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Americans spend more on medical care than those in other wealthy countries, but we’re a lot sicker. "The Price We Pay" will explore the reasons for that and possible solutions to our health care crisis. Listen to "The Price We Pay" Tuesdays on WFAE's Morning Edition and All Things Considered. Also, we'll go deeper on some of the issues in this series on Charlotte Talks with Mike Collins.

In Places Like Rural NC, 'Deaths Of Despair' And Education Level Lead To Decline In Life Expectancy

Taylorsville, NC
Courtesy Gary Herman
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Taylorsville, North Carolina, is a small town about 60 miles northwest of Charlotte

This Part 3 of an 11-part series. Read the full series here.

Americans’ life expectancy declined a year-and-a-half last year because of the pandemic, according to the Centers for Disease Control and Prevention. But even before COVID-19 hit, Americans were dying younger than people in other wealthy countries — more than 3-1/2 years younger. And the gap has been growing.

Why? It turns out working-age Americans are dying prematurely. And you can learn a lot by looking at what’s happened in Taylorsville, a small community 60 miles northwest of Charlotte.

Cody Wingler was born and raised in Taylorsville, a town of 2,300 in largely rural Alexander County. He returned eight years ago, after getting his medical degree. He said he wants to serve the community that’s seen better days.

Cody Wingler
Courtesy Joan Malloch
Cody Wingler stands outside the shuttered factory where his grandmother worked in Taylorsville, North Carolina.

“This is the old Box Factory that sort of is no longer,” he said, standing outside the shuttered plant. ”You can look and see things aren’t really what they used to be, they’re not as well taken care of.”

The Box Factory is where Wingler’s grandmother worked. His parents worked in the town’s furniture factories, too. But a lot of those good-paying jobs are gone, and many health problems have worsened. Over the past 30 years, Alexander County lost 45% of its manufacturing jobs, and many communities in western North Carolina had steep losses, as well.

Suicides and premature deaths in Alexander County started to rise in the early 2000s, according to data from the CDC and the Robert Wood Johnson Foundation. Deaths from drug overdoses shot up as well, although they’ve dipped in the last few years according to state health data. And life expectancy in Taylorsville is two years shorter than the U.S. average.

Wingler says the lost jobs and premature deaths are connected.

“People who are in a place where there’s not a job, places where people don’t feel like they have the ability to move forward with their lives sort of go up the ladder … I would say that would increase the risk for all these things,” Wingler said.

Suicides, drug overdoses and alcohol poisonings have been described as “deaths of despair” by Nobel Prize-winning economist Angus Deaton. He initially found they were rising fastest among middle-aged, working class white people, but new data shows they’re increasing among minorities, too.

And the common factor, he says, is the lack of a bachelor’s degree.

“Education is becoming much more important in some ways than race,” Deaton said. “It’s still true that educated Blacks die earlier than educated whites, but those gaps have gotten very much smaller, and the gaps by education have become enormous.”

F1.large (1).jpg
Courtesy Proceedings of the National Academy of Sciences of the United States of America

Education And Health Are Linked

Only 13% of Taylorsville’s adults have a bachelor’s degree, compared to a third of the rest of the country. And the median wage is $30,659 a year.

It’s hard to measure “despair” says University of North Carolina’s Kathleen Mullan Harris. But she agrees that education levels are increasingly important predictors of health and longevity. Those with less training have diminished opportunities.

“This is a digital world and you need to have skills in technology and computer skills and there’s where the opportunities are,” Harris said. “So, you know, the high school education or less — you’re just not going to pick those things up.”

Harris led a recent National Academy of Sciences investigation into America’s rising mortality rates. Her team found it’s not just middle-aged workers who are hurting. The newest data show some of the largest increases in suicide, drug- and alcohol-related deaths are among younger workers without college degrees. And the problem is worse in rural areas.

Her team also found there’s another reason working-age Americans are dying younger: cardiovascular diseases caused by obesity. And those deaths are rising among younger people without degrees, too.

“What’s alarming about that, I think these things are going to get worse,” Harris said. “They’re entering their work ages with chronic disease and they’re going to carry this heavy burden of chronic disease through to adulthood. It has implications for families. You know, (the) major breadwinner may die.”

“The great majority of my patients have at least three comorbidities or if not more. There’s more diabetes, there’s more high blood pressure, and it’s not necessarily people that are in their 50s or 60s or 70s. I’ve got people in their 20s that that have diabetes.”
Cody Wingler, doctor in Taylorsville, North Carolina

Wingler worries about that in Taylorsville.

“The great majority of my patients have at least three comorbidities or if not more,” he said. ”There’s more diabetes, there’s more high blood pressure, and it’s not necessarily people that are in their 50s or 60s or 70s. I’ve got people in their 20s that that have diabetes.”

The United States has the dubious distinction of being the most obese of the world’s wealthy nations, according to OECD data. The obesity epidemic started here in the 1980s. The causes are complex, but researchers say the timing coincides with increasing availability of inexpensive, highly processed, high-calorie foods in the American market. And kids who grew up in environments with less exercise and lots of high-calorie foods are the most vulnerable.

“The longer a person is obese,” Harris said, “the higher their risk of developing these chronic conditions like hypertension, diabetes, high cholesterol and heart disease.”

Wingler agreed. “I think if they wanted to actually see their study in motion they could come to Taylorsville and watch,” he said

Processed Foods, Drugs And Job Losses

Wingler points to the fast food joints that dominate the town’s restaurant options. He says they are one reason rates of obesity, diabetes and stroke are all higher than the national average.

Availability of processed foods and drugs combined with job losses contribute to America’s rising rates of premature death among working-age adults.

But Deaton, the economist, said American health care gets some of the blame, too. The opioid epidemic is largely an American phenomenon. The pills were aggressively marketed by American drug companies who knew how addictive they were, and doctors overprescribed.

“It’s true that they pulled back when they realized what the devil was they let out of the bottle,” he said. But the addiction was created. “Then the drug dealers were waiting outside the pain clinic,” Deaton said.

And our medical care is responsible in another way, Deaton said. It’s high cost is a tax on U.S. employers — and that affects jobs.

“Take a big manufacturer,” Deaton said. ”They used to have all these support staff who were less educated people. So there were mail room operators, there were cleaners, there were food service workers.

“No big firms hire those people anymore and part of it is because it takes $20,000 a year for the health insurance.”

And when those jobs go away, a lot of people get hurt — like the residents of Taylorsville.

Next week, we look at why health care is so expensive.

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