Walk into the Rebound recovery center, on the Main Street of Hazard, Kentucky, a small Appalachian coalmining town, and you will get an instantly friendly welcome. Yet the stories you hear are bleak.
On a white board at the end of the room, across from the sofas, the names of former clients who have died of overdoses in the past few years are listed. Though the town has a population of just 5,000, there are at least 20 names.
James Colwell, a 33-year-old former heroin addict, who has been clean for eight years, and who now works at the center, says that the toll keeps growing. Heroin addiction is actually less common than it used to be, he says, thanks in part to the proliferation of treatment. The problem is that “everyone is on meth. And they’re putting fentanyl in the pills.” The very next day, he says, he is going to the funeral of a middle-aged former nurse who died after accidentally taking fentanyl, a powerful synthetic opiate.
Hazard was named after Oliver Hazard Perry, a naval hero of the war of 1812, rather than for its character. Yet it is an appallingly dangerous place to live.
In 2019, even before the pandemic, the town and surrounding area, Perry County, came sixth-from-bottom out of America’s 3,142 counties on a measure of age-standardized mortality. At every age, people were far more likely to die.
Opiates, which began to spread around 25 years ago, when doctors prescribed them to former coalminers for chronic pain, are a large part of the reason. But heart attacks are also more common. So are traffic deaths, something local police put down to the refusal of people driving on the winding mountain roads to wear seat belts.
Last year the town flooded, and mountain walls slid onto houses. And guns are everywhere. It all adds up to a lot of death. On average, people in Perry could expect to live to just 69 in 2019, compared with 79 in America as a whole.
In the past 20 years, on economic measures, America has outperformed other rich countries. Over that period, median wages grew by 25%, compared with just 17% in Germany. Managers at Buc-ee’s, a Texas-based chain of stores, can make more than experienced doctors earn in Britain.
But on a more fundamental measure of wellness—how long people live—America is falling behind. To its detractors, this is a cause for schadenfreude. “Many people say it is easier to buy a gun than baby formula in the US,” gloated a statement released by the Chinese Ministry of Foreign Affairs last year, which also pointed to declining life expectancy in general. In the past few years, according to some estimates, life expectancy in China overtook that in America. For Americans, that ought to be a more serious source of introspection than it is.
According to a study by Jessica Ho of the University of Southern California, published last year, which looked at 18 high-income countries, from a fairly average position in 1980, by 2018 America had fallen to dead last on life expectancy.
In the 1960s Americans could expect to live seven or eight years longer than people from Portugal, the country in the study that now has the next-lowest life expectancy. By 2018 they could expect to live over a year less. Areas like eastern Kentucky, which have been worst hit, help illustrate why.