Shrinking Poor White Life Spans: Class, Race, and Health Justice

Abstract

An absolute decline in US life expectancy in low education whites has alarmed policy makers and attracted media attention. Depending on which studies are correct, low education white women have lost between 3 and 5 years of lifespan; men, between 6 months and 3 years. Although absolute declines in life expectancy are relatively rare, some commentators see the public alarm as reflecting a racist concern for white lives over black ones. How ought we ethically to evaluate this lifespan contraction in low education whites? Should we care, or is it racist to care? Does it constitute an injustice or reflect justice being done? I argue that the lifespan contraction in low education whites violates key normative criteria used to make determinations of health justice, and that these judgments do not vitiate concerns about racism. I conclude with reflections on US population health policy and building an inclusive health equity movement.

KEYWORDS:

• population
• population health
• race and culture/ethnicity

This article is referred to by:

Response to Commentaries on “Shrinking Poor White Life Spans”

A Crisis of Identity, a Crisis of Place

Racism and the Health of White Americans

Shrinking Poor White Life Spans and the Requirements of Justice

Floating All Boats: Promoting Solidarity to Advance Social Justice

The Racist Underbelly of Health Disparities in America

Retribution, Reparation, and the Moral Claims of Communities

A Human Rights Approach to Health Disparities

Responsibility for Poor Health Status of Lower Income People Must Account for Morally Blameworthy Decisions Made by Employers Who Exploit Them

It Is Past Time to Think More Inclusively About “Deaths of Despair”

Social Reproductive Labor, Gender, and Health Justice

Notes

1. I use the terms “blacks” and “whites,” “males” and “females,” and “low education” (those with 11 or fewer years of education) to describe the social groups of primary interest, as is common in epidemiological and demographic studies.

2. Moody-Adams (1992–1993) departs from Rawls’s definition of self-respect, distinguishing between self-worth and having confidence in one’s life plan and to carry it out, referring to the former as self-respect and the latter as self-esteem. She argues that class position is more likely to affect self-esteem than self-respect, but acknowledges that when economic deprivation is severe enough it can compromise self-respect. See pp. 257–258.

3. For a discussion of the moral risks entailed in acknowledging or failing to acknowledge the ways in which class differences can influence the development of personality and character, see Sayer (2005), especially pp. 206–209.

4. See Wikler (1987) for a helpful discussion.

5. There are many different forms of racism, for example, interpersonal, institutional, implicit. By “racism” I mean simply “an unethical disregard for people who belong to a different race” (Taylor 2013, 32).