaviors as heavy drinking or drug abuse may feel they have burdens unique to them, when in fact most other people have similar crosses to carry, said Katie Wojtalewicz, a St. James psychologist. But, they feel isolated and “stuck,” “spinning their wheels.”
Katie Lohse, community health manager for Public Health at Watonwan County Human Services, said she’s long been aware of the rising levels of “high risk” behaviors like drinking and drug abuse among this subset of the population, but she didn’t realize it was adding up to this many deaths nationwide. “I hadn’t seen the bigger picture put together.”
The decades-long shakeup in gender roles, with women routinely working full-time jobs and still being domestic caregivers, plus changes in rural America, like a disappearance of jobs, particularly in the manufacturing sector, have caused “a more stressful environment,” Lohse said. Fortunately, in Watonwan County, “we have great access to healthcare,” which many rural areas and small towns do not.
Some of the increase in deaths of rural white middle age women may be due to a question of “access” in rural areas, but it’s less a lack of facilities than a matter of cost said Julie Pace, nurse practitioner at Mayo Clinic Health System in St. James. Yes, there is access to healthcare, but is it affordable?
In rural areas, the spike in death rate among middle-aged white women first became apparent as far back as 1990, according to The Post. “Since then, death rates for rural white women in midlife have risen by nearly 50 percent.”
Pace said she was “somewhat surprised” by the findings, but “the bottom line is” getting individuals into medical centers to discuss their health and perform pivotal screenings. So many conditions, diseases, and illnesses can be prevented--or at least ameliorated--with early detection and care.
Though it’s important to note white women still live longer than white men and African-Americans, that advantage has shrunk drastically, and multiple factors may be culpable.
For example, drinking has increased among this subset of population, The Post found. Deaths of rural white women in their early 50s from cirrhosis of the liver have doubled since the end of the 20th century.
“Women of middle age are catching up to men on drinking,” Lohse said. “It’s definitely a concern.”
There can be a disconnect in perception when it comes to drinking, Pace said. Sometimes, patients will deny they have a drinking problem, but when asked by medical professionals how much they drink, they respond with amounts that anyone would consider excessive.
Alcohol abuse can be “masking anxiety and stress,” Pace said, and part of healthcare is managing stress. “We ask, we want to know how people are managing stress in their lives.”
Traditionally, hospitals and clinics were considered by many as separate spheres from mental health and therapists, but those “worlds” are now “connected,” Wojtalewicz said. “We are definitely tag-teaming with Mayo, [etc.,] especially in a rural area like this to make sure people don’t fall through the cracks--it would be a disservice not to.”
“I talk lifestyle all the time, and doctors talk” about mental health routinely, she added. “A lot of my referrals are from Mayo.”
The suicide rate is also climbing, according to a report released late last month by the National Center for Health Statistics. Though the overall suicide rate in the country increased by 24 percent from 1999-2014, the suicide rate among women ages 45–64 jumped an astounding 63 percent over that timeframe.
Economic concerns tend to be a major contributing factor in suicides, Wojtalewicz said. “Financial burdens are real, and they put intense stress on families...people feel they just run out of options.”
Suicide is hopelessness of change, and people “feel defeated,” she continued. And, while she can assist in many ways, she can’t change “environmental factors,” like making jobs return to rural areas, or helping families pay their heating bills.
Something that comes up often in her office, especially among the rural white middle-aged women contingent, is a peculiar social media phenomenon, Wojtalewicz said. Individuals see all the glory, happiness, and boasts of their friends, family, and acquaintances broadcast on platforms like Facebook and Instagram, and they begin to think everyone is having a perfect life except for them.
Indeed, a study published in the February 2015 edition of the journal “Computers in Human Behavior” found that, “Paying too much attention to your Facebook friends’ updates could be bad for your mental health,” according to The Huffington Post. “Researchers found that heavy Facebook use may make certain people experience feelings of envy, which in turn could lead to depression.”
In addition, January 2013 research from a pair of German universities indicated that both men and women feel pressure to portray themselves in the “best light” to their Facebook friends, according to Time. “The most common cause of Facebook frustration came from users comparing themselves socially to their peers.”
“A large part of my job is reassuring people how normal they really are,” Wojtalewicz said. “You give people permission and remind them that life can be hard.”
Another factor leading to increased mortality is a veritable obesity epidemic.
More than a third of adults in the United States are considered obese, The Post noted. The average American woman today weighs as much as an American man did in the early 1960s.
Obesity can lead to Type 2 diabetes, which can in turn cause organ damage, and high blood pressure and high cholesterol often accompany obesity, Pace said. Obesity also causes joint pain, which leads to a downward spiral of inactivity; if people are in pain, they don’t move about, which makes it nearly impossible to lose weight.
Chronic pain can easily lead to a rapid deterioration of mental health, Wojtalewicz said. When people can’t do things they’ve grown accustomed to, their quality of life is negatively impacted.
Wojtalewicz helps people “make Plan B work,” she said. “A lot of times, deep down, we know what would help us; if you feel you can work it out on your own, great, but if you can’t, ask for help.”
Public Health has for years been utilizing SHIP grants to foster healthier environments in communities, including trying to combat obesity with everything from walking paths to making more nutritious beverage choices, Lohse said. So much of what Public Health does is education, like teaching people the dangers of high risk habits, including, for example, smoking.
“Women in middle age also are more likely to smoke or to have smoked at some point in their lives, and smoking-related diseases are a huge factor in women’s mortality,” according to The Post. Lung cancer now kills far more women than breast cancer.
“It’s never too late to stop smoking,” Pace said. Even longtime smokers can derive immediate benefits from quitting.
Finally, Americans are being prescribed more prescription opioids than ever, and “people hooked on opioids often turn to street heroin, which gives the same effect and is cheaper,” according to The Post. This crisis is especially prevalent in rural areas.
A medical study last year reported that 90 percent of the people who tried heroin for the first time in the past decade were white, according to The Post. Meanwhile, overdoses from painkillers, heroin and other opiates have been rising faster among women.
Wojtalewicz said she wasn’t remotely surprised about the increase in abuse of opioids; intentions are often good when prescription painkillers are prescribed, but their use can quickly become “a slippery slope.” “We reach for the ‘coping strategies’ available to us.”
“People can think they’re above (becoming addicted), but it’s complicated,” she said. “We (too) often look to medications to take away a lot more problems than they are able to.”
Lohse was also not surprised to learn of the opiate abuse, as it’s “getting a lot of attention” at every level of public health. Opiate overdoses have become a major factor in rural southern Minnesota in recent years.
So, what can rural white middle-aged women do to avoid becoming part of this negative trend? Pace, Lohse, and Wojtalewicz all concur that seeking help and not trying to rectify everything on one’s own is paramount.
“There are a lot of women who feel they have barriers to healthcare,” Pace said, but healthcare providers can assist as long as patients are willing to discuss their struggles. For example, for those who can’t afford medication, “we can work with social services” to ensure patients receive adequate prescriptions.
“We have a large multi-disciplinary team that can help manage individual needs,” she said. But, too often, “so many of these things we just don’t know about.”
It’s pivotal patients come to a healthcare provider for annual appointments and screenings, like mammograms to detect breast cancer, colorectal screenings after age 50, cervical cancer screenings, blood pressure screenings, sexually transmitted diseases screenings, and depression screenings, Pace said. There’s an “evidence-based screening practice” for depression, for example, as depression is “a physical problem that manifests itself in a psychological way.”
Screenings and check-ups are crucial because so many health issues are “silent,” Pace said. “You may not know you have it.”
“Do not isolate yourself,” Wojtalewicz said. “Self-destruction is absolutely preventable.”
Lohse concurred, saying, “Being connected to your community is” a major plus in curbing this troubling trend. Only by individuals spreading the word to those they interact with can crucial information feed through to everyone.
Indeed, “you are the only one” who can reduce or eliminate the “stigma” around mental health, Wojtalewicz said. Only by bring these issues out into the open will people realize their struggles are not unique to them, and they’ll be more likely to see help if necessary.
Ryan Anderson can be reached at firstname.lastname@example.org and followed on Twitter @randerson_ryan