The blogger Evolutionistx had an interesting discussion of “What Ails Appalachia,” which discussed different hypotheses for West Virginia’s extremely high mortality rates for middle-aged whites, in the context of broader Appalachian poverty and social dislocation. West Virginia has the second highest death rate for middle-aged whites (after Mississippi), but is the poorest state for this group (income data taken from the 2013 CPS):
On the other hand, West Virginians have not done especially badly relative to their 1999 baseline in terms of income, even as their death rates have increased more than any other state:
For another example, West Virginia incomes for this group (45-54 YO Non-Hispanic Whites) have increased a comparable amount to Pennsylvania incomes, even as death rates in Pennsylvania barely increased at all:
And employment rates in Pennsylvania have decreased more than employment rates in West Virginia:
In fact, West Virginia is among the very few states which have increased their labor force participation since 1999, probably due to the general boom in resource demand:
The other major predictors of death rates I found, obesity and SSI-Disability receipt, tell a similar story: West Virginia has among the highest levels, but these values have not increased especially quickly in West Virginia relative to their increase elsewhere in the country, even as death rates have increased more quickly in West Virginia.
I don’t think this is a surprising finding, but it’s worth underlining: there’s a tendency to explain recent trends through recent changes, when in reality they may be the cumulative result of decades. The best book I read last year was Homer Hickam’s memoir Rocket Boys, which is about a West Virginia coal town coming together to push their most promising young men out of coalmining and likely out of West Virginia, because they know their town is going to die when the mine closes. The book takes place in 1958.
My belief is that the increases in death rates among middle-aged whites are exactly what they appear to be: suicide, drug overdose, and alcoholic cirrhosis, all three driven partly by chronic pain and isolation as well as easily available guns and legal and illegal drugs. Obesity may play a mediating role of increasing pain and making mobility difficult*, and SSI-Disability receipt may be both a consequence of actual pain and cause additional harm by enabling long-term isolation and detachment from the labor market. This does not mean that broader economic and social trends do not play a role. This could be the disappearance of the community ties that allowed Coalwood, West Virginia to come together so effectively in 1958 but might not do so today; or the decline of churchgoing or marriage, or other sad judgments that many have passed on working class whites. But these are not sudden or abrupt changes. They are bills that are being collected, with interest, after many years.
This is why I am much more pessimistic about the long-term effects of cash transfer programs than I am about their short-term costs (the kinds that can be measured through “well-identified” experiments or quasi-experimental designs.) The diminution of spirit caused by a world without work takes time, whether you are drinking yourself to death as an individual or, as a society, turning mere material insufficiency into squalor.
The bad news takes a long time to arrive.
*I’ve read actual transcripts of interviews with low-income parents where they say “it’s hard for me to get to school events because I am obese.” I found it a remarkable display of honesty, but for every one willing to make that admission, it seems likely there are many for whom it is true. As I’ve said elsewhere, schools in many ways are the last redoubt of in-person community for many people; getting parents involved is unlikely to boost test scores but it doesn’t mean it doesn’t have benefits for individual adults as well as kids.