White Americans' True Midlife Crisis and How it Plays Out in Idaho 

Sick, sad and middle-aged

On his commute to work one recent morning, Dr. Ted Epperly turned up the radio.

"Oh my God," he said aloud, as he listened to a National Public Radio report about a drastic increase in the death rate among middle-aged, white Americans. "Oh my God," he repeated.

The NPR piece highlighted the results of a study conducted by Princeton University economists Anne Case and Angus Deaton—the latter won the Nobel Prize for economic studies in October—covering the 14 years from 1999 to 2013. The study results, published Nov. 2 in the Proceedings of the National Academy of Sciences, shocked Epperly, the president and CEO of the Family Medicine Residency in Idaho and the governor-appointed chairman of the board for the Idaho Healthcare Coalition, tasked with transforming healthcare in the state.

"I didn't know this had become this big of a problem," he said. "I was aware of individuals, but I wasn't aware collectively of the problem. It immediately caught my attention because I am in this age group, along with patients I've had."

According to the study, the death rate among white Americans 45-54 years of age rose dramatically over the study period—reversing a decadeslong trend that saw the mortality rate for the same group fall an average of 2 percent per year between 1978 and 1998. Since 1998, their mortality rate instead increased an average of 0.5 percent per year even as the rates for Hispanic and black Americans in the age group fell by 1.8 percent and 2.6 per year, respectively. The most likely culprits, according to the study: suicide, drug and alcohol poisoning, and chronic liver diseases and cirrhosis.

The findings from Case and Deaton gained widespread media attention not only because they bucked the overall trend of increasing health and longevity among all Americans, but because the reversal "was unique to the United States; no other rich country saw a similar turnaround."

If mortality rates had continued at the average yearly decline recorded from 1978-1998, nearly 500,000 deaths would have been avoided from 1999 to 2013—"comparable to the lives lost in the U.S. AIDS epidemic through mid-2015," the study authors wrote.

Epperly pays close attention to these issues. In addition to his work in Idaho, Epperly also served as board chair of the American Academy of Family Physicians, overseeing 135,000 family doctors nationwide. His fingerprints are even on the Affordable Care Act, which he worked closely with President Barack Obama to craft.

"All three of those are large issues in Idaho, both urban and rural Idaho," Epperly said, referring to suicide, poisonings and liver disease. "This is a real phenomena. It is not a data artifact."

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