Vacant homes in Huntington, West Virginia.
Vacant homes in Huntington, West Virginia. Parts of the state have some of the lowest life expectancies in the U.S. Lexi Browning/Reuters

It’s lack of economic opportunity that is dooming more Americans to “diseases of despair.”

The devastation to struggling small towns and cities of Appalachia and the Northeast unleashed by the opioid epidemic has brought renewed attention to the connection between the physical health of individuals and the economic health of their communities. Indeed, the opioid crisis is an especially pernicious example of the many national-scale public health challenges that disproportionately affect economically distressed places throughout the country.

Our organization, the Economic Innovation Group (EIG), works to shed light on the socioeconomic fault lines dividing American communities. We recently cross-walked county-level measures of economic well-being from EIG’s Distressed Communities Index (DCI) with data from the Centers for Disease Control and Prevention (CDC), finding that distressed counties have drug death rates that are on average 37 percent higher than well-off places and opioid prescription rates that are nearly 56 percent higher.

Such gaps are, unfortunately, typical across a remarkably wide array of measures of health and physical well-being.


For example, the connection between place and life expectancy is unmistakable. People residing in prosperous counties—the one-fifth of counties that score best on the DCI—live on average nearly five years longer than their neighbors in economically distressed ones. The average life expectancy in distressed places, at 75.2 years, is nearly four years below the U.S. average of 79.1 years.


Overall, life expectancy among counties varies by nearly 20 years, from 86.8 years in prosperous Summit County, Colorado, to only 67.6 years in distressed Union County, Florida. The relationship is a strong one: Of the 10 percent of counties with the shortest life expectancy, nearly 74 percent rate as “distressed” on the DCI while only one of those 313 counties is prosperous.


A number of other negative health outcomes, from obesity and diabetes to mortality and substance abuse, all become both more prevalent and more threatening as economic conditions in a community deteriorate. Mortality rates are more than 25 percent higher in distressed counties than in prosperous ones, and mortality rates specifically from mental and substance abuse disorders are 64 percent higher. In some particularly desolate corners of the country, mortality rates from these “diseases of despair”—including suicide, alcohol abuse, and drug overdose—reach more than four times the national rate. The remotest corners of Appalachia and the most isolated Native American reservations of the West are worst affected. Such place-based disparities in mental and physical health are yet another demonstration of the widening gulf between America’s thriving communities and those being left behind as the economy evolves in the 21st century.


The causes of poor public health may be manifold, but community economic conditions clearly play a role. The struggle to find work or meet your family’s basic needs can take a heavy physical and psychological toll. People surrounded by economic distress are less likely to lead healthy lifestyles, such as engaging in regular exercise or refraining from smoking. Geography compounds the problem: In our increasingly urban age, most economically distressed counties are sparsely populated places where access to quality healthcare facilities is limited.

Particular demographic groups suffer disproportionately under the nexus between poor health outcomes and economic strain. Minorities constitute 72 percent of the population living in distressed ZIP codes, and those most likely to live in distressed ZIP codes—namely blacks and Native Americans—register lower life expectancies than whites. Not coincidentally, the only demographic group for which life expectancy has started to deteriorate in recent years is also the only group for which economic circumstances have significantly deteriorated: the white working class (specifically those without some college education).

Academics studying the plight of this group, which the opioid epidemic has hit particularly hard, have established a strong connection between their newly strained economic circumstances and the incidence of diseases of despair. Princeton economist Angus Deaton, one of those academics, summed his research up in testimony before Congress earlier this year: “Heavy drinking, obesity, increasing social isolation, drugs, and suicide are plausible outcomes of [these] cumulative processes that deprive white working class lives of their meaning.” His statement underscores a broader truth: Much of the country’s public health challenge is rooted in deeply uneven access to economic opportunity from one community to the next.

The human suffering associated with economic distress weighs on society as whole. In the short-term, a failing local economy translates into higher benefits outlays and increased healthcare spending—burdens borne by all taxpayers, regardless of where they reside. (Two times more public medical assistance spending flows to distressed counties than to prosperous ones.) In the longer term, the tragic waste of human capital in struggling communities reduces our nation’s economic growth potential and erodes its social fabric.

What can be done to address the underlying causes of these disparities? Tackling them at their roots requires a greater focus on place-based policymaking. We should start with innovative public policies that spur investment, empower entrepreneurs, encourage mobility in the labor market, and restore economic dynamism neighborhood by neighborhood. Most such solutions must be enacted at the state and local level. However, the Investing in Opportunity Act, currently being considered in Congress, is one promising federal concept to democratize access to capital and encourage private investment in low-income communities nationwide. Policymakers should be far bolder in pursuing new ideas designed for the current landscape—and stop trying to solve 21st century economic challenges with whatever is left of the 20th century policy toolkit.

Republicans and Democrats alike recognize problems like the opioid epidemic require urgent intervention. But to fully address deep-seated public health challenges nationwide, our leaders must apply that same sense of urgency to an economic re-connection agenda that puts struggling communities on the road to rehabilitation.

About the Author

Most Popular

  1. a photo of a highway

    Americans Are Spending Billions on Bad Highway Expansions

    PIRG’s annual list of “highway boondoggles” includes nine transportation projects that will cost a total of $25 billion while driving up emissions.

  2. Transportation

    CityLab University: Induced Demand

    When traffic-clogged highways are expanded, new drivers quickly materialize to fill them. What gives? Here’s how “induced demand” works.

  3. Design

    What Cities Can Do to Help Birds and Bees Survive

    Pollinators—the wildlife that shuffle pollen between flowers—are being decimated. But they may still thrive with enough help from urban humans.

  4. Transportation

    America Would Happily Pay Uber An Extra $7 Billion

    Economists put a (big) number on the ride service’s consumer surplus in 2015.

  5. Maps

    The Squirrel Census Answers a Question You Weren’t Asking

    How many squirrels live in New York City's Central Park? Finding the answer was surprisingly complicated.