Just in time for the renewed, fast-tempo debate over health care in Washington, public health researchers at Georgia State University have produced a pair of studies that help underline just what's at stake.
The more provocative of the two papers has intriguing national implications: In large swaths of the United States, swing areas that handed the presidency to Donald Trump last year, a white woman’s chances of dying from breast cancer have skyrocketed.
One common factor linking politics and women’s health is suggested but unproven: a fatalistic despair that better times will ever come.
First, some background.
After much secrecy, Majority Leader Mitch McConnell, R-Ky., on Thursday unveiled the Senate version of the Republican attempt to repeal the Affordable Care Act. There are multiple differences that are still being analyzed, but the Senate plan walks much the same path as the one passed by House Republicans in May.
Protections for those with pre-existing conditions would be weakened. Government-assisted coverage for those with lower incomes would shrink and eventually be subject to a cap.
Obamacare had put us on the road to health care as a right, paid for by the wealthy. The current Republican effort would return us closer to the status quo ante. A safety net would remain in place to help the most abjectly poor, but the rest of us would again have to prove ourselves economically worthy of good health.
Rural Georgia would continue to be a desert of health care, and thus economic development. Earl Rogers, a good Republican and president of the Georgia Hospital Association, referred to the proposed Senate cuts to Medicaid as "devastating."
Which brings us to that first study by GSU's School of Public Health. A team led by Lia Scott has discovered a cluster of an aggressive form of breast cancer in South Georgia. It's one of four in the nation. Inflammatory breast cancer can't be detected through mammograms and thus is often caught only in its late stages.
African-American women are at greater risk. Poverty may lie at the root of the situation. In that sense, the cluster fits a well-worn stereotype of breast cancer victims.
It is the second GSU study that shatters the breast cancer cliché. Lee Rivers Mobley, the lead author, also had a hand in the first study.
The science of public health is the study of disease and treatment outcomes in community settings. Mobley’s team realized that while many researchers had examined the health care access made available to minorities in largely minority neighborhoods, something was missing.
Mobley looked at “hyper-segregated” communities in which 90 percent or more of the residents are white. Few of them are in the South. We are a racial jambalaya that way. Rather, the 522 counties in 40 states that Mobley looked at stretch from the tip of Maine, run through Appalachia, then shift to the upper Midwest and West.
These aren’t poverty-stricken counties — far from it. But neither are they home to big cities.
What Mobley has found turns breast cancer assumptions upside down.
"If you just look at someone's race or ethnicity, the white person is less likely to be diagnosed late," she said. "But if they live in one of these hyper-segregated communities, they're more likely to be diagnosed late."
And thus more likely to die from the disease.
“I’m really wondering, what is it about the lifestyle of these females in these highly segregated white communities that is detrimental to their health?” Mobley said.
Mobley isn’t a student of politics, but I am. So let me be the one to say that, Southern states aside, her map of highly segregated white communities in the U.S. looks very much like the coalition of Rust Belt states that Trump united last year to win the White House.
One year before Trump's victory, two Princeton University economists completed a study, since updated, that showed mortality rates among Americans of all racial and ethnic backgrounds and most age groups in healthy decline.
The study found only one exception, a group in which deaths by suicide, alcohol, drug poisoning and liver disease were increasing at a rate unseen anywhere else in the world.
That group: middle-age white Americans whose educations went no further than high school — and thus were most likely to be displaced by automation or watch their jobs moved overseas. People who thought they had nothing more to lose became the backbone of the Trump electorate. When Trump said, “Make America great again,” they were his primary audience.
In an interview, Mobley said more research is needed to figure out why so many of these women are dying of breast cancer. “Going in on the ground is expensive, but it’s really the only way to know what’s going on,” she said.
But her team’s paper hints that a resigned attitude toward breast cancer and its treatment may be just one more symptom of “death by despair.” It is peculiarly limited to white communities. In highly segregated Asian communities, for instance, residents have lower instances of late-stage breast cancer diagnoses.
The GSU paper identified one theory worth exploring:
"This sense of pessimism can lead to despair and a sense of failure, which can manifest in unhealthy behaviors and a fatalistic attitude."
That’s just a theory. But it’s also a solid reminder that health care, economic development, politics and individual self-worth are all of a piece. They’re all tied together.
The question is whether these pockets of despair, this deep well of Trump support, will be helped by the Obamacare repeal measure that now sits in the U.S. Senate. One suspects not.
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