Drugs, alcohol, and suicides are contributing to an alarming drop in US life expectancy, particularly among middle-aged white Americans and those living in rural communities, according to an editorial co-authored by Steven Woolf, MD, director of the Center on Society and Health at Virginia Commonwealth University. The editorial, titled “Failing Health of the United States,” was published in the British Medical Journal on Feb. 7.

“States are finding the biggest increases in death rates from drug overdoses, alcoholism, and suicides are in rural counties, where residents have often struggled for years with stagnant wages, unemployment, and poverty,” Woolf said. “The social fabric of these communities is coming apart.”

Woolf co-authored the editorial with Urban Institute senior fellow Laudan Aron. The researchers argue that the ideal of the American dream is increasingly out of reach as social mobility declines and fewer children face a better future than their parents.

Woolf and Aron support their argument with timely evidence, including a National Research Council and Institute of Medicine study they led, which demonstrated that Americans have shorter lives and live in poorer health than people in other high-income countries. Their editorial notes that life expectancy in the US has decreased for the second year in a row, while it continues to rise in other developed countries.

Between 2000 and 2014, the rate of fatal drug overdoses in the US rose by 137%, a crisis fueled by the opioid addiction epidemic. US death rates from alcohol abuse and suicides also have been increasing. Between 1999 and 2014, the US suicide rate increased by 24%.

“Our health relative to our peers in other countries has been deteriorating since the 1980s, and the problem has only grown worse,” Woolf said. “Our country may have the best hospitals and scientists, but we have shorter lives and poorer health.” In the editorial, Woolf and Aron trace the problem to challenging life conditions and the policies behind them.

Woolf directs VCU’s Center on Society and Health, which raises awareness about social and environmental conditions that affect population health. Woolf’s team recently completed studies of rising mortality rates among middle-aged white adults in California and Missouri. The VCU researchers found the most dramatic increases in death rates from drug overdoses, alcoholism, and suicide are in impoverished, rural areas, such as the Central Valley of California and the Ozarks region of Missouri. A similar analysis for Virginia is due in the spring.

“The deaths won’t end until policymakers promote education, jobs, and investment in neglected communities,” Woolf said. “These data are telling us that inattention to the middle class is costing lives. This means not only an increase in illness in the US, but further spiraling of health-care costs. It means US workers will be less productive, our businesses will be less competitive against foreign businesses with healthier workers, and the US economy will suffer. Our children, who will inherit this situation, will suffer the most.”