America's Declining Well-Being, Health, and Life Expectancy: Not Just a White Problem

Peter A. Muennig, MD, MPH; Megan Reynolds, PhD; David S. Fink, MPH; Zafar Zafari, PhD; Arline T. Geronimus, ScD


Am J Public Health. 2018;108(12):1626-1631. 

In This Article


We undertook a critical cross-examination of the deaths of despair hypothesis. The United States has experienced what amounts to a social crisis that dates back to at least the 1980s. This crisis is reflected not only in various measures of worsening despair but also in declining relative life expectancy. It is a problem that has recently received a good deal of attention because Whites were identified as the primary victims. But it is a problem that is more extensive and more enduring than the White despair narrative can fully explain. As 1 example, the earlier crack and HIV/AIDS epidemic, neglected in the recent narratives about despair in the United States, also produced a decline in life expectancy in the United States. It is logical that groups with higher levels of disadvantage would be struck by declines in health first.[41]

However, the relative increase in various measures of despair recorded in the sociological literature and the relative decline in health and well-being in the public health literature also preceded this epidemic among Blacks. The epidemic of opioid-related deaths has brought renewed attention to this downturn. But middle-aged non-Hispanic Whites are not the core protagonists in the story, nor are opioids. Rather, it seems that the opioid epidemic is sitting on top of a much longer, and more poorly understood, decline in well-being in the United States.